Cutaneous Blood Flow in Legs with Severe Chronic Venous Insufficiency Recorded before and after a Single Treatment Using Intermittent Pneumatic Compression

1996 ◽  
Vol 11 (1) ◽  
pp. 30-33 ◽  
Author(s):  
K. Malanin ◽  
P. J. Kolari ◽  
A. Haapanen ◽  
I. Helander ◽  
V. K. Havu
Keyword(s):  
Chronic Venous Insufficiency ◽  
Healthy Subjects ◽  
Venous Insufficiency ◽  
Intermittent Pneumatic Compression ◽  
Laser Doppler ◽  
Sitting Position ◽  
Single Treatment ◽  
Recumbent Position ◽  
Doppler Flowmetry ◽  
Before And After

Objective: To investigate the skin laser Doppler flux (LDF) in legs with severe chronic venous insufficiency (CVI). Design: Comparison of the legs with severe CVI with the healthy legs and with the patients' contralateral legs. Setting: Department of Dermatology, University of Turku, Turku, Finland. Patients and control subjects: Ten patients and eight age-matched subjects with healthy legs. Interventions: A single treatment using intermittent pneumatic compression (IPC) of 45 min duration. Main outcome measures: Laser Doppler flowmetry with the subjects in a recumbent and a sitting position. Results: The LDF values were higher for the legs with severe CVI than for the legs of healthy subjects ( p<0.001 in a recumbent and p<0.01 in a sitting position). A single IPC increased the LDF in a recumbent position in the patients' legs with severe CVI ( p=0.019) but had no significant effect on the LDF value in the sitting position. The venoarteriolar response was significantly better in the legs with severe CVI than in the legs of healthy subjects ( p<0.05). Conclusions: The LDF is increased in legs with severe CVI and a single IPC further increases it in a recumbent position. The venoarteriolar response is not impaired in legs with severe CVI.

Three Tests of Microcirculatory Function in the Evaluation of Treatment for Chronic Venous Insufficiency

1990 ◽  
Vol 5 (3) ◽  
pp. 165-172 ◽  
Author(s):  
T. R. Cheatle ◽  
G. M. McMullin ◽  
J. Farrah ◽  
P. D. Coleridge Smith ◽  
J. H. Scurr
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Subcutaneous Fat ◽  
Intermittent Pneumatic Compression ◽  
Laser Doppler ◽  
Response To Treatment ◽  
Venous Disease ◽  
Doppler Flowmetry ◽  
Xenon Clearance ◽  
Microcirculatory Function

No investigation exists which has been shown to detect accurately microcirculatory improvement following treatment for chronic venous insufficiency. This study examines three possible techniques for doing so. Fourteen patients with chronic venous insufficiency and fourteen controls underwent measurement of transcutaneous PO2, 133xenon clearance from the skin and subcutaneous tissues and laser–Doppler flowmetry in the gaiter region. Patients with venous disease then followed a regime of intermittent pneumatic compression for 4 h each day for 4 weeks. The same measurements were then repeated. Xenon clearance from subcutaneous fat and the time taken to reach maximal laser–Doppler flow after release of a tourniquet showed a significant improvement after compression treatment. These tests may be useful as parameters in the objective monitoring of response to treatment in patients with liposclerotic skin.

Microcirculation disturbances in different stages of chronic venous insufficiency

Phlebologie ◽  
2001 ◽  
Vol 30 (01) ◽  
pp. 11-15 ◽  
Author(s):  
Pavel Poredoš ◽  
Igor Švab ◽  
Josip Car ◽  
Blaž Mlačak
Keyword(s):  
Chronic Venous Insufficiency ◽  
Healthy Subjects ◽  
Venous Insufficiency ◽  
Cuff Pressure ◽  
Arterial Occlusion ◽  
Flow Regulation ◽  
Venous Hypertension ◽  
Laser Doppler ◽  
Specific Flow ◽  
Doppler Flux

