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Assessment of the microcirculation provides additional information in critical limb ischaemia
M J Jacobs1, D T Ubbink, P J Kitslaar
1Department of Surgery, Academic Hospital Maastricht, The Netherlands.
Insights
Microcirculatory assessment, including capillary microscopy and transcutaneous oximetry, offers valuable insights into arterial occlusive disease progression. Dynamic microcirculatory parameters significantly aid in identifying critical limb ischemia beyond traditional ankle pressure measurements.
Area of Science:
- Vascular Medicine
- Microcirculation Research
- Peripheral Artery Disease Diagnostics
Background:
- Ankle and toe pressure measurements are standard for diagnosing arterial occlusive disease.
- Chronic critical limb ischemia is defined by persistent pain and ankle pressure < 50 mmHg.
- The adjunct value of microcirculatory assessment requires further investigation.
Purpose of the Study:
- To evaluate the supplementary role of microcirculatory assessment in arterial occlusive disease.
- To compare capillary microscopy and transcutaneous oximetry findings with pressure measurements across disease severity.
Main Methods:
- Capillary microscopy and transcutaneous oximetry were performed in asymptomatic, claudicant, and critical limb ischemia patients (Fontaine stages F1-F4).
- Evaluated parameters included capillary morphology (diameter, density) and dynamics (red blood cell velocity - RBCV).
- Transcutaneous oximetry and ankle/toe pressures were compared across Fontaine groups.
Main Results:
- Ankle and toe pressures differed significantly between groups (p < 0.001), but showed considerable overlap.
- Capillary density, diameter, peak RBCV, time to peak RBCV, and transcutaneous oximetry parameters were significantly different between groups (p < 0.05 to p < 0.001) and worsened with ischemia.
- Supine transcutaneous oxygen pressure (TcpO2) uniquely separated critical limb ischemia patients (F3/4); dynamic RBCV parameters were lower in critical limb ischemia patients irrespective of ankle pressure.
Conclusions:
- Microcirculatory assessment provides significant, complementary data to pressure measurements in peripheral artery disease.
- Dynamic microcirculatory parameters, like peak RBCV and time to peak RBCV, are crucial for identifying critical limb ischemia.
- These findings highlight the additional diagnostic value of microcirculatory assessment, especially in complex cases.
Abstract:
Systolic ankle and toe pressure measurements are considered to be the best way of documenting arterial occlusive disease. In the European consensus, chronic critical limb ischaemia is defined as persistent pain with an ankle pressure lower than 50 mmHg. To investigate the possible adjunct value of microcirculatory assessment, capillary microscopy and transcutaneous oximetry were performed in 21 asymptomatic persons (F1), 89 claudicants (F2) and 54 patients with critical limb ischaemia (F3/4). Capillary morphology (diameter, density) and dynamics [red blood cell velocity (RBCV), peak RBCV and time to peak RBCV], as well as transcutaneous oximetry parameters were determined for each Fontaine group and compared with ankle and toe pressure measurements. Despite considerable overlap, ankle and toe pressures were significantly (p less than 0.001) different between F1, F2 and F3/4 patients. Capillary density (p less than 0.05), diameter (p less than 0.05), peak RBCV (p less than 0.05) and time to peak RBCV (p less than 0.01), as well as transcutaneous oximetry parameters (p less than 0.001) were significantly different between all groups and impaired with progression of ischaemia. However, a similar overlap between all groups was observed, except the supine TcpO2 parameter which separated F3/4 patients completely from the other groups. In all patients with critical limb ischaemia, dynamic parameters, such as peak RBCV (p less than 0.01) and time to peak RBCV (p less than 0.001), were significantly lower as compared to non-critically ischaemic patients, irrespective of an ankle pressure below or above a value of 50 mmHg, illustrating the additional value of microcirculatory assessment in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)