title: Effects of posture and venous insufficiency on endothelial-dependent and -independent cutaneous vasodilation in the perimalleolar region.
abstract: OBJECTIVE
  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.
  
  
  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 healthy controls (n = 28) using laser Doppler fluximetry (LDF) and iontophoresis of vasodilators.
  
  
  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).
  
  
  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.
authors.affiliation: Division of Vascular Medicine, University of Nottingham, Derby, UK.
authors.forename: M
authors.initials: M
authors.lastname: Klonizakis
authors.forename: J M C
authors.initials: JM
authors.lastname: Yeung
authors.forename: J R
authors.initials: JR
authors.lastname: Nash
authors.forename: K
authors.initials: K
authors.lastname: Lingam
authors.forename: G
authors.initials: G
authors.lastname: Manning
authors.forename: R
authors.initials: R
authors.lastname: Donnelly
mesh_terms: D000109:Acetylcholine / Q000494:pharmacology; D000328:Adult; D000368:Aged; D000842:Ankle / Q000098:blood supply*; D004305:Dose-Response Relationship, Drug; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007478:Iontophoresis; D017078:Laser-Doppler Flowmetry; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009599:Nitroprusside / Q000494:pharmacology; D011187:Posture; D012867:Skin / Q000098:blood supply*; D014664:Vasodilation / Q000187:drug effects / Q000502:physiology*; D014665:Vasodilator Agents / Q000494:pharmacology; D014689:Venous Insufficiency / Q000503:physiopathology*
chemical_list: D014665:Vasodilator Agents; D009599:Nitroprusside; D000109:Acetylcholine