School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, NE 68182, USA.
Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA.
Int J Environ Res Public Health. 2021 Mar 1;18(5):2384. doi: 10.3390/ijerph18052384.
Peripheral artery disease (PAD) is characterized by the development of atherosclerotic plaques in the lower-body conduit arteries. PAD is commonly accompanied by microvascular disease, which may result in poor wound healing, plantar ulcer development, and subsequent limb amputation. Understanding the mechanisms underlying the development of plantar ulcers is a critical step in the development of adequate treatment options for patients with PAD. Skin is classified into two major components: glabrous and non-glabrous. These skin types have unique microcirculation characteristics, making it important to differentiate between the two when investigating mechanisms for plantar ulcer development in PAD. There is evidence for a microcirculation compensatory mechanism in PAD. This is evident by the maintenance of basal microcirculation perfusion and capillary filling pressure despite a reduced pressure differential beyond an occlusion in non-critical limb ischemia PAD. The major mechanism for this compensatory system seems to be progressive vasodilation of the arterial network below an occlusion. Recently, heat therapies have emerged as novel treatment options for attenuating the progression of PAD. Heat therapies are capable of stimulating the cardiovascular system, which may lead to beneficial adaptations that may ultimately reduce fatigue during walking in PAD. Early work in this area has shown that full-body heating is capable of generating an acute cardiovascular response, similar to exercise, which has been suggested as the most efficient treatment modality and may generate adaptations with chronic exposure. Heat therapies may emerge as a conservative treatment option capable of attenuating the progression of PAD and ultimately impeding the development of plantar ulcers.
外周动脉疾病（PAD）的特征是下肢通道动脉中动脉粥样硬化斑块的发展。PAD 通常伴有微血管疾病，这可能导致伤口愈合不良、足底溃疡发展和随后的肢体截肢。了解足底溃疡发展的机制是为 PAD 患者开发足够治疗选择的关键步骤。皮肤分为两个主要成分：无毛和有毛。这两种皮肤类型具有独特的微循环特征，因此在研究 PAD 中足底溃疡发展的机制时，区分两者非常重要。有证据表明 PAD 存在微循环代偿机制。这在非关键肢体缺血性 PAD 中，尽管阻塞后压力差降低，但基础微循环灌注和毛细血管充盈压保持不变，这一点显而易见。这种代偿系统的主要机制似乎是阻塞下方动脉网络的渐进性血管扩张。最近，热疗已成为治疗 PAD 进展的新方法。热疗能够刺激心血管系统，这可能导致有益的适应，最终减少 PAD 患者行走时的疲劳。该领域的早期工作表明，全身加热能够产生类似于运动的急性心血管反应，这被认为是最有效的治疗方式，并且可能在慢性暴露中产生适应。热疗可能成为一种保守的治疗选择，能够减缓 PAD 的进展，并最终阻止足底溃疡的发展。
