Peripheral blood flow rates and microvascular responses to orthostatic pressure changes in claudicants before and after revascularisation

Abstract

Objectives: To study the effect of arterial reconstruction for occlusive atherosclerotic disease with intermittent claudication on blood flow rate during rest and on microvascular responses to orthostatic pressure changes in the pulp skin of the first toe where arteriovenous anastomoses are numerous. Material: eleven patients with Fontaine IIa claudication (ankle blood pressure index > 0.30) before and 7 (range: 2-11) months after intervention. Methods: blood flow rate was measured by the heat washout method with the toe at heart level and after passive lowering to 50 cm below this level using a Clark type electrode with thermostatically controlled cap that was fixed to the pulp of the first toe by adhesive tape. Results: at heart level, blood flow rate was lower in claudicants before reconstruction as compared to a group of previously published control subjects (p = 0.0076, Wilcoxon), blood flow rate increased in claudicants from before to after intervention (p = 0.0128), and postoperative blood flow rate was like that of normals (N.S.). Before surgery, blood flow rate in claudicants increased in median with a factor of 1.79 during lowering (p < 0.0051). Conclusions: the disturbance of the microcirculatory responses to orthostatically induced pressure changes in claudiants reverted towards normal after arterial reconstruction.