Der Laser-Doppler in der Gefäßchirurgie: Anwendungsmöglichkeiten aus der Sicht des Klinikers

  • Andreas Becker
  • K. H. Vestweber
  • A. Gaitzsch
Conference paper
Part of the Berliner Gefäßchirurgische Reihe book series (BERLINGEFÄß, volume 4)

Zusammenfassung

Unsere Auswertung von 61 Artikeln über Anwendungen des Laser-Dopplers in der Gefäßchirurgie an insgesamt 2870 Patienten zeigt vielversprechende Ergebnisse im Hinblick auf die Einsatzmöglichkeiten in der klinischen Medizin. Das Verfahren ist nichtinvasiv, unkompliziert und einfach zu benutzen, wiederholbar, die Daten sind speicherbar und können mittels geeigneter Software leicht ausgewertet werden. Darüberhinaus kann der Laser-Doppler erfolgreich im perioperativen Langzeitmonitoring eingesetzt werden und spricht schnell auf Veränderungen in der Mikrozirkulation an. Um die Methode zukünftig fest in der diagnostisch-therapeutischen Planung zu etablieren, bedarf es der weiteren Entwicklung standardisierter Meßroutinen in prospektiven Studien.

Summary

The analysis of 61 articles about the use of laser-Doppler in vascular surgery (in a total of 2870 patients and controls) shows very promising results concerning the applicability in daily clinical medicine. It is harmless to the patient, rapid, simple and easy to use, repeatable, early responsive to microvascular changes, and capable of prolonged constant monitoring. However, to establish the method as a basic-test that is able to change the diagnostic and therapeutic approach in angiology and vascular-surgery, standardized procedures and provocation-tests should be developed in future prospective trials.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. 1.
    Becker A, Vestweber KH (1991) Quo vadis laser-Doppler? A critical review of 356 articles on the measurement of the laser-Doppler signal. Proceedings of the First European LD Users Meeting Oxford 1991:1Google Scholar
  2. 2.
    Belcaro GV, Gabini M, Cacchio M (1987) Evaluation of the efficacy of the treatment of Raynaud’s penomenon with nifedipine by laser-Doppler flowmetry. Panminerva Medica 29:223–227PubMedGoogle Scholar
  3. 3.
    Belcaro G, Gaspari A, Legini M, Napolitano A, Marelli C (1988) Evaluation of the effects of elastic compression in patients with chronic venous hypertension by laser-Doppler flowmetry. Acta Chirurgica Belgica 88: 163–167PubMedGoogle Scholar
  4. 4.
    Belcaro G, Nicolaides A (1989) Microvascular evaluation of the effects of Nifedipine in vascular patients by laser Doppler flowmetry. Angiology 40: 689–693PubMedCrossRefGoogle Scholar
  5. 5.
    Belcaro G, Rulo A, Vasdekis S, Williams MA, Nicolaidaes AN (1988) Combined evaluation of postphlebitic limbs by Laserdoppler flowmetry and transcutaneuos PO2/PCO2 measurements. Vasa 17: 259–261PubMedGoogle Scholar
  6. 6.
    Bengtsson M (1984) Changes in Skin Blood Flow and Temperature during Spinal Analgesia Evaluated by Laser Doppler Flowmetry and Infrared Thermography. Acta Anaesthesiologica Scandinavica 28: 625–630PubMedCrossRefGoogle Scholar
  7. 7.
    Bengtsson M, Nilsson GE, Löfström JB (1983) The Effect of Spinal Analgesia on Skin Blood Flow, Evaluated by Laser Doppler Flowmetry. Acta Anaesthesiologica Scandinavica 27:206–210PubMedCrossRefGoogle Scholar
  8. 8.
    Boccalon, Marguery M, Ginestet M, Puel P (1987) Laser Doppler flowmeter and standardized thermal test in normals and Raynaud’s phenomenon. International Angiology 6: 107–118PubMedGoogle Scholar
  9. 9.
    Cochrane T, Fail T, Sheriff S (1987) Comparison of Laser Doppler and Doppler Ultrasound in Lower Limb Vascular Diagnosis. Clinical Physics and Physiological Measurement 8: 231–238PubMedCrossRefGoogle Scholar
  10. 10.
    Creutzig A, Caspary L, Ranke C, Kiessling D, Wilkens J (1987) Transkutaner PO2 und Laser Doppler Flux bei steigenden Dosierungen von intraarteriell und intravenös appliziertem Prostaglandin E1. Vasa 16: 114–118PubMedGoogle Scholar
