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Clinical applications of capillaroscopy in vascular surgery

Vascular surgery deals with arteries and veins and uses techniques of reparation, derivation and substitution and remotion to restore the correct vascular anatomy in different parts of the body.

Videocapillaroscopy can be used in monitoring the distrectual irroration after by-pass surgery or revascularization of ischemic territories, in studying boundary areas of amputated limbs, and in the assessment of the effects induced by epidural cord stimulation.

ISCHEMIA

A marked decrease in the local blood pressure may lead to tissue ischemia. In critical ischaemia, total skin perfusion is reduced and there is a total lack of reactive hyperaemia. In patients the risk of skin necrosis can be evaluated by microscopic classification of the structural changes of the capillaries in the area of ischemia. When the skin capillaries are void of erythrocytes the risk of necrosis is imminent. Nailfold capillaroscopy appear useful in detecting critical ischaemia that requires amputation, which is not detected by blood pressure or clinical indicators.

EPIDURAL CORD STIMULATION

Epidural spinal cord electrical stimulation has been suggested as an alternative treatment in patients with limb-threatening ischemia due to atherosclerotic disease, in whom vascular reconstructive surgery is not possible anymore. Angiography showed occluded crural arteries technically unsuitable for reconstructive surgery.

Videocapillaroscopy was used to assess capillary diameters and red blood cell (RBC) velocity in the dorsum of the foot, before and after ESES. The current results show that in patients with severe occlusive arterial disease of the lower limbs, ESES recruits capillaries not perfused in the control situation and enhances skin blood flow.