Integrity of veno-arteriolar reflex determines level of microvascular flow enhancement by intermittent pneumatic compression.

Husmann M, Willenberg T, Keo HH, Spring S, Kalodiki E, Delis KT.


J Vasc Surg. 2008 Sep 30.


OBJECTIVE: To investigate whether intermittent pneumatic compression (IPC) augments skin blood flow through transient suspension of local vasoregulation, the veno-arteriolar response (VAR), in healthy controls and in patients with peripheral arterial obstructive disease (PAD). METHODS: Nineteen healthy limbs and twenty-two limbs with PAD were examined. To assess VAR, skin blood flow (SBF) was measured using laser Doppler fluxmetry in the horizontal and sitting positions and was defined as percentage decrease in skin blood flow in sitting position compared with supine position [(horizontal SBF - sitting SBF)/horizontal SBF x 100]. During IPC application to the foot, the calf, or both, SBF was measured by laser Doppler fluxmetry with the probe on pulp of the big toe. RESULTS: Baseline VAR in controls was greater with 63.8 +/- 6.4% compared with PAD (31.7 +/- 13.4%, P = .0162). IPC generated significantly higher SBF in both groups than at rest (P < .0001), showing a higher percentage increase in controls (242 +/- 85% to 788 +/- 318%) compared with PAD (98 +/- 33% to 275 +/- 72%) depending on the site of compression delivery. The effects of IPC on SBF correlated with VAR for all three compression modes (r = 0.58, P = .002 for calf compression, r = 0.65, P < .0001 for foot compression alone, and r = 0.64, P = .0002 for combined foot and calf compression). CONCLUSION: The integrity of postural lower limb veno-arteriolar response correlates with the level of skin blood flow augmentation induced by intermittent pneumatic compression, suggesting that compression transiently suspends local autoregulatory vasoconstriction in healthy controls and in patients with PAD.