title: Assessment of lower limb microcirculation: exploring the reproducibility and clinical application of laser Doppler techniques.
abstract: OBJECTIVE
  Non-invasive laser Doppler fluximetry (LDF) and laser Doppler imaging (LDI), combined with iontophoresis, have been used to study the microcirculation in a range of clinical conditions including lower limb venous disease. A prerequisite for an accurate measurement tool is that it is reproducible. However, there is currently no literature with respect to the reproducibility of LDF and LDI combined with iontophoresis in the lower limb (in general) and in the upright position (in specific). Furthermore, the two techniques have been used interchangeably by researchers and the association between these two different measurement methods has not been explored, nor have the factors that affect them been well described. Thus the aim of this study was to determine the reproducibility of LDF and LDI with iontophoresis in the lower limb and investigate factors that influence their clinical application.
  
  
  METHODS
  Cutaneous microvascular responses in the lower limb were measured in the supine and standing positions using LDF and LDI combined with iontophoretic administration of endothelial-dependent (acetylcholine, ACh) and -independent (sodium nitroprusside) vasodilators in 25 patients with uncomplicated isolated superficial venous incompetence (ISVI) and 26 healthy controls.
  
  
  RESULTS
  Maximum perfusion had the best reproducibility assessed by LDF (CV 20.5-24.3%) and LDI (15.8-17.6%). Both techniques were positively influenced by iontophoretic dose (e.g. p = 0.0001 for LDF) and the use of vasodilator agents (e.g. p = 0.0001 for LDF), but negatively influenced in the standing position and/or in the presence of ISVI (p = 0.0016 and 0.045, respectively, for LDF). There was a statistically significant positive relationship between the two techniques, for example ACh maximum perfusion versus LDF ACh maximum perfusion (r = 0.404, p = 0.016).
  
  
  CONCLUSIONS
  Both techniques are reproducible, in line with similar studies undertaken in other areas of the human body, and provide useful information for the study of the lower-limb microcirculation. Direct comparison between techniques based on absolute numbers should be avoided and the technique choice should be based on individual study needs.
authors.affiliation: Division of Vascular Medicine, School of Graduate Entry Medicine and Health, University of Nottingham, Nottingham, UK.
authors.forename: M
authors.initials: M
authors.lastname: Klonizakis
authors.forename: G
authors.initials: G
authors.lastname: Manning
authors.forename: R
authors.initials: R
authors.lastname: Donnelly
mesh_terms: D000109:Acetylcholine / Q000493:pharmacokinetics; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007478:Iontophoresis; D017078:Laser-Doppler Flowmetry / Q000379:methods*; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009599:Nitroprusside / Q000493:pharmacokinetics; D015203:Reproducibility of Results; D014689:Venous Insufficiency / Q000175:diagnosis* / Q000473:pathology
chemical_list: D009599:Nitroprusside; D000109:Acetylcholine