  11. 11.
    Del Guercio R, Leonardo G, Arpia MR (1986) Evaluation of Postischemic Hyperemia on the Skin Using Laser Doppler Velocimetry: Study on Patients with Claudication Intermittens. Microvascular Research 32: 289–299PubMedCrossRefGoogle Scholar
  12. 12.
    Del Guercio R, Arpaia MR, Del Guercio M, Leonardo G (1990) Evaluation of microvascular run-off by laser-doppler and TcPO2 in severe ischemia of the limbs. Abstract: International Journal of Microcirculation Clinical and Experimental Vol. 9 Suppl 1: 37Google Scholar
  13. 13.
    Dormandy JA, Stock G (Eds.) 1990 Critical Leg Ischemia. Its Pathophysiology and Management. Springer, Berlin Heidelberg New YorkGoogle Scholar
  14. 14.
    Dormandy JA, Murray GD (1991) The Fate of the Claudicant-A Prospective Study of 1969 Claudicants. European Journal of Vascular Surgery 5: 131–133PubMedCrossRefGoogle Scholar
  15. 15.
    Earnshaw JJ, Hopkinson BR, Makin GS (1990) Acute Critical Ischemia of the Limb: A Prospective Evaluation. European Journal of Vascular Surgery 4: 365–368PubMedCrossRefGoogle Scholar
  16. 16.
    Elam JH, Martinell S, Niemand D, Elam M (1987) Peridural morphine reduces skin blood flow in the lower limb in man. Acta Physiologica Scandinavica 131: 629–630PubMedCrossRefGoogle Scholar
  17. 17.
    Fairs SLE, Ham RO, Conway BA, Roberts VC (1987) Limb perfusion in the lower limb ampu-tee-a comparative study using a laser Doppler flowmeter and a transcutaneous oxygen electrode. Prosthetics and Orthotics International 11: 80–84PubMedGoogle Scholar
  18. 18.
    Gaitzsch A, Becker A, Häuser G, Moser KH, Glöckner W, Martini M (1989) A computer-assisted system for the combined assessment of microcirculation. Abstract: International Journal of Microcirculation: Clinical and Experimental Vol 8 (1): 105Google Scholar
  19. 19.
    Gebuhr P, Jörgensen J, Vollmer-Larsen B, Loumann-Nielsen S (1989) Estimation of amputation level with a laser Doppler flowmeter. Journal of Bone and Joint Surgery 71: 514–517PubMedGoogle Scholar
  20. 20.
    Goldstein D, Bonner R, Zimlichman R, Zahn T, Cannon R (1986) Indices of Sympathetic Vascular Innervation in Sympathectomized Patients. Journal of the Autonomic Nerve System 15:309–318CrossRefGoogle Scholar
  21. 21.
    Hiemer W, Gruss JD, Kroiss A, Stritter W (1991) Analyse von 130 Sofortverschlüssen nach femorodistalen “in-situ” Rekonstruktionen. ANGIO 3: 89–94Google Scholar
  22. 22.
    Hoffmann U, Schneider E, Bollinger A (1990) Flow motion waves with high and low frequency in severe ischemia before and after percutaneous transluminal angioplasty. Cardiovascular Research 24: 711–718PubMedCrossRefGoogle Scholar
  23. 23.
    Hoffmann U, Yanar A, Franzeck UK, Bollinger A (1991) Fluxmotionsmuster bei Gesunden und Patienten mit peripherer arterieller Verschlußkrankheit (PAVK), VASA Suppl 33: 273–274PubMedGoogle Scholar
  24. 24.
    Holloway GA, Burgess EM (1983) Preliminary experiences with laser Doppler velocimetry for the determination of amputation levels. Prosthetics and Orthotics International 7: 63–66PubMedGoogle Scholar
  25. 25.
    Holm J, Frid I, Akerström G, Haljamöe H (1988) Ankle-Brachial Index (ABI) and Leg Blood Flow Following Epidural Anaesthesia. International Angiology 7: 26–31PubMedGoogle Scholar
  26. 26.
    Jones B 450 (1984) Monitors for the Cutaneous Microcirculation. Plastic and Reconstructive Surgery 73: 843–850PubMedCrossRefGoogle Scholar
  27. 27.
    Karanfilian R, Lynch T, Lee C, Long JB, Hobson RW (1984) The Assessment of Skin Blood Flow in Peripheral Vascular Disease by Laser Doppler Velocimetry. American Surgeon 50: 641–644PubMedGoogle Scholar
  28. 28.