Summary Objectives: The aim of this study was to investigate patients with different clinical stages of chronic venous insufficiency (CVI) by laser Doppler fluxmetry (LDF) in order to asses whether these clinical entities correspond to specific flow regulation. Methods: 3 groups of subjects were incorporated in the study. Microcirculation investigations were carried out at rest and after hemodynamics tests. Changes in the laser Doppler flux minus the biological zero value were measured after 3 minutes of arterial occlusion and by experimental venous hypertension (40 and 70 mmHg) and expressed relatively to the pretest resting value. Results: Resting LDF was significantly higher in patients with CVI II and CVI III stage as compared to the both groups with healthy subjects and the group with CVI I stage (p <0.001). In patients with CVI II and CVI III stage LDF remained nearly unchanged after arterial occlusion (6% increase vs. 342% in healthy subjects and 214% increase in patients with CVI I (p <0.001 vs. p <0.001). Experimental venous hypertension (cuff pressure 70 mmHg) led to profound reduction of flux in all 3 groups (I: –90%; II: –91.7%; III: –91.4%). At the same time, absolute LDF values during experimental venous hypertension (40 and 70 mmHg) were significantly higher in patients with CVI II and III in comparison to patients with CVI I and healthy subjects (p <0.001 vs. p <0.001). Conclusion: It seems that in severe CVI patients the venoarteriolar reflex, despite being comparable in magnitude to that in healthy subjects, may nonetheless be insufficient to reduce LDF during experimental venous hypertension to the level similar to that in healthy subjects and patients with CVI I.

Non-linear analysis of skin blood flow in patients suffering from chronic venous leg ulcers

Phlebologie ◽  
2009 ◽  
Vol 38 (02) ◽  
pp. 64-70
Author(s):  
K. Bräuer ◽  
C. Radke ◽  
A. Strölin ◽  
H.-M. Häfner
Keyword(s):  
Time Series ◽  
Blood Flow ◽  
Wavelet Analysis ◽  
Chronic Venous Insufficiency ◽  
Healthy Subjects ◽  
Venous Insufficiency ◽  
Laser Doppler ◽  
Healthy Controls ◽  
Laser Doppler Fluxmetry ◽  
Significant Difference

SummaryThe elevated ambulatory pressure in the peripheral venous system in patients suffering from chronic venous insufficiency manifests itself not only in the form of disturbed macrocirculation but also and particularly in microangiopathic changes. Laser Doppler fluxmetry is a well established method to measure cutaneous blood flow. Aim of the study was to investigate the cutaneous vasomotion at the inner ankle in patients suffering from chronic venous insufficiency in the clinical stadium C6 compared to healthy subjects. Patients, methods: In 38 patients suffering from venous ulcer and in 33 healthy subjects continous time series of Laser Doppler fluxmetry (LDF) data were recorded with a sampling frequency of 50 Hz over a period of 15 min. The patients were supine and LDF was measured at the inner ankle. Time series were analyzed using newly developed methods (wavelet analysis and biorthogenal decomposition). Results: There was a statistically significant difference in mean LDF between patients and healthy controls (94 SD 65 AU [C6] vs. 28 SD 13 AU (C0), p < 0.001). There also were statistically significant differences in the scaling levels using wavelet analysis corresponding to sympathetic activity, corresponding to myogenic activity in the vessel wall and corresponding to the heart beat. Conclusion: There are changes in vasomotion between patients with venous ulcers and healthy controls. We found a vasale neuropathy and a high degree in dysregulating skin perfusion. The new innovative strategies are suited for describing microcirculation and controlling therapies.

Microangiopathy in Chronic Venous Insufficiency before and after Sclerotherapy and Compression Treatment: Results of a One-Year Follow-up Study

1993 ◽  
Vol 8 (3) ◽  
pp. 99-106 ◽  
Author(s):  
A. J. Leu ◽  
A. Yanar ◽  
M. Geiger ◽  
U. K. Franzeck ◽  
A. Bollinger
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Compression Therapy ◽  
Laser Doppler ◽  
University Hospital ◽  
Functional Changes ◽  
Severe Stage ◽  
Before And After ◽  
One Year ◽  
Doppler Flux

Objective: To characterize microangiopathy in patients with chronic venous insufficiency (CVI) of a moderate to severe stage and to evaluate improvement of the microcirculatory parameters after sclerotherapy of incompetent perforators and compression therapy. Design: Fluorescence videomicroscopy (Na-fluore-scein), laser Doppler fluxmetry and tc Po2 measurements (43°C) at the medial ankle in healthy controls and patients. Laser Doppler flux and tc Po2 were recorded in supine and sitting position in order to evaluate postural vasoconstriction. The measurements were repeated 6 and 12 months after sclerotherapy of incompetent perforators (Polidocanol 40 mg/ml) and compression therapy by below-knee class II or III stockings (Sigvaris®). Setting: Department of Internal Medicine, Angiology Division, University Hospital, Zurich, Switzerland. Patients, participants: 15 healthy subjects (15 legs, mean age 53.3 years) and 15 patients with CVI of a moderate to severe stage (17 legs, mean age 56.8 years). Results: Microangiopathy in CVI is characterized by significantly enlarged, elongated and dilated capillaries with increased diameters of the pericapillary spaces (‘halos’). Single capillaries may be thrombosed. Laser Doppler flux is increased and tc Po2 is decreased. After therapy, there was a trend to decreased laser Doppler flux and an increase in tc Po2, but the differences were not statistically significant. Capillary thromboses were no longer detected. Mean halo diameters tended to decrease, but this difference was not statistically significant. Conclusions: Microangiopathy in CVI is characterized by morphological and functional changes. Beneficial changes induced by therapy develop slowly and emphasize the importance of long-lasting treatment.

