Discrepancies Between Total and Nutritional Skin Microcirculation in Patients with Peripheral Arterial Occlusive Disease (PAOD)

Clinical observations indicate that a discrepancy may exist between the total and nutritional skin microcirculation in extremities of patients with peripheral arterial occlusive disease (PAOD), which suggests a local maldistribution of blood flow. The present study was performed to investigate how the skin blood flow is locally distributed in the toes of patients with PAOD. The total skin microcirculation was evaluated by laser Doppler fluxmetry (LDF), and the blood flow in the nutritional skin capillaries by dynamic capillaroscopy. This combination was simultaneously used to study the nailfold microcirculation in the big toe of 12 legs of 8 patients with various degrees of PAOD, using 10 legs of 8 healthy subjects as control. Capillary blood cell velocity (CBV) was evaluated by a new computerized videophotometric technique (CapiFlow). It was found that the nutritional blood flow, as evaluated by CBV, was similar in both groups (0.2 vs. 0.25 mm/s, NS), whereas the total blood flow, as evaluated by LDF, was significantly (p less than 0.05) increased in toes of patients with PAOD (11.7 AU) in comparison to normal subjects (2.0 AU). The postocclusive reactive hyperemia was impaired for both CBV (6% vs. 70%, p less than 0.05) and LDF (14% vs. 50%, p less than 0.01) in the PAOD group. The prevalence of flow motion (30% vs. 80%) was significantly (p less than 0.05) lower in patients as compared to controls. It is concluded that the resting blood flow in the skin microcirculation is increased but maldistributed in patients with PAOD. The reactivity of the microcirculation is also impaired in the affected region.(ABSTRACT TRUNCATED AT 250 WORDS)