title: Assessment of macro- and microcirculation in contemporary critical limb ischemia.
abstract: OBJECTIVE
  A paucity of data exists regarding manifestations of macro- and microcirculation in contemporary critical limb ischemia (CLI). The aim of this study was (1) to evaluate the differences in foot circulation based on angiographic findings, (2) to clarify the relationship between macro- and microcirculation, and (3) to investigate the effects of postural changes on micro as well as macrocirculation between the supine position to the dependent position.
  
  
  METHODS
  A total of 40 critically ischemic limbs in 29 patients were included in this study. Noninvasive evaluation of macrocirculation, based on the ankle brachial index (ABI) and ankle pressure, and microcirculation, using skin perfusion pressure (SPP), was performed in both the supine and dependent positions.
  
  
  RESULTS
  There was no significant difference in macro- and microcirculations between any angiographical involvements. In the supine position, dorsal SPP correlated significantly with ABI (P = 0.021, r = 0.363) and ankle-pressure (P = 0.001, r = 0.495), whereas plantar SPP failed to correlate with ABI (P = 0.198, r = 0.208) or ankle-pressure (P = 0.185, r = 0.214). In the dependent position, however, SPP showed no significant correlation with ABI and ankle pressure. Postural change from the supine to dependent position yielded a significant increase in SPP (dorsal: 37.2 ± 16.2 to 77.9 ± 17.7 mm Hg, P < 0.001; plantar: 33.6 ± 17.3 to 75.7 ± 18.3 mm Hg, P < 0.001) as well as ABI and ankle-pressure (ABI: 0.70 ± 0.35 to 0.78 ± 0.42, P = 0.003; ankle-pressure; 108 ± 61 to 111 ± 60 mm Hg, P = 0.038). The effect of postural change on SPP showed no difference between patients with and without any clinical and angiographical complications.
  
  
  CONCLUSIONS
  Of microcirculation assessed, only dorsal SPP correlated significantly with macrocirculation in the supine position. Furthermore, postural change from the supine to dependent position produced a dramatic improvement in microcirculation due to the effects of gravity.
authors.affiliation: Department of Cardiology, Kishiwada Tokushukai Hospital, 4-27-1, Kamori, Kishiwada-city, Osaka 596-8522, Japan. kawarada90@hotmail.com
authors.forename: Osami
authors.initials: O
authors.lastname: Kawarada
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Yokoi
authors.forename: Akihiro
authors.initials: A
authors.lastname: Higashimori
authors.forename: Naoto
authors.initials: N
authors.lastname: Waratani
authors.forename: Masahiko
authors.initials: M
authors.lastname: Fujihara
authors.forename: Teruyoshi
authors.initials: T
authors.lastname: Kume
authors.forename: Kenji
authors.initials: K
authors.lastname: Sakata
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Honda
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Fitzgerald
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015901:Angiography, Digital Subtraction; D055109:Ankle Brachial Index; D001783:Blood Flow Velocity; D001794:Blood Pressure; D016638:Critical Illness; D005260:Female; D005528:Foot / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D007564:Japan; D017078:Laser-Doppler Flowmetry; D016014:Linear Models; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D012720:Severity of Illness Index; D012867:Skin / Q000098:blood supply*; D016683:Supine Position