Rosato E, Roumpedaki E, Pisarri S, Salsano F
Sapienza University of Rome, Italy.
Vasa. 2009 Nov;38(4):390-3. doi: 10.1024/0301-1526.38.4.390.
The impairment of microcirculation is a cardinal feature of systemic sclerosis (SSc). Raynaud's phenomenon and SSc can cause painful digital ulcers on the fingers or toes, with resulting complications such as serious infections, gangrene or possible amputation. This case report shows the possible role laser Doppler perfusion imaging (LDPI) could play in diagnosis and follow-up of digital arterial obstructions in SSc patients. LDPI is a non-invasive microvascular imaging technique able to provide maps of the cutaneous blood flow (CBF). We describe here the case of a woman affected by SSc who suddenly presented with pallor and pain; afterwards an area of necrosis became clearly visible at the distal phalanx of the third right finger. The LDPI of the dorsal surface of that finger showed a reduction of CBF. Selective arteriography was performed in order to assess the degree and location of the obstruction before proceeding with adventitiectomy. Following this procedure LDPI showed a normal CBF in the distal phalanx and complete healing of the necrotic area. Consequently, we can state that LDPI alone provides an indirect functional estimation of possible digital artery obstruction. Further, we can assert that the overall effect of the adventitiectomy resulted in an increase of the CBF.
微循环障碍是系统性硬化症（SSc）的一个主要特征。雷诺现象和系统性硬化症可导致手指或脚趾出现疼痛性指端溃疡，并引发严重感染、坏疽或可能需要截肢等并发症。本病例报告显示了激光多普勒血流成像（LDPI）在系统性硬化症患者指动脉阻塞的诊断和随访中可能发挥的作用。LDPI是一种无创微血管成像技术，能够提供皮肤血流（CBF）图。我们在此描述了一名患有系统性硬化症的女性患者的病例，她突然出现面色苍白和疼痛；随后，右手第三指远端指骨处出现明显的坏死区域。该手指背侧的LDPI显示CBF降低。在进行外膜剥脱术前，进行了选择性动脉造影以评估阻塞的程度和位置。此手术后，LDPI显示远端指骨处CBF正常，坏死区域完全愈合。因此，我们可以说仅LDPI就能对可能的指动脉阻塞提供间接的功能评估。此外，我们可以断言外膜剥脱术的总体效果导致了CBF的增加。
