Impaired Microcirculation in Patients with Peripheral Vascular Disease: Pathophysiological and Therapeutic Aspects

  • A. M. Ehrly


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.


Intermittent Claudication Impaired Microcirculation Decrease Blood Viscosity Tissue Oxygen Pressure Tissue Oxygen Supply 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Lassen NA, Laren OA, Sörensen A W (1968) Conservative treatment of gangrene using mineralocorticoid induced moderate hypertension. Lancet I: 606CrossRefGoogle Scholar
  2. 2.
    Ehrly AM (1976) Improvement of the flow properties of blood: A new therapeutical approach in occlusive arterial disease. Angiology 27: 188–196PubMedCrossRefGoogle Scholar
  3. 3.
    Ehrly AM (1973) Verbesserung der Fließeigenschaften des Blutes: Ein neues Prinzip zur medikamentosen Therapie chronischer peripherer arterieller Durchblutungsstörungen. VASA 2, Suppl. 1Google Scholar
  4. 4.
    Forconi S, Pieragalli D, Acciavatti A, Del Bigo C, Galigani C, Ralli L, Guerrini M, Di Perri T (1984) Positive effect of oral Buflomedil on exercise-induced hemorheological damage and on claudication distance in peripheral obliterative arterial disease patients. J Int Med Res 12: 188–192PubMedGoogle Scholar
  5. 5.
    Ehrly AM (1969) The effect of plasma substitutes on erythrocyte aggregation and blood viscosity. Bibl Heamat 33: 302Google Scholar
  6. 6.
    Ehrly AM, Köhler HJ (1976) Impaired erythrocytes deformability in patients with chronic occlusive arterial disease. In: Seki K, Mishima Y (eds) Proceedings X International Congress of Angiology, Tokyo. p 407Google Scholar
  7. 7.
    Renkin EM (1968) Transcapillary exchanges in relation to capillary circulation. J Gen Physiol 52: 96PubMedCrossRefGoogle Scholar
  8. 8.
    Schroeder W, Rathscheck W (1973) Investigation of the influence of acetylcholine on the distribution of capillary flow in the skeletal muscle of the guinea pig by recording of the pO2 in the muscle tissue. Pflügers Arch 345: 335PubMedCrossRefGoogle Scholar
  9. 9.
    Ehrly AM, Schroeder W (1979) Zur Pathophysiologie der chronischen arteriellen Verschlußerkrankung: I. Mikrozirkulatorische Blutverteilungsstörung in der Skelettmuskulatur. Herz Kreislauf 11: 275Google Scholar
  10. 10.
    Ehrly AM (1980) New pythophysiological concept of ischemic diseases: Microcirculatory blood maldistribution (MBM). Bibl Anat 20: 456Google Scholar
  11. 11.
    Ehrly AM, Köhler HJ, Schroeder W, Müller R (1975) Sauerstoffdruckwerte im ischämischen Muskelgewebe von Patienten mit chronischen peripheren arteriellen Verschlußkrankheten. Klin Wschr 53: 687PubMedCrossRefGoogle Scholar
  12. 12.
    Ehrly AM, Schroeder W (1977) Oxygen pressure in ischemic muscle tissue of patients with chronic occlusive arterial diseases. Angiology 28: 101PubMedCrossRefGoogle Scholar
  13. 13.
    Ehrly AM (1983) Verbesserung der nutritiven Durchblutung bei peripheren ischamischen Erkrankungen. VASA 12: [Suppl] 11Google Scholar
  14. 14.
    Ehrly AM, Schroeder W, Dannhof S (1977) The effect of pentoxifylline on the oxygen pressure of ischemic muscle tissue on patients with chronic arterial occlusion. IRCS Med Science 5: 411Google Scholar
  15. 15.
    Ehrly AM, Landgraf H (1984) Effects on muscle tissue oxygen tension in claudicants: infusions of 5% albumine versus 10% hydroxyethylstarch solution (20010,5) Int J Microcirc 3 (3–4): 521Google Scholar
  16. 16.
    Ehrly, AM, Landgraf, H, Saeger-Lorenz K (1987) Effect of infusion of 500 ml 5% human albumin on the muscle tissue oxygen pressure in patients with intermittent claudication. In: Ehrly AM, Hauss J, Huch R (eds) Clinical oxygen pressure measurement. Springer, Berlin Heidelberg New York Tokyo, pp 104–108CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 1988

Authors and Affiliations

  • A. M. Ehrly
    • 1
  1. 1.Division of Angiology, Department of Internal MedicineJ.W. Goethe-University Medical SchoolFrankfurt am Main 70Federal Republic of Germany

Personalised recommendations