Eickhoff J H
Surgery. 1985 Jan;97(1):72-82.
Two local blood flow regulating mechanisms were studied before and after arterial reconstruction in 30 limbs suffering from occlusive arterial disease. Changes in forefoot blood flow were measured from the washout of a subcutaneous 133xenon depot. Arterial and venous pressures were changed by passive lowering and elevation of the foot. In 14 limbs suffering from severe ischemia, the local vasoconstrictor response to increased venous pressure was abolished as blood flow increased 37% when the limbs were lowered 40 cm. Autoregulation of blood flow was abolished also as flow decreased 51% when the limbs were elevated 20 cm. The estimated vascular resistance was constant during lowering and elevation, indicating paralysis of the arterioles. The vasoconstrictor response had returned at the tenth postoperative day as blood flow decreased 32% during lowering. Autoregulation had also returned as blood flow remained almost constant during elevation to 40 cm. In 16 limbs with less severe ischemia, vasoconstrictor response as well as autoregulation was preserved before operation, and no disturbances occurred after operation. Despite the early normalization of local blood flow regulation, postoperative hyperemia developed in most limbs. Post-reconstruction edema developed after all but one of the 13 femorodistal bypass operations and after only one of the 17 aortoiliac reconstructions. This suggests that post-reconstruction hyperemia and post-reconstruction edema are not caused by arteriolar insufficiency.
对30条患有闭塞性动脉疾病的肢体在动脉重建前后研究了两种局部血流调节机制。通过皮下注射133氙储存库的洗脱来测量前足血流的变化。通过被动降低和抬高足部来改变动脉压和静脉压。在14条患有严重缺血的肢体中，当肢体降低40厘米时，随着血流增加37%，对静脉压升高的局部血管收缩反应消失。当肢体抬高20厘米时，随着血流减少51%，血流的自动调节也消失。在降低和抬高过程中估计的血管阻力恒定，表明小动脉麻痹。术后第10天血管收缩反应恢复，降低过程中血流减少32%。当抬高至40厘米时血流几乎保持恒定时，自动调节也已恢复。在16条缺血程度较轻的肢体中，术前血管收缩反应以及自动调节功能均得以保留，术后未出现任何紊乱。尽管局部血流调节早期恢复正常，但大多数肢体术后仍出现充血。在13例股腘动脉搭桥手术中，除1例之外均出现了重建后水肿，在17例主髂动脉重建手术中仅1例出现重建后水肿。这表明重建后充血和重建后水肿并非由小动脉功能不全引起。
