Monitoring functional disorders of microcirculation using laser Doppler flowmetry in patients with chronic venous insufficiency class 2 according to CEAP classification before and after varicose veins surgery

Česká verzia

Authors: S. Šárník; I. Hofírek; R. Panovský
Authors place of work: I. interní kardio-angiologická klinika Lékařské fakulty MU a FN u sv. Anny Brno, přednosta prof. MUDr. Jiří Vítovec, CSc., FESC
Published in the journal: Vnitř Lék 2007; 53(12): 1286-1295
Category: Original Contributions

Summary

Introduction:
Laser Doppler flowmetry is a sensitive modern method for evaluating the function of small veins which allows for the detection and assessment of early pathological changes in microcirculation. The method uses a low power laser beam which is emitted into the tissue where it is reflected and further recollected and analysed. The objective of the study was to compare laser Doppler flowmetry parameters for patients with chronic venous insufficiency (class 2 according to CEAP, primary varices) prior to and 1 month after surgery of varicose veins.

Methodology and patient sample:
The examination was performed by a Periflux laser Doppler apparatus made by Perimed. Blood flow was examined on the dorsal side of foot fingers. A total of 42 patients were examined prior to and one month following the varicose veins surgery, of whom 28 women and 14 men. The mean age of the patient sample was 49 years. A 45 minute pre-op and postop recording of the limb was made for each patient. The protocol consisted of a 10 minute recording in rest, followed by a 4 minute ischemisation of the limb with the use of a blood pressure measuring cuff, subsequent release of the cuff, a 15 minute recording of the reperfusion and a test of vasodilatation using nitrate, and a 10 minute recording following vasodilatation. Evaluation was performed for a 4 minute period at the end of the initial rest period, for reperfusion after the release of the cuff and for the interim period of rest immediately preceding the application of nitrate, and finally for a 5 minute period after nitrate application. Statistical evaluation was performed for data acquired during the movement of blood elements and data acquired in the frequency analysis of the movement of the blood vessel wall. 3 variables were chosen for the statistical evaluation of the blood cell movement data: „the area under the curve“, „the mean value of the deviation“ and „the percentage change“ in the different phases of the measurement, i.e. as compared with the rest recording: comparing the ischemisation and the rest recordings, comparing the vasodilatation and the rest recordings, and comparing the restitution and the rest recordings. The above variables were not assessed as absolute numbers but as the difference of values before and after the surgery. The above differences were tested in the Wilcoxon test. The intensity of blood vessel movements in the frequency range from 0.008 to 0.200 Hz and 0.210–0.420 Hz was evaluated in frequency analyses.

Results:
Significant differences in peripheral microcirculation in lower limbs were found in the evaluation of data acquired during the movement of the different blood elements before and after varicose vein surgery (p = = NS). On the contrary, evaluation of frequency analysis for both the operated and non-operated limb shows a decrease in spontaneous arterial reactivity after varicose vein surgery. This decrease is statistically significant in the frequency range from 0.102 to 0.228 on operated limbs after the removal of a varix in a T1 test (i. e. after reperfusion) as compared with the values before the surgery (p < 0.05).

Conclusion:
Varicose vein surgery results in the reduction of spontaneous vasomotion in the periphery of the operated limb.

Keywords:
Laser Doppler flowmetry – microcirculation disorders – movement of blood elements – arterial vasomotion – varicose vein surgery

Zdroje

1. Prázný M. Využití laser doppleru při vyšetření tkáňové perfuze. DMEV 2000; 3: 111-116.

2. www.perimed.se - Evaluations

3. www.medata.cz

4. Hofírek I, Sochor O, Olšovský J. Změny periferní mikrocirkulace u diabetiků 1. typu sledované laser dopplerem. Vnitř Lék 2004; 50: 836-841.

5. Carpentier P. New techniques for clinical assessment of the peripheral microcirculation. Druha 1999; 59: 17-22.

6. Kvernmo HD, Stefanovska A, Kirbeboen KA et al. Oscilations in the human cutaneos blood perfusion signal modified by endothelium-dependent and endothelium-independent vasodilatatore. Microvascular Research 1999; 57: 298-309.

