Level of arterial obstruction in patients with peripheral arterial occlusive disease (PAOD) determined by laser Doppler fluxmetry

doi:10.1016/S0950-821X(05)80717-0

European Journal of Vascular Surgery

Volume 7, Issue 6, November 1993, Pages 684-689

https://doi.org/10.1016/S0950-821X(05)80717-0 Get rights and content

Aim: To evaluate the laser Doppler fluxmeter as a non-invasive screening method to determine the level of peripheral arterial occlusive disease (PAOD) in the lower limb. Design: Open study of the veno-arterial reflex (VAR) during a shift in body position using a laser Doppler fluxmeter at five probe positions distal to the knee, compared with the occlusion level determined by arteriography and segmental plethysmography. Materials: 50 legs comprising 10 normal controls, 20 legs with suprainguinal obstructions (10 claudication and 10 critical ischaemia) and 20 legs with infrainguinal obstructions (10 claudication and 10 critical ischaemia). Results: Controls had normal VAR (mean flux reductions of 38% during dependency) at all probe positions. Legs with infrainguinal disease had normal reflexes proximally but significantly disturbed reflexes distally, whereas suprainguinal disease showed alterations at all sites. Claudicants had diminished flux reduction (mean 12%) whilst those with critical ischaemia increased the flux (mean 32%). Conclusion: This simple, non-invasive technique may be of use in determining the level of obstruction in PAOD.

References (21)

ReddyDJ et al.
Limitations of the femoral artery pulsatility index with aortoiliac artery stenosis. An experimental study
J Vasc Surg
(1986)
RutherfordRB et al.
Combining segmental systolic pressures and plethysmography to diagnose arterial occlusive disease of legs
Am J Surg
(1979)
BernsteinE et al.
Thigh pressure artifacts with noninvasive techniques in an experimental model
Surgery
(1981)
KverneboK et al.
Laser doppler flowmetry in evaluation of lower limb resting circulation. A study in healthy controls and atherosclerotic patients
Scand J Clin Lab Invest
(1988)
FairsSLE et al.
Limb perfusion in the lower limb amputee—a comparative study using laser Doppler flowmeter and a transcutaneous oxygen electrode
Prosthet Orthot Int
(1987)
CreutzigA et al.
Disturbances of skin microcirculation in patients with chronic arterial occlusive disease and venous incompetence
VASA
(1988)
HillestadLK
The peripheral blood flow in intermittent claudication. The significance of oscillometry
Acta Med Scand
(1962)
AhmadAK et al.
Mechanism of the postural vasoconstrictor response in the human foot
Clin Scien
(1988)
HenriksenO
Local reflex mechanism in microcirculation in human subcutaneous tissue
Acta Physiol Scand
(1976)
FranzeckUK et al.
Transcutaneous P02 measurements in healthy and peripheral arterial occlusive disease
Surgery
(1982)

There are more references available in the full text version of this article.

Cited by (12)