Haemodynamic changes with the use of neuromuscular electrical stimulation compared to intermittent pneumatic compression

2014 ◽  
Vol 30 (5) ◽  
pp. 365-372 ◽  
Author(s):  
KJ Williams ◽  
HM Moore ◽  
AH Davies
Keyword(s):  
Electrical Stimulation ◽  
Healthy Subjects ◽  
Peak Velocity ◽  
Neuromuscular Electrical Stimulation ◽  
Haemodynamic Effect ◽  
Maximum Velocity ◽  
Intermittent Pneumatic Compression ◽  
Laser Doppler ◽  
Thrombosis Prophylaxis ◽  
Electrical Stimulator

Introduction Enhancement of peripheral circulation has been shown to be of benefit in many vascular disorders, and the clinical effectiveness of intermittent pneumatic compression is well established in peripheral vascular disease. This study compares the haemodynamic efficacy of a novel neuromuscular electrical stimulation device with intermittent pneumatic compression in healthy subjects. Methods Ten healthy volunteers (mean age 27.1 ± 3.8 years, body mass index 24.8 ± 3.6 kg/m2) were randomised into two groups, in an interventional crossover trial. Devices used were the SCD Express™ Compression System, (Covidien, Ireland) and the geko™, (Firstkind Ltd, UK). Devices were applied bilaterally, and haemodynamic measurements taken from the left leg. Changes to haemodynamic parameters (superficial femory artery and femoral vein) and laser Doppler measurements from the hand and foot were compared. Results Intermittent pneumatic compression caused 51% ( p = 0.002), 5% (ns) and 3% (ns) median increases in venous peak velocity, time-averaged maximum velocity and volume flow, respectively; neuromuscular electrical stimulator stimulation caused a 103%, 101% and 101% median increases in the same parameters (all p = 0.002). The benefit was lost upon deactivation. Intermittent pneumatic compression did not improve arterial haemodynamics. Neuromuscular electrical stimulator caused 11%, 84% and 75% increase in arterial parameters ( p < 0.01). Laser Doppler readings taken from the leg were increased by neuromuscular electrical stimulator ( p < 0.001), dropping after deactivation. For intermittent pneumatic compression, the readings decreased during use but increased after cessation. Hand flux signal dropped during activation of both devices, rising after cessation. Discussion The neuromuscular electrical stimulator device used in this study enhances venous flow and peak velocity in the legs of healthy subjects and is equal or superior to intermittent pneumatic compression. This warrants further clinical and economic evaluation for deep venous thrombosis prophylaxis and exploration of the haemodynamic effect in venous pathology. It also enhances arterial time-averaged maximum velocity and flow rate, which may prove to be of clinical use in the management of peripheral arterial disease. The effect on the microcirculation as evidenced by laser Doppler fluximetry may reflect a clinically beneficial target in microvascular disease, such as in the diabetic foot.

Effect of Compression Stockings on the Skin Microcirculation in Chronic Venous Insufficiency

1995 ◽  
Vol 10 (1) ◽  
pp. 5-11 ◽  
Author(s):  
A. Abu-Own ◽  
J. H. Scurr ◽  
P. D. Coleridge Smith
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Laser Doppler ◽  
Controlled Study ◽  
Fibre Laser ◽  
Medial Malleolus ◽  
Compression Stocking ◽  
Compression Stockings ◽  
Median Increase ◽  
The Subject

Objective: To use a single fibre laser Doppler fluxmeter to assess the microcirculatory effects of compression stockings. Design: Controlled study comprising patient and control groups. Setting: Department of Surgery, University College London Medical School, London, UK. Patients and participants: Ten patients with lipodermatosclerosis caused by chronic venous insufficiency and 10 control subjects. Interventions: Measurements were made from the liposclerotic skin of patients and 8 cm above the medial malleolus in controls. Laser Doppler flux (LDF), blood ce velocity (BCV) and concentration of moving blood cells (CMBC) were recorded with the subject lying supine. A class II graduated compression stocking was applied to the leg and laser Doppler recordings were repeated. The protocol was repeated with the subject sitting. Main outcome measures: The effects of a compression stocking on LDF, BCV and CMBC in the horizontal and sitting positions were measured. Results: In patients in the supine position, the compression stocking resulted in a 28% median increase in LDF ( p = 0.03), with a corresponding 29% median increase in BCV. There was no significant change in CMBC. In the sitting position, the compression stocking caused a 105% median increase in LDF ( p < 0.01) due to a corresponding 89% median increase in BCV ( p = 0.01); there was only 25% median increase in CMBC. The effects of compression in controls were similar to those in patients. Conclusion: Compression stockings may be effective in the treatment of chronic venous insufficiency by increasing the microcirculatory flow velocity.

