Are the vasodilators needed in critical limb ischemia? Laser Doppler flowmetry study

Twenty patients with critical limb ischemia, fulfilling the criteria of European Consensus of Critical Limb Ischemia, were included in the study. Fifteen healthy subjects served as the controls. Laser Doppler flowmetry method was applied to assess the peripheral skin microcirculation during provocation tests such as transcutaneous electrical nerve stimulation and veno-arterial reflex. In physiological conditions transcutaneous electrical nerve stimulation evokes short term, reversible increase of cutaneous blood flow during stimulation. Veno-arterial reflex is defined as an increase of precapillary resistance while standing or lowering of the extremity, mirrored by the reduction of skin perfusion. The results of the study justify the thesis, that the vasodilators may not be effective in the treatment of critical limb ischemia. Further trials directly assessing the influence of vasodilatating agents on microcirculation in critical limb ischemia are required.