Clinical application of laser doppler flowmetry in neurology
2012, Perspectives in Medicine
Citation Excerpt :
Registration of initial skin perfusion in controlled standard laboratory conditions is measured at first with the natural superficial skin temperature of the patient and then the perfusion is recommended to be measured at 32–33° Celsius superficial skin temperature in order to make skin perfusion at a definite site between different persons comparable. The accuracy and sensitivity of LDF is improved by applying standardized functional tests [8]. Monitoring of microvascular responses to autonomic vasomotor stimuli is a recognized method for functional diagnosis and assessment of peripheral dysautonomy and function of small unmyelinated autonomic fibers [9].
Laser Doppler flowmetry is a contemporary method for microcirculatory investigation used in different medical fields including neurology.
To present principles and clinical application of laser-Doppler method in neurology and related pathologies.
The diagnostic value was studied by evaluating systematic literature and personal experience. It is based on Doppler principle and uses a laser-generated monochromatic light beam, a fiber-optic probe and sensitive photodetectors. The tissue perfusion of a sample volume is calculated by multiplying the number of moving blood cells and their velocity and is presented in perfusion units.
A high diagnostic value was established in studying microcirculation and its autoregulation using a battery of functional tests for evaluation of vasomotor response mediated by sympathetic neural, axon-reflex, receptor or endothelial mechanisms. It has clinical significance in assessment of Raynaud's phenomenon, distal autonomic neuropathy of the small C fibers due to diabetes mellitus, peripheral arterial occlusive disease, systemic autoimmune diseases, chronic venous insufficiency, peripheral neuropathies, for medical expertise of occupational diseases as hand-arm vibration syndrome, toxic neuropathies, etc. By iontophoretic transducer different drugs or substances might be applied locally to test an effect, physiological or pathophysiological mechanisms. Unlike the contemporary ultrasound investigations it studies the blinded sphere for neurosonology – microcirculation and its autoregulation.
Laser Doppler flowmetry is a valuable and reliable method for diagnostics of microcirculation and perfusion, for assessment of autoregulation and effect of treatment, for experimental studies and research. In combination with ultrasound sonography it gives a thorough information for both macro- and microcirculation.
The Effect of Gua Sha Treatment on the Microcirculation of Surface Tissue: A Pilot Study in Healthy Subjects
2007, Explore: The Journal of Science and Healing
Citation Excerpt :
In this sense, our study establishes—at least with Gua Sha—that there are actual changes in microcirculation PUs with what has been observed, somatically experienced, and termed increased circulation. The modern technology of laser Doppler scanning is well established as a measure of surface microcirculation in two-dimensional patterns of perfusion,112 with clinical applications in evaluating patients with diabetes,113 diabetic neuropathy,115 chronic venous insufficiency,116 and venous ulcers,117,118 as well as assessing superficial tissue function before and after surgery,119,120 or for example, in determining the depth of burns,121 diagnosing complex regional pain syndrome,122 or assessing the level of peripheral arterial occlusive disease123 or circulatory compromise in sympathetic dystrophies.124 Laser Doppler imaging has been shown to be reproducible and reliable as a standard of measure in vivo.108
Gua Sha, therapeutic surface frictioning that intentionally raises transitory petechiae and ecchymosis, is a traditional East Asian healing technique also known as cao gio, coining, scraping, and spooning. There are case reports in Western literature but no studies on the physiological effects of Gua Sha.
To study the microcirculatory effects of Gua Sha on the skin and subcutis in humans to elucidate physiological mechanisms responsible for the clinically observed pain-relieving effect of this treatment
Laser Doppler imaging (LDI) was used to make sequential measurements of the microcirculation of surface tissue before and after Gua Sha treatment in 11 healthy subjects. The effect of Gua Sha treatment on the microcirculation of surface tissue was expressed as changes from baseline in arbitrary perfusion units (PU).
The study was conducted at the Department of Nephrology, Unit of Circulation Research, University Hospital of Essen, Germany.
Subjects were volunteers from the nursing and physician staff of the Kliniken Essen.
A single Gua Sha treatment was applied to an area of each subject’s back.
Change in microcirculation was measured in PUs. Change in myalgia was subjectively reported and confirmed by manual palpation.
Gua Sha caused a fourfold increase in microcirculation PUs at the treated area for the first 7.5 minutes following treatment and a significant increase in surface microcirculation during the entire 25 minutes of the study period following treatment (P < .001). Females showed significantly higher rates of response than males (P = .003). Each subject experienced immediate decrease in myalgia in both the site treated, in the related distal control site, and in some cases, other distal sites. Pain relief persisted to some extent up to the follow-up visit. There were no adverse reactions.
Gua Sha increases microcirculation local to a treated area, and that increase in circulation may play a role in local and distal decrease in myalgia. Decrease in myalgia at sites distal to a treated area is not due to distal increase in microcirculation. There is an unidentified pain-relieving biomechanism associated with Gua Sha.
Laser Doppler-recorded venoarteriolar reflex in Raynaud's phenomenon
2004, Autonomic Neuroscience: Basic and Clinical
The aim of the study was to assess whether Laser Doppler-recorded venoarteriolar reflex (VAR) response to hand lowering can contribute to differentiate primary from secondary Raynaud's phenomena.
Skin fingerpulp perfusion (PU) of each hand of 60 persons was investigated: 15 healthy controls; 15 primary Raynaud's phenomenon (RP) patients; 15 patients with Raynaud's phenomenon secondary to systemic sclerosis (SSc); 15 patients with Raynaud's phenomenon secondary to vibration exposure. Blood perfusion was monitored by Laser Doppler flowmetry (LDF) as initial values and at a temperature of 32 °C with hands on the sternum (PUh) and in dependency (PUd). VAR indices were analyzed: delta VAR (ΔVAR) calculated as (PUd−PUh); percent change of perfusion—{(ΔVAR/PUh)×100}; and vasoconstriction response—(PUd/PUh).
