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[What is a microcirculatory disorder in chronic degenerative vascular disease? (author's transl)]
Insights
New definitions clarify microcirculatory disorders, distinguishing them from macrocirculatory issues. These disorders stem from intrinsic abnormalities in vascular walls and blood, impacting degenerative vascular diseases.
Area of Science:
- Physiology
- Vascular Biology
- Pathophysiology
Context:
- Microcirculatory disorders are recognized complications of degenerative vascular diseases.
- Existing definitions of microcirculatory abnormalities are often vague.
- Understanding normal microcirculation is key to defining pathological states.
Purpose:
- To propose new, precise definitions for microcirculatory disorders.
- To differentiate microcirculatory abnormalities from macrocirculatory ones.
- To outline therapeutic strategies and classification criteria for microcirculation-focused drugs.
Summary:
- Normal microcirculation involves vascular integrity, blood composition, rheology, and vascular tone.
- Abnormalities are defined as autonomous and autochthonous changes in vascular wall, blood, and interstitial cells/fluids.
- These microcirculatory disorders are qualitatively distinct from hypoperfusion and complicate macrocirculatory diseases.
Impact:
- Provides a clearer framework for understanding and diagnosing microcirculatory disorders.
- Facilitates the development of targeted therapies for degenerative vascular diseases.
- Introduces the concept of a 'useful therapeutic effect' for complex vascular conditions.
Abstract:
At present, it is generally accepted that "microcirculatory disorders" are important, sometimes decisive complications of degenerative vascular diseases. In an attempt to sharpen the profile of these sometimes vaguely defined abnormalities, new definitions of "microcirculatory disorders" are proposed. After describing the normal circulation on the basis of the normal vascular integrity, the normal composition of blood and interstitial fluid, the normal rheological behavior of blood cells (in their natural habitat, the flowing blood) and the normal vascular tone, it becomes possible to define abnormalities. These abnormalities are not only quantitatively (as hypoperfusion) but also qualitatively different from the normal state of microcirculation. A microcirculatory disorder is therefore defined as a consequence of autonomous and autochthonous abnormalities of vascular wall, blood, and interstitial cells and fluids, which are basically independent of the macrocirculatory abnormalities but highly effective in complicating them. Proposals for therapeutic consequences of such concepts are given and criteria for the classification of drugs effective in the microcirculation are delineated. Lastly, in vitro and in vivo tests allowing to classify the success of the therapy are proposed. In the complex, chronic and multifacetted obliterative vascular diseases a pharmacological goal short of "clinical efficacy" is defined: a "useful therapeutic effect".