Peripheral Blood Perfusion Correlates with Microvascular Abnormalities in Systemic Sclerosis: A Laser-Doppler and Nailfold Videocapillaroscopy Study

2010 ◽  
Vol 37 (6) ◽  
pp. 1174-1180 ◽  
Author(s):  
MAURIZIO CUTOLO ◽  
CARMELA FERRONE ◽  
CARMEN PIZZORNI ◽  
STEFANO SOLDANO ◽  
BRUNO SERIOLO ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Negative Correlation ◽  
Healthy Subjects ◽  
Blood Perfusion ◽  
Laser Doppler ◽  
Nailfold Videocapillaroscopy ◽  
Microvascular Damage ◽  
Local Skin ◽  
Doppler Flowmetry ◽  
Prostacyclin Analog

Objective.To investigate possible correlations between fingertip blood perfusion (FBP) status, assessed by laser Doppler flowmetry (LDF), and morphological microvascular abnormalities, detected by nailfold videocapillaroscopy (NVC), in patients with systemic sclerosis (SSc). The effects on FBP of intravenous (IV) treatment with the prostacyclin analog iloprost were also investigated.Methods.Thirty-four consecutive patients with SSc and 16 healthy subjects were evaluated. LDF was performed by analyzing blood perfusion at the fingertips in both hands. Patients with SSc were distributed into the appropriate NVC pattern of microangiopathy (early, active, and late). Iloprost was administered to inpatients with SSc by 24-hour IV infusion for 7 consecutive days (4 μg/h).Results.FBP was significantly lower in patients with SSc (p < 0.05) compared to controls. Heating of the LDF probe at 36°C induced a significant increase of FBP in all subjects (p < 0.001), but the slope of variation was significantly lower in patients with SSc compared to controls (p < 0.05). Patients with SSc showing the late NVC pattern of microangiopathy had significantly lower FBP than patients with the active and early NVC patterns (p < 0.05). A negative correlation was observed between FBP and NVC rating of the microvascular damage (p < 0.05). After iloprost treatment, a significant increase of FBP was observed in patients with SSc (p < 0.05).Conclusion.Patients with SSc show a decreased FBP partially reversible by local skin heating. The FBP correlated negatively with the extent of nailfold microvascular damage, and IV iloprost treatment increased the FBP.

scholarly journals Modulation of Circulating Cytokine-Chemokine Profile in Patients Affected by Chronic Venous Insufficiency Undergoing Surgical Hemodynamic Correction

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Veronica Tisato ◽  
Giorgio Zauli ◽  
Sergio Gianesini ◽  
Erica Menegatti ◽  
Laura Brunelli ◽  
...  
Keyword(s):  
Varicose Vein ◽  
Chronic Venous Insufficiency ◽  
Healthy Subjects ◽  
General Circulation ◽  
Venous Insufficiency ◽  
Ex Vivo ◽  
Hemodynamic Forces ◽  
Circulating Levels

The expression of proinflammatory cytokines/chemokines has been reported inin vitro/ex vivosettings of chronic venous insufficiency (CVI), but the identification of circulating mediators that might be associated with altered hemodynamic forces or might represent innovative biomarkers is still missing. In this study, the circulating levels of 31 cytokines/chemokines involved in inflammatory/angiogenic processes were analysed in (i) CVI patients at baseline before surgical hemody namic correction, (ii) healthy subjects, and (iii) CVI patients after surgery. In a subgroup of CVI patients, in whom the baseline levels of cytokines/chemokines were analyzed in paired blood samples obtained from varicose vein and forearm vein, EGF, PDGF, and RANTES were increased at the varicose vein site as compared to the general circulation. Moreover, while at baseline, CVI patients showed increased levels of 14 cytokines/chemokines as compared to healthy subjects, 6 months after surgery, 11 cytokines/chemokines levels were significantly reduced in the treated CVI patients as compared to the CVI patients before surgery. Of note, a patient who exhibited recurrence of the disease 6 months after surgery, showed higher levels of EGF, PDGF, and RANTES compared to nonrecurrent patients, highlighting the potential role of the EGF/PDGF/RANTES triad as sensitive biomarkers in the context of CVI.

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