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Influence of peripheral arterial disease on capillary pressure in the foot  Jurgen C de Graaff, MD, PhD, Dirk Th Ubbink, MD, PhD, Joost A van der Spruit,

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Presentation on theme: "Influence of peripheral arterial disease on capillary pressure in the foot  Jurgen C de Graaff, MD, PhD, Dirk Th Ubbink, MD, PhD, Joost A van der Spruit,"— Presentation transcript:

1 Influence of peripheral arterial disease on capillary pressure in the foot 
Jurgen C de Graaff, MD, PhD, Dirk Th Ubbink, MD, PhD, Joost A van der Spruit, MD, Sjoerd M Lagarde, MD, Michael J.H.M Jacobs, MD, PhD  Journal of Vascular Surgery  Volume 38, Issue 5, Pages (November 2003) DOI: /S (03)

2 Fig 1 Experimental setup with micropipette (1), laser Doppler probe (2), thermometer (3), cuff of continuous toe blood pressure measurement (4), reference electrode (5), and capillary microscope lens (6). Journal of Vascular Surgery  , DOI: ( /S (03) )

3 Fig 2 Typical variation over time for laser Doppler flux recording, capillary blood pressure, toe blood pressure, and electrocardiogram tracing. Note for capillary blood pressure, valid measurement period is indicated by the arrow, after a period in which flow is obstructed by the pipette and disturbed by noise. Journal of Vascular Surgery  , DOI: ( /S (03) )

4 Fig 3 Typical recordings of laser Doppler perfusion, capillary blood pressure, toe blood pressure, and electrocardiogram in a healthy volunteer while sitting (A) and supine (B), and in a patient with rest pain while sitting (C) and supine (D). Journal of Vascular Surgery  , DOI: ( /S (03) )

5 Fig 4 Schema of microcirculatory regulation mechanisms of skin perfusion with change to the sitting position. Increase in orthostatic pressure with dependency activates two local vasoconstriction responses, the myogenic response and the venoarteriolar response. In the myogenic response, orthostatic rise in arteriolar transmural pressure causes smooth muscle contraction in the arteriolar wall. In the venoarteriolar response, increase in peripheral venous pressure activates stretch receptors in the venules, directly triggered by an increase in venous volume, leading to a local, retrograde axon reflex, which causes arteriolar construction.7 In (severe) arterial insufficiency these regulation mechanisms seem to maintain constant capillary pressure at the expense of capillary perfusion. Journal of Vascular Surgery  , DOI: ( /S (03) )

6 Fig 5 Systolic toe pressure and systolic capillary blood pressure in the sitting and supine positions, in healthy volunteers (squares), patients with intermittent claudication (triangles), and patients with ischemic rest pain, ulcer, or gangrene (circles). Journal of Vascular Surgery  , DOI: ( /S (03) )

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