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Effects of posture and venous insufficiency on endothelial-dependent and -independent cutaneous vasodilation in the perimalleolar region

By Markos Klonizakis, Justin M. C. Yeung, Roddy Nash, Krishna Lingam, Gillian Manning and Richard Donnelly


Objectives: To assess the effects of posture, endothelial function and venous insufficiency on cutaneous microvascular vasodilator function in the gaiter area, in particular defining factors which may affect microangiopathy and ulcer formation.\ud Methods: Endothelial-dependent and –independent vasodilator responses to incremental-doses of acetylcholine (Ach) and sodium nitroprusside (SNP) were evaluated in the perimalleolar region in the supine and standing positions in middle-aged patients with isolated superficial venous insufficiency (ISVI) (n=25) and health controls (n=28) using laser Doppler fluximetry (LDF) and iontophoresis of vasodilators.\ud Results: The venoarteriolar reflex (vasoconstriction on standing) was equally present in both groups, and reduced the vasodilator responses to SNP in the upright position (e.g for patients with ISVI, peak SNP response was 82+11 PU [standing] vs 123+15 PU [supine]). The presence of ISVI had no effect on endothelial vasodilator function in the supine position, but on standing cutaneous reactivity to Ach was significantly reduced (e.g peak Ach response 69+8 PU [ISVI] vs 109+11 PU [controls], p<0.003). \ud Conclusions: Upright posture impairs cutaneous endothelial-dependent vasodilation in the gaiter area of patients with ISVI. This may be of clinical and prognostic utility in identifying which patients with uncomplicated ISVI are at highest risk of tissue breakdown and ulcer formation in the gaiter area

Topics: A300 Clinical Medicine
Publisher: Elsevier
Year: 2003
DOI identifier: 10.1053/ejvs.2002.1953
OAI identifier:

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  4. (1988). Impaired postural vasoconstriction: a contributory cause for oedema in patients with chronic venous insufficiency. Phlebology
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  9. (1995). Normal cutaneous microcirculation in gaiter zone (ulcer-susceptible skin) versus nearby regions in healthy young adults. doi
  10. (1996). Skin blood flow responses to the iontophoresis of acetylcholine and sodium nitroprusside in man: possible mechanisms.
  11. (1998). Studies with iontophoretic administration of drugs to human dermal vessels in vivo: cholinergic vasodilation is mediated by dilator prostanoids rather than nitric oxide. doi
  12. (1997). The microcirculation in venous hypertension. doi
  13. (2002). Treatment of venous ulcers with pentoxifylline: a 12-month, doubleblind, placebo controlled trial. Microcirculation and healing. Angiology
  14. (1991). Vasodilatory capacity of the skin in venous disease and its relationship to transcutaneous oxygen tension. doi
  15. (1991). Vasomotion in venous disease. doi
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