ORIGINAL ARTICLES   

International Angiology 1998 March;17(1):53-7

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Importance of cutaneous postural reflex vasoconstriction in patients with atherosclerotic occlusive disease of the lower extremities

Vayssairat M., Tribout L., Gouny P., Gaitz J. P., Baudot N., Cheynel C., Nussaume O.

From the Unit of Vascular Medicine and * Department of Vascular Surgery, Tenon Hospital, Paris, France

Objective. The ­present study was ­designed to meas­ure the cuta­ne­ous pos­tu­ral vas­o­con­stric­tive ­reflex (PVR) in nor­mal con­trols and ­patients with ath­e­ros­cle­rot­ic occlu­sive dis­ease of the lower extrem­ities, and to deter­mine its diag­nos­tic and prog­nos­tic rel­e­vance.
Experimental ­design. The pos­tu­ral vas­o­con­stric­tive ­reflex was record­ed in 34 ­patients with ath­e­ros­cle­rot­ic occlu­sive dis­ease of the lower limbs and 27 nor­mal con­trols, using laser-Doppler flow­me­try. Patients also had ankle and toe pres­sure meas­ure­ments and trans­cu­ta­ne­ous oxim­e­try (TcPO2).
Setting. University hos­pi­tal.
Results. The PVR on the pulp of the big toe was 20±7 arbi­trary per­fu­sion units in nor­mal con­trols, 9.4±12 in ­patients with claud­i­ca­tion, and -19±5 in ­patients with rest pain and/or gan­grene, who dif­fered from the clau­di­cant and con­trol ­groups (p=0.001 and 0.0001 respec­tive­ly). The sen­si­tiv­ity of neg­a­tive PVR in the big toe was 89% for the diag­no­sis of rest pain and/or gan­grene, and its spec­i­fic­ity, 83%. The sever­ity of foot ischae­mia and PVR val­ues exhib­it­ed a sig­nif­i­cant ­inverse cor­re­la­tion (r=-0.56, p<0.0001). All ­patients with a poor out­come, ie. death and/or major ampu­ta­tion with­in 100 days of fol­low-up, had a neg­a­tive PVR, and all ­patients with a pos­i­tive PVR had a good 100-day prog­no­sis with­out even a minor ampu­ta­tion.
Conclusions. Laser-Doppler pro­vides use­ful addi­tion­al infor­ma­tion in the assess­ment of foot ischae­mia sever­ity by show­ing that pos­tu­ral vaso­con­stric­tion is ­impaired in ­patients with ­severe ath­e­ros­cle­rot­ic occlu­sive dis­ease of the lower limbs, result­ing in ­increased skin micro­cir­cu­la­to­ry flow dur­ing leg depen­den­cy.