Effekte der Vakuum-Kompressions-Behandlung auf die Hautmikrozirkulation von Patienten mit peripherer arterieller Verschlußkrankheit

Background: We investigated the short-term effect of vacuum compression (VC) treatment on skin microcirculatory perfusion in the foot of patients with lower limb ischaemia and healthy controls. Patients and Methods: Ten patients with intermittent claudication or rest pain and 5 healthy controls underwent vacuum-compression treatment for half an hour. The leg was positioned in an air-tight plexiglass cylinder in which hypobaric (–115 mm Hg) and hyperbaric (75 mm Hg) pressure could be generated alternately, in order to improve peripheral circulation. The effect on skin microcirculation was investigated using nailfold capillary microscopy (measuring nutritive perfusion), laser Doppler fluxmetry (LDF) (total skin perfusion) and transcutaneous oxygen tension measurements (TcpO2). Results: A few patients experienced ischaemic symptoms during VC, probably because the leg was pinched off through inflation of the cuff. In both patients and controls capillary microscopic parameters did not change significantly. In some cases, microcirculatory perfusion decreased because the leg had cooled during the treatment. Application of a heating matrass annihilated this effect. Only in the patient group a few LDF- and TcpO2 parameters improved slightly, but significantly. Conclusion: Vacuum-compression therapy only slightly improves total skin perfusion and oxygenation, but not the nutritive microcirculation, being an essential factor in the occurrence of ischaemic symptoms. We therefore conclude that this instrument in its present form is not an aid in the treatment of lower limb ischaemia.

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Minimising failure in critical lower limb ischaemia intervention: Adjuvant capillary bed recruitment is the missed opportunity

Vascular ◽

10.1177/1708538117753213 ◽

2018 ◽

Vol 26 (4) ◽

pp. 449-454

Author(s):

Sherif Sultan ◽

Edel Patricia Kavanagh ◽

Niamh Hynes

Keyword(s):

Lower Limb ◽

Peripheral Circulation ◽

Arterial Disease ◽

Muscle Disease ◽

Critical Limb Ischaemia ◽

High Morbidity ◽

Limb Ischaemia ◽

Lower Limb Ischaemia ◽

Capillary Bed ◽

Peripheral Arterial

Critical limb ischaemia is the end stage of peripheral arterial disease before limb loss. Contemporary interventions to restore blood flow have high morbidity and mortality and fail to provide sustained restoration of peripheral circulation. Cell-based therapies designed to promote neovascularisation or angiogenesis have been shown in trials to be safe but clinically ineffective. Notwithstanding endless research in the area, no headway has been made in identifying a successful therapy designed specifically to target muscle disease in critical lower limb ischaemia. Thus, the quest to find an effective, lasting solution for critical lower limb ischaemia continues and requires more innovative therapeutic tactics. Our aim is to highlight the crucially interlinked role of the capillary bed, skeletal muscle mass and mitochondria in critical lower limb ischaemia patients and to identify novel therapeutic mechanisms that the vascular interventionalist can add to their armamentarium.

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Significance of Buerger's Test in the Assessment of Lower Limb Ischaemia

Journal of the Royal Society of Medicine ◽

10.1177/014107688908201209 ◽

1989 ◽

Vol 82 (12) ◽

pp. 729-731 ◽

Cited By ~ 12

Author(s):

R L Insall ◽

R J Davies ◽

W G Prout

Keyword(s):

Lower Limb ◽

Limb Ischaemia ◽

Rest Pain ◽

Peripheral Vascular ◽

Transcutaneous Oxygen ◽

Arteriosclerosis Obliterans ◽

Positive Group ◽

Lower Limb Ischaemia ◽

Vascular Assessment ◽

Trophic Changes

In claudicante with arteriosclerosis obliterans admitted for vascular surgery, Buerger's test was compared with other indicators of lower limb ischaemia. Rest pain, gangrene, trophic changes, and chronic erythro-melia were significantly commoner and more distal pulses were absent in Buerger positive limbs. Doppler and transcutaneous oxygen pressures and indices were significantly lower in Buerger positive legs. Significantly more occlusions were noted on arteriography in arteries distal to the adductor hiatus in the Buerger positive group. Buerger's test is a useful adjunct to routine peripheral vascular assessment and, if positive, suggests more severe ischaemia with distal limb artery involvement.

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Acute complications in the post-anaesthesia care unit after infrainguinal surgery for lower limb ischaemia – a prospective observational cohort study

VASA ◽

10.1024/0301-1526/a000745 ◽

2019 ◽

Vol 48 (1) ◽

pp. 89-97

Author(s):

Karin Yeung ◽

Jonas Peter Eiberg ◽

Henrik Kehlet ◽

Eske Kvanner Aasvang

Keyword(s):

Lower Limb ◽

Severe Pain ◽

Observational Cohort Study ◽

Limb Ischaemia ◽

Post Anaesthesia Care Unit ◽

Lower Limb Ischaemia ◽

Acute Complications ◽

Observational Cohort ◽

Anaesthesia Care ◽

Pacu Stay

Abstract. Background: Arterial surgery for lower limb ischaemia is a frequently performed procedure in patients with severe cardio-pulmonary comorbidities, making them high-risk patients for acute postoperative complications with a need for prolonged stay in the post-anaesthesia care unit (PACU). However, detailed information on complications during the PACU stay is limited, hindering mechanism-based interventions for early enhanced recovery. Thus, we aimed to systematically describe acute complications and related risk factors in the immediate postoperative phase after infrainguinal arterial surgery. Patients and methods: Patients transferred to the PACU after infrainguinal arterial surgery due to chronic or acute lower limb ischaemia were consecutively included in a six-month observational cohort study. Pre- and intraoperative data included comorbidities as well as surgical and anaesthetic technique. Data on complications and treatments in the PACU were collected every 15 minutes using a standardised assessment tool. The primary endpoint was occurrence of predefined moderate or severe complications occurring during PACU stay. Results: In total, 155 patients were included for analysis. Eighty (52 %) patients experienced episodes with oxygen desaturation (< 85 %) and moderate or severe pain occurred in 72 patients (47 %); however, circulatory complications (hypotension, tachycardia) were rare. Preoperative opioid use was a significant risk factor for moderate or severe pain in PACU (59 vs. 38 % chronic vs. opioid naïve patients (P = 0.01). Conclusions: Complications in the PACU after infrainguinal arterial surgery relates to saturation and pain, suggesting that future efforts should focus on anaesthesia and analgesic techniques including opioid sparing regimes to enhance early postoperative recovery.

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