7. Cogliati Ch, Magatelli R, Montano N et al. Detection of low and high frequency rhythms in the variability of skin sympathetic nerve activity. American Journal Heart Circulation Physiological 2002; 278: 1256-1260.

8. Šárník S. Poruchy mikrocirkulace u chronické žilní nedostatečnosti. Kardiologická revue 2005; 7: 152-155.

9. Prázný M, Škrha J. Mikrocirkulace v kůži horních končetin u diabetiků I. typu sledovaná laser dopplerem. Čas Lék Čes 2000; 24: 309-312.

10. Arora S, Smakowski P, Frygberg R et al. Defferences in foot and forearm skin microcirculation in diabetic patients with and without neuropaty. Diabetes care 1998; 21: 1339-1344.

11. Melenovský V. Patofyziologické mechanismy endoteliální dysfunkce. Cor et Vasa 2000; 42: 4.

12. Junger M, Steins J. Microcirculatory dysfunction in chronic venous insufficiency. PMID: 11151969 [PubMed - indexed for MEDLINE].

13. Leu AJ, Franzeck UK. Microangiopathies in chronic venous insufficiency. Ther Umsch 1991; 48: 715-716.

14. Bornmyr S, Arner M, Svensson H. Laser Doppler imaging of finger skin blood flow in patients after microvascular repair of the ulnar artery at the wrist. Journal of Hand Surgery 1994; 19: 295-300.

15. Junger M, Steins A, Hahn A et al. Microcirculatory dysfunction in chronic venous insufficiency. Microcirculation 2000; 7: 3-12.

16. Gschwandtner ME, Ehringer H. Microcirculation in chronic venous insufficiency. Vascular Medicine 2000; 6: 169-179.

17. Belcaro G, Cesarone MR, Nicolaides AN et al. Improvement of microcirculation and healing of venous hypertension and ulcers with Crystacide. Evaluation of free radicals, laser Doppler flux and PO2. A prospective-randomized-controlled study. Angiology 2003; 54: 325-330.

18. Gschwandtner ME, Ambrozy E, Maric S et al. Microcirculation is similar in ischemic and venous ulcers. Microvasc Res 2001; 62: 226-235.

19. Gschwandtner ME, Ambrozy E, Fasching S et al. Microcirculation in venous ulcers and the surrounding skin: findings with capillary microscopy and a laser Doppler imager. Eur J Clin Invest 1999; 29: 708-716.

20. Stucker M, Huntermann C, Bechara FG et al. Capillary blood cell velocity in periulcerous regions of the lower leg measured by laser Doppler anemometry. Skin Res Technol 2004; 10: 174-177.

21. Cheatle TR, Shami SK, Stibe E et al. Vasomotion in venous disease. Journal of the Royal Society of Medicine 1991; 84: 261-263.

22. Shami SK, Shields DA, Farrah J et al. Peripheral nerve function in chronic venous insufficiency. Eur J Vasc Surg 1993; 7: 195-200.

23. Le Dévéhat C, Khodabandehlou T, Vimeux M et al. Evaluation of haemorheological and microcirculatory disturbances in chronic venous insufficiency: activity of Daflon 500 mg. Int J Microcirc Clin Exp 1997; 17(Suppl 1): 27-33.

24. Wollina U, Abdel-Naser MB, Mani R. A review of the microcirculation in skin in patients with chronic venous insufficiency: the problem and the evidence available for therapeutic options. International Journal of Lower Extremity 2006; 5: 169-180.

25. Iabichella ML, Melillo E, Mosti G A review of microvascular measurements in wound healing. International Journal of Lower Extremity Wounds 2006; 5: 181-199.

26. Stücker M, Steinbrügge J, Memmel U et al. Disturbed vasomotion in chronic venous insufficiency. J Vasc Surg 2003; 38: 522-527.

27. Shami SK, Cheatle TR, Scurr JH. Hyperaemic response in the skin microcirculation of patients with chronic venous insufficiency. British Journal of Surgery 1994; 80: 433-435.

28. Abu-Own A, Shami SK, Chittenden SJ et al. Microangiopathy of the skin and the effect of leg compression in patients with chronic venous insufficiency. Journal of Vascular Surgery 1994; 19: 1074-1083.