Postocclusive reactive hyperemia during vascular reconstruction
Tóm tắt
The purpose of this basic investigation was to clarify the postocclusive reactive hyperemia during vascular reconstruction using laser Doppler flowmetry (LDF). For the fundamental experiment, thirty-nine limbs with arteriosclerosis obliterans (ASO) in Stage II according to Fontaine's classification and 33 limbs without arterial or venous disease were chosen. In the supine position, a thigh cuff was applied to the lower thigh of a subject. Systolic Doppler thigh pressure was obtained and thigh/arm pressure index (TPI) was calculated. A LDF probe was then fixed to the bottom of the first toe and cutaneous blood flow was measured continuously before, during, and after femoral artery occlusion by the thigh cuff. The occlusion time was 3 and 6 minutes. For the clinical study, thirty-three lower limbs with arterial occlusive disease were selected. During the vascular surgery, the LDF probe was attached to the bottom of the first toe and cutaneous blood flow was monitored continuously before, during, and after the vascular clamping. In the fundamental experiment, after the release of the occlusion, the maximum blood flow of the reactive hyperemia (peak flow) appeared. The period between the release of the occlusion and the peak flow was called the peak time. When the occlusion time was longer, the reactive hyperemia appeared later and was bigger. When TPI decreased, the peak time lengthened and the peak flow after a 6-minute occlusion decreased. In the clinical study, the more severe the degree of the preoperative limb ischemia was, the longer was the peak time. The longer the intraoperative clamping time, the longer the peak time. In conclusion, postocclusive reactive hyperemia during vascular surgery was influenced by the degree of the preoperative limb ischemia and the length of the vascular clamping time.
Tài liệu tham khảo
Hillestad LK (1963) The peripheral blood flow in intermittent claudication. V. Plethysmographic studies. The significance of the calf blood flow at rest and in response to timed arrest of circulation. Acta Med Scand 174:23–41.
Delius W (1969) Hämodynamiasche Untersuchungen über den systolischen Blutdruck und die arterielle Durchblutung distal von arteriellen Gefäsverschlussen an den unteren Extremitäten. Z Kreislauf 58:319–332.
Fronek A, Coel M, Bernstein EF (1977) The pulse-reappearance time: An index of over-all blood flow impairment in the ischemic extremity. Surgery 81:376–381.
Van De Water JM, Indech CDV, Indech RB, Randall HT (1980) Hyperemic response for accurate diagnosis of arterial insufficiency. Arch Surg 115:851–856.
Ward AS, Martin TP (1980) Some aspects of ultrasound in the diagnosis and assessment of aortoiliac disease. Am J Surg 140:260–265.
Del Guercio R, Leonardo G, Arpaia MR (1986) Evaluation of postischemic hyperemia on the skin using laser Doppler velocimetry: Study on patients with claudicatio intermittens. Microvasc Res 32:289–299.
Ranft J, Heidrich H, Peters A, Trampish H (1986) Laser-Doppler examinations in persons with healthy vasculature and in patients with peripheral arterial occlusive disease. Angiology 37:818–827.
Van den Brande P, Welch W (1988) Diagnosis of arterial occlusive disease of the lower extremity by laser Doppler flowmetry. Int Angiol 224–230.
Tur E (1991) Skin reactive hyperemia in diabetic patients. A study by laser Doppler flowmetry. Diabetes Care 14:958–962.
Walden R, Bass A, Balaciano M, Modan M, Zulty L, Adar R (1992) Laser Doppler flowmetry in lower extremity ischemia: Application and interpretation. Ann Vasc Surg 6:511–516.
Jochmann W, Mostbeck A, Partsch H (1993) Postocclusive reactive hyperemia and postural vasoconstriction in different kinds of leg ulcers—Investigations with laser Doppler. VASA 22:306–315.
Coles DR, Cooper KE (1959) Hyperemia following arterial occlusion or exercise in the warm and cold human forearm. J Physiol 145:241–250.
Myhre HO (1975) Reactive hyperemia of the human lower limb. VASA 4:227–234.
Hummel BW, Hummel BA, Mowbry A, Maixner W, Barnes RW (1978) Reactive hyperemia vs treadmill exercise testing in arterial disease. Arch Surg 113:95–98.
Fronek A, Bernstein EF (1993) Postocclusive reactive hyperemia in the testing of the peripheral arterial system: Pressure, velocity, and pulse reappearance time. In: Vascular Diagnosis, 4th ed. Bernstein EF, (ed). Mosby Year Book, Inc.: St. Louis, pp 554–560.
Johnson WC (1975) Doppler ankle pressure and reactive hyperemia in the diagnosis of arterial insufficiency. J Surg Res 18:177–180.
Ninet J, Fronek A (1985) Cutaneous postocclusive reactive hyperemia monitored by laser Doppler flux metering and skin temperature. Microvasc Res 30:125–132.
Wilkin J (1986) Periodic cutaneous blood flow during postocclusive reactive hyperemia. Am J Physiol 250:H765-H768.
Ostergren J, Schops P, Fagrell B (1988) Evaluation of a laser Doppler multiprobe for detecting skin microcirculatory disturbances in patients with obliterative arteriosclerosis. Int Angiol 7:37–41.
Seifert H, Jager K, Bollonger A (1988) Analysis of flow motion by the Laser Doppler technique in patients with peripheral arterial occlusive disease. Int J Microcirc Clin Exp 7:223–236.
Kvernebo K, Slasgsvold CE, Stranden E (1989) Laser Doppler flow-metry in evaluation of skin post-ischemic reactive hyperemia. J Cardiovasc Surg 30:70–75.
Hanssler L, Hendricks O, Ranft J, Blank M (1995) Reaktive Hyperämie nach arterieller Okklusion: Vergleich der Infrarot-Tele-Thermographie und der Laser-Doppler-Fluxmetrie. VASA 24:148–154.