    Karanfilian R, Lynch T, Zirul V, Padberg F, Jamil Z (1986) The Value of Laser Doppler Velocimetry and Transcutaneous Oxygen Tension in Predicting Healing of Ischemic Forefoot Ulcerations and Amputations in Diabetic and Nondiabetic Patients. Journal of Vascular Surgery 4: 511–516PubMedGoogle Scholar
  29. 29.
    Költringer P (1988) A new diagnosis for polyneuropathies: the hyperthermal laser Doppler flowmetry. Acta Medica Austriaca 15: 87–91PubMedGoogle Scholar
  30. 30.
    Kram HB, Appel PL, Shoemaker WC (1989) Prediction of below-knee amputation wound healing using noninvasive laser Doppler velocimetry. American Journal of Surgery 158: 29–31PubMedCrossRefGoogle Scholar
  31. 31.
    Krogh-Sorensen K, Kvernebo K (1989) Laser Doppler flowmetry in evaluation of colonic blood flow during aortic reconstruction. European Journal of Vascular Surgery 3: 37–41CrossRefGoogle Scholar
  32. 32.
    Kvernebo K, Slagsvold CE, Gjolberg T (1988) Laser Doppler Flux Reappearance Time (FRT) in Patiens with Lower Limb Atherosclerosis and Healthy Controls. European Journal of Vascular Surgery 2: 171–176PubMedCrossRefGoogle Scholar
  33. 33.
    Kvernebo K (1991) Standardization of laser doppler flowmetry measurements: A prerequisite for routine clinical applications. Proceedings of the First European LD Users Meeting Oxford 1991:2Google Scholar
  34. 34.
    Lantsberg L, Goldman M (1990) Lower limb sympathectomy assessed by laser Doppler blood flow and transcutaneous oxygen measurements. Journal of Medical Engineering and Technology 14: 182–183PubMedCrossRefGoogle Scholar
  35. 35.
    Lantsberg L, Goldman M (1991) Laser Doppler Flowmetry, Transcutaneous Oxygen Tension Measurements and Doppler Pressure Compared in Patients Undergoing Amputation. European Journal of Vascular Surgery 5: 195–197PubMedCrossRefGoogle Scholar
  36. 36.
    Leonardo G, Arpaia M, Del Guercio R (1986) Evaluation of the effects of vasoactive drugs on cutaneous microcirculation by laser Doppler velocimetry. Angiology 37: 12–20PubMedCrossRefGoogle Scholar
  37. 37.
    Leonardo G, Arpaia M, Del Guercio R (1987) A new method for the quantitative assessment of arterial insufficiency of the limbs: cutaneous postischemic hyperemia test by laser Doppler. Angiology 38: 378–385PubMedCrossRefGoogle Scholar
  38. 38.
    Line P, Sörensen K, Kvernebo K (1991) Double hump response in laser Doppler recorded skin postocclusive hyperemia:artifact or a phenomenon induced by arterial stenosis? Proceedings of 5. World Congress Microcirculation 1991 Louisville: 371Google Scholar
  39. 39.
    Ludbrook J, Clarke AM, McKenzie JK (1962) Significance of absent ankle pulse. British Medical Journal 1: 1724–1726PubMedCrossRefGoogle Scholar
  40. 40.
    Moneta G, Schneider E, Jäger K, Brülisauer M, Thüring-Vollenweider Ü (1988) Laser Doppler flux and vasomotion in patients before and after transluminal angioplasty for limb salvage. Vasa 17: 26–31PubMedGoogle Scholar
  41. 41.
    Müller Ph, Keller R, Imhof P (1987) Laser Doppler Flowmetry, a Reliable Technique for Measuring Pharmacologically Induced Changes in Cutaneous Blood Flow? Methods and Findings in Experimental and Clinical Pharmacology 9: 409–420PubMedGoogle Scholar
  42. 42.
    Pabst T, Castronuovo J, Sharon M, Jackson S, Schuler J (1985) Evaluation of the Ischemic Limb by Pressure and Flow Measurements of the Skin Microcirculation as Determined by Laser Doppler Velocimetry. Current Surgery 42: 29–31PubMedGoogle Scholar
  43. 43.
    Ranft J, Heidrich H, Peters A, Trampisch H (1986) Laser Doppler examinations in persons with healthy vasculature and in patients with peripheral arterial occlusive disease. Angiology 11:818–827CrossRefGoogle Scholar
  44. 44.
    Scheffler A, Rieger H (1990) A microcomputer system for evaluation of laser doppler blood flux measurement. International Journal of Microcirculation. Clinical and Experimental 9: 357–368Google Scholar
