Skin microcirculation in peripheral arterial obliterative disease

The important role of microcirculation in the pathophysiology and symptoms of peripheral arterial obliterative disease (PAOD) has been progressively emphasized during the past twenty years, thanks to the use of different non-invasive methods, such as capillaroscopy, laser Doppler (LD) fluxmetry and transcutaneous measurement of oxygen tension (tcPO2). Basally, in the diseased leg of stage II PAOD patients, leg skin perfusion recorded by means of LD fluxmetry is quantitatively normal. However, spectral analysis of skin LD tracing shows an abnormal flowmotion, with increased amplitude of the flowmotion waves related to endothelial, neurogenic and myogenic activities, suggesting a relatively early skin microcirculatory adaptation in this PAOD stage. Following ischemia, an impaired total skin LD hyperemia and a reduced skin capillary nutritional blood flow at capillaroscopy, concomitantly with a reduced increase of flowmotion waves related to endothelial, myogenic and sympathetic activities, have been observed in the diseased leg of stage II PAOD patients. In critical limb ischemia (CLI), a more advanced cutaneous microcirculatory deterioration has been clarified, with a more severely impaired post-ischemic hyperemia, a reduced tcPO2 and a severely perturbed skin flowmotion in the diseased leg. This integrated skin microcirculatory diagnostic approach can be used for a better management of PAOD patients.