Initial mean superficial skin temperatures and perfusions in Raynaud's phenomenon groups were significantly lower compared to healthy controls but with wide overlap of the values in individual cases. Venoarteriolar indices were significantly different between secondary Raynaud's phenomenon groups and healthy controls and between secondary and primary Raynaud's phenomenon groups. Percent changes were significantly higher in control and primary RP groups compared to secondary RP groups. Vasoconstriction indices between primary and secondary RP patients (p<0.0001) and between controls and secondary RP patients (p<0.0001) also differed. A loss of venoarteriolar reflex (ΔPU≥0) was established in 10.0% of primary, 53.3% of sclerodermic, and 36.7% of vibration-induced Raynaud's phenomenon patients. The significantly higher prevalence rate of impaired venoarteriolar reflex in secondary Raynaud's phenomenon patients proves local vasomotor dysfunction and reflects either postganglionar sympathetic insufficiency with vascular tone failure or altered smooth muscle cells' responses.
Laser Doppler flowmetry is a valuable noninvasive method for investigation of the very early skin venoarteriolar dysfunctions, for evaluation of focal autonomic dysregulation and skin vasomotor abnormalities in RP patients. Laser Doppler-recorded venoarteriolar reflex testing is a simple procedure and an adequate additional diagnostic tool, which contributes to diagnose RP and differentiate primary from secondary RP.
The significance of microcirculatory examinations
1998, European Journal of Vascular and Endovascular Surgery
The predictive value of laser Doppler fluxmetry and transcutaneous oximetry for clinical outcome in patients undergoing revascularisation for severe leg ischaemia
1997, European Journal of Vascular and Endovascular Surgery
To investigate the predictive value of laser Doppler fluxmetry and transcutaneous oximetry in 41 patients undergoing technically successful revascularisation for severe leg ischaemia.
Toe and ankle systolic arterial pressures, transcutaneous oxygen tension (tcpO₂), and stressed laser Doppler fluxmetry at the foot (time to peak laser Doppler flux following 2 min arterial occlusion, t_p LDF, and the response of LDF to raising the leg 40 cm, the elevated:supine LDF ratio) were measured before revascularisation. Six months later these measurements were compared in those patients who were clinically improved, and those who still had symptoms of severe ischaemia or had lost their limb.
Vascular Laboratory, St. George's Hospital, London SW17, U.K.
Six months following revascularisation 30 (73%) of the 41 patients had partial or complete symptomatic relief. Six (15%) had undergone major amputation and five (12%) still had symptoms of severe ischaemia. Before intervention toe and ankle systolic pressures were similar in the 30 who were improved and the 11 who had lost, or were still at risk of losing, their leg. Pre-revascularisation tcpO₂ was significantly lower (18.3 mm Hg vs 33.5 mm Hg; p < 0.05) and t_p LDF significantly longer (140 s vs 92 s; p < 0.05) in the 11 patients who were not clinically improved at 6 months. Whilst pre-revascularisation toe and ankle pressures below 30 mm Hg and 50 mm Hg respectively identified only 55% of those patients who were not improved 6 months later, a t_p LDF in excess of 100 s identified 82% (p < 0.05) and was noted in five of the six amputees.
Microcirculatory assessments performed in patients with limb-threatening ischaemia are likely to be more deranged in those patients who suffer clinical failure or amputation despite an apparently successful revascularisation procedure.
Changes in postocclusive reactive hyperaemic values as measured with laser doppler fluxmetry after infrainguinal arterial reconstructions
1995, European Journal of Vascular and Endovascular Surgery
The aim of the present study was to evaluate microcirculatory changes of the postocclusive reactive hyperaemia test measured with Laser Doppler fluxmetry to detect results of arterial reconstructions.
Prospective open study.
Vascular laboratory of a University Hospital.
Sixty patients with peripheral arterial occlusive disease who underwent infrainguinal reconstruction were examined the day before and 1–2 days after surgery.
The values were obtained during postocclusive reactive hyperaemia induced by release of a 3 min arterial occlusion with a cuff at ankle level with the laser Doppler probe placed dorsally on the first toe. The alterations after surgery in these hyperaemia parameters were compared to changes in ankle/brachial index and clinical improvement at 30 days postoperatively.
Patients improved by surgery according to ankle/brachial index had significantly reduced time to peak (p <0.001) and significantly increased resting flux value (p <0.05) and peak flux value (p <0.05). There was a significant correlation between the change after surgery in time to peak flux and increment of ankle/brachial index (r = 0.63, p <0.001).
Changes in reactive hyperaemia values as measured with laser Doppler fluxmetry, expecially the time to peak flux, seem to detect circulatory changes caused by arterial reconstructions.

View all citing articles on Scopus

View full text

Original articleLevel of arterial obstruction in patients with peripheral arterial occlusive disease (PAOD) determined by laser Doppler fluxmetry

J Vasc Surg

Am J Surg

Thigh pressure artifacts with noninvasive techniques in an experimental model

Surgery

Laser doppler flowmetry in evaluation of lower limb resting circulation. A study in healthy controls and atherosclerotic patients

Scand J Clin Lab Invest

Limb perfusion in the lower limb amputee—a comparative study using laser Doppler flowmeter and a transcutaneous oxygen electrode

Prosthet Orthot Int

Disturbances of skin microcirculation in patients with chronic arterial occlusive disease and venous incompetence

VASA

The peripheral blood flow in intermittent claudication. The significance of oscillometry

Acta Med Scand

Mechanism of the postural vasoconstrictor response in the human foot

Clin Scien

Local reflex mechanism in microcirculation in human subcutaneous tissue

Acta Physiol Scand

Transcutaneous P02 measurements in healthy and peripheral arterial occlusive disease

Surgery

Original article
Level of arterial obstruction in patients with peripheral arterial occlusive disease (PAOD) determined by laser Doppler fluxmetry