Evaluation of the microcirculation in vascular disease

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Presentation transcript:

Evaluation of the microcirculation in vascular disease Christopher J. Abularrage, MD, Anton N. Sidawy, MD, Gilbert Aidinian, MD, Niten Singh, MD, Jonathan M. Weiswasser, MD, Subodh Arora, MD Journal of Vascular Surgery Volume 42, Issue 3, Pages 574-581 (September 2005) DOI: 10.1016/j.jvs.2005.05.019 Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 1 Mechanism of endothelium-dependent (left) and endothelium-independent (right) vasoreactivity. In endothelium-dependent vasoreactivity, acetylcholine (AC) binds the endothelial receptor, thus leading to an increase in intracellular calcium and upregulation of endothelial nitric oxide synthase (eNOS). In endothelium-independent vasoreactivity, nitroprusside releases nitric oxide, which then diffuses to the vascular smooth muscle cell. Both pathways converge in the vascular smooth muscle cell, where nitric oxide increases the activity of guanyl cyclase and causes vasodilatation. RBC, Red blood cell; NADPH, nicotinamide adenine dinucleotide phosphate; NADP+, oxidized nicotinamide adenine dinucleotide phosphate; GTP, guanosine triphosphate; cGMP, cyclic guanosine monophosphate. Journal of Vascular Surgery 2005 42, 574-581DOI: (10.1016/j.jvs.2005.05.019) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 2 Mechanism of the Lewis triple-flare response (nerve axon reflex). Pain caused by injury results in orthodromic signals to the spinal cord and antidromic signals to C-nociceptive fibers. Release of substance P and calcitonin gene-related peptide (cGRP) causes endothelium-dependent vasodilatation. Journal of Vascular Surgery 2005 42, 574-581DOI: (10.1016/j.jvs.2005.05.019) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 3 Iontophoresis setup. The chamber (small arrow) is attached to the volar surface of the proximal forearm with the single-point probes (arrowhead), and a grounding pad is applied to the wrist. The laser Doppler scan can be seen at the top of the figure (large arrow). Journal of Vascular Surgery 2005 42, 574-581DOI: (10.1016/j.jvs.2005.05.019) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions