Impaired Microcirculation in Patients with Peripheral Vascular Disease: Pathophysiological and Therapeutic Aspects
The common causal explanation for ischemic symptoms in chronic occlusive arterial disease, based on arteriosclerosis, is the existence of stenosis and occlusions of the larger arteries like the femoral artery. This almost anatomical and mechanistic way of thinking led to the surgical therapy of “desobliteration” or bypass operations, which is in fact helpful in selected cases. However, only 30% of all patients suffering from intermittent claudication, rest pains, or ischemic ulcers can be operated upon. The remaining 70% with very peripheral occlusions are unsuitable for surgical therapy and must be treated conservatively. Since this is the case, noninterventional types of therapy are needed. These therapies should be based on a more detailed knowledge of the pathophysiology of the disease. This was and is the aim of the scientific work of many groups. The direction of research was outlined in the late 1960s—away from the large arteries and toward the microcirculation. This makes sense, since if the macrocirculatory flow is reduced by stenoses or occlusions, the blood flow in the microcirculation must be impaired and vice versa. What we did not know at that time was that functional vicious circles and mechanisms exist which act in a self-perpetuating way. So far, the logical consequence was to investigate what happens in the ischemic microcirculation in muscle tissue and skin and, if possible, to draw therapeutical consequences from these results.
KeywordsIntermittent Claudication Impaired Microcirculation Decrease Blood Viscosity Tissue Oxygen Pressure Tissue Oxygen Supply
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