  45. 45.
    Scheffler A, Rieger H (1988) Signalverlaufsmuster des Laser-Doppler-Fluxes bei peripherer arterieller Verschlußkrankheit ob ihre Beziehung zum systolischen Knöcheldruckindex. Proceedings of 12. Jahrestagung der Ges. für Mikrozirkulation 1988: 73–77Google Scholar
  46. 46.
    Schmidt J, Firestone G, Fronek A (1991) Objective frequency determination of periodic hemodynamics (flowmotion) in arterial occlusive disease. Proceedings of 5. World Congress Microcirculation 1991 Louisville: 580Google Scholar
  47. 47.
    Sciacca V, Mingoli A, Magiore C, Fiume D, diMarzo L (1991) Laser Doppler Flowmetry and Transcutaneous Oxygen Tension in Patients with Severe Arterial Insufficiency Treated by Epidural Spinal Cord Electrical Stimulation. Vascular Surgery 3: 165–170Google Scholar
  48. 48.
    Scott HJ, McMullin GM, Coleridge Smith PD, Scurr JH (1990) The microvascular lesion in venous ulceration and the role of the white blood cell. Journal of Medical Enginering and Technology 14: 184–187CrossRefGoogle Scholar
  49. 49.
    Seifert H, Jäger K, Bollinger A (1988) Analysis of flow motion by the Laser Doppler technique in patients with peripheral arterial occlusive disease. International Journal of Microcirculation Clinical and Experimental 7: 223–236Google Scholar
  50. 50.
    Stikovac M (1991) Short term results of prostaglandin therapy in chronic critical limb ischaemia evaluated by laser Doppler fluxmetry. Proceedings of 5. World Congress Microcirculation 1991 Louisville: 628Google Scholar
  51. 51.
    Svenson H, Berggquist D, Tokolander R (1987) Laser Doppler Flow Monitoring in Reconstructive Vascular Surgery: Case Studies. Vascular Surgery: 58–65Google Scholar
  52. 52.
    Troidl H (1990) Surgical endoscopy and sonography. Surgery at the crossroads. Surgical Endoscopy 4: 41–46PubMedCrossRefGoogle Scholar
  53. 53.
    Troidl H (1991) Quality of life: definition, conceptualization and implications-a surgeon’s view. Theoretical Surgery 6: 138–142Google Scholar
  54. 54.
    Van den Brande P, Welch W (1988) Diagnosis of arterial occlusive disease of the lower extremities by laser Doppler flowmetry. International Angiology 7: 224–230PubMedGoogle Scholar
  55. 55.
    Wahlberg E (1991) Changes after arterial reconstructions and percutaneous transluminal dilatation (PTA) in laser Doppler post reactive hyperemic values. Proceedings of 5. World Congress Microcirculation 1991 Louisville: 703Google Scholar
  56. 56.
    Walmsley D, Goodfield M J (1990) Evidence for an abnormal peripherally mediated vascular response to temperature in Raynaud’s phenomenon. British Journal of Rheumatology 29:181–184PubMedCrossRefGoogle Scholar
  57. 57.
    Walmsley D, Wales JK, Wiles PG (1989) Reduced hyperaemia following skin trauma: evidence for an impaired microvascular response to injury in the diabetic foot. Diabetologia 32: 736–739PubMedCrossRefGoogle Scholar
  58. 58.
    Yanar A, Hoffmann U, Geiger M, Franzeck UK, Bollinger A (1989) Laser-Doppler-Fluxmo-tion bei peripherer arterieller Verschlußkrankheit (PAVK). Vasa Supplement 27: 48–50Google Scholar
  59. 59.
    Yanar A, Leu AJ, Franzeck UK, Bollinger A (1991) Are high frequency flux motion waves (HFW) induced by respiration or by local vasomotion? Proceedings of 5. World Congress Microcirculation 1991 Louisville: 703Google Scholar

Copyright information

© Dr. Dietrich Steinkopff Verlag, GmbH & Co. KG, Darmstadt 1992

Authors and Affiliations

  • Andreas Becker
    • 1
  • K. H. Vestweber
    • 1
  • A. Gaitzsch
    • 2
  1. 1.Abteilung für AllgemeinchirurgieStädtisches Krankenhaus Leverkusen, Akademisches Lehrkrankenhaus der Universität zu KölnLeverkusen 1Deutschland
  2. 2.Klinikum Köln-MerheimII. Lehrstuhl für Chirurgie der Universität zu KölnDeutschland

Personalised recommendations