The special hemodynamics and metabolism in severe disturbances of peripheral blood flow and their treatment.
Hemodynamic investigations were carried out in the various stages of a peripheral arterial occlusive disease, primarily using venous occlusion plethysmography, and simultaneous metabolic determinations were performed in groups of 60 patients. As a rule, there were poorly collateralized occlusions at several levels in the severe stages of the peripheral blood-flow disorders. Venous occlusion plethysmography shows a pathological profile of reactive hyperemia. The parameters of resting blood flow in the severe stages were not found to be lowered in any patient; their average value was higher than that of a healthy comparison group (60 limbs). The oxygen saturation in the femoral vein in almost equal to that in the femoral artery in the exercise period in these severe stages, i.e. no oxygen utilization takes place in the periphery. While a rise in various enzyme activities could be observed after ergometric exercise in patients in stage II according to Fontaine, this is not possible in stages III and IV. There were no significant differences in measurements of the arteriovenous lactate-pyruvate difference, the pO2, the pH, the standard bicarbonate the hematocrit and the viscometry. In the severe stages, there is thus a situation of anaerobic metabolism and an accumulation of acid metabolites. An attempt is made to explain why a systematically perfomed vasodilatation has no positive effect but can lead to undesired side-effects such as a borrowing-lending phenomenon. Intra-arterial vasodilatation with short-acting vasodilators can only lead to a necessary blood-flow when the vascular occlusion is compensated by a well collateralized cirulation. In the severe stages, a fall in the perfusion pressure and blocking of the terminal blood vessel is possible. In advanced stages of a blood flow disorder it is therefore necessar during the first infusion to demonstrate by venous plethymography a quantitative increase in blood flow and to exclude a local peripheral steal effect. Various other possibilities of therapy are indicated.
D000328:Adult; D001157:Arterial Occlusive Diseases / Q000188:drug therapy / Q000503:physiopathology; D005121:Extremities / Q000098:blood supply; D006439:Hemodynamics; D006801:Humans; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption; D005082:Physical Exertion; D014666:Vasomotor System / Q000503:physiopathology
D010100:Oxygen