Abstract
BackgroundIntermittent negative pressure (INP) applied to the lower leg and foot increases foot perfusion in healthy volunteers. The aim of the present study was to describe the effects of INP to the lower leg and foot on foot macro- and microcirculation in patients with lower extremity peripheral arterial disease (PAD).MethodsIn this experimental study, we analyzed foot circulation during INP in 20 patients [median (range): 75 (63-84yrs)] with PAD. One leg was placed inside an air-tight vacuum chamber connected to an INP-generator. During application of INP (alternating 10s of -40mmHg/7s of atmospheric pressure), we continuously recorded blood flow velocity in a distal foot artery (ultrasound Doppler), skin blood flow on the pulp of the first toes (laser Doppler), heart rate (ECG), and systemic blood pressure (Finometer). After a 5-min baseline sequence (no pressure), a 10-min INP sequence was applied, followed by 5-min post-INP (no pressure). To compare and quantify blood flow fluctuations between sequences, we calculated cumulative up-and-down fluctuations in arterial blood flow velocity per minute.ResultsOnset of INP induced an increase in arterial flow velocity and skin blood flow. Peak blood flow velocity was reached 3s after the onset of negative pressure, and increased 46% [(95% CI 36–57), P<0.001] above baseline. Peak skin blood flow was reached 2s after the onset of negative pressure, and increased 89% (95% CI 48–130), P<0.001) above baseline. Cumulative fluctuations per minute were significantly higher during INP-sequences compared to baseline [21 (95% CI 12–30)cm/s/min to 41 (95% CI 32–51)cm/s/min, P<0.001]. Mean INP blood flow velocity increased significantly ~12% above mean baseline blood flow velocity [(6.7 (95% CI 5.2–8.3)cm/s to 7.5 (95% CI 5.9–9.1)cm/s, P = 0.03)].ConclusionINP increases foot macro- and microcirculatory flow pulsatility in patients with PAD. Additionally, application of INP resulted in increased mean arterial blood flow velocity.
Highlights
Lower extremity atherosclerotic peripheral arterial disease (PAD) results in reduced tissue perfusion and inadequate oxygen delivery due to narrowing of the arterial tree [1]
Onset of Intermittent negative pressure (INP) induced an increase in arterial flow velocity and skin blood flow
Peak skin blood flow was reached 2s after the onset of negative pressure, and increased 89%, P
Summary
Lower extremity atherosclerotic peripheral arterial disease (PAD) results in reduced tissue perfusion and inadequate oxygen delivery due to narrowing of the arterial tree [1]. Insufficient blood flow may result in inadequate nutritive supply with tissue breakdown and ulceration, a process that if untreated may lead to frank gangrene and loss of the extremity [1]. The majority of treatment strategies for PAD are geared towards impeding progression of the disease and increasing blood flow [1]. The first-line treatment for PAD focuses on behavioral changes, such as reducing risk factors and improving exercise performance through ambulatory exercise [1,2,3]. The aim of the present study was to describe the effects of INP to the lower leg and foot on foot macro- and microcirculation in patients with lower extremity peripheral arterial disease (PAD)
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