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D T Ubbink

Publications and source records attributed to D T Ubbink.

At least 19 recordsLinked to original sources
PubMed2007

Predictive factors associated with prolonged chest drain production after esophagectomy.

After esophagectomy, pleural drainage is performed to ensure complete drainage of the pleural cavities. The aim of this study was to detect predisposing factors for prolonged drainage. Patients who underwent transhiatal or extended transthoracic esophagectomy for adenocarcinoma of the distal esophagus or gastroesophageal junction were included. Patients who underwent esophagectomy produced a median total drainage volume of 2477 mL (range 30-14,908). Seventy-five patients needed chest drainage = 7 days (short drainage) while 57 patients needed chest drainage > 7 days (prolonged drainage). Factors associated with prolonged drainage were a transthoracic approach (P < 0.001), a higher volume of blood loss (P = 0.027), a higher number of resected lymphnodes (P = 0.046) and a radical dissection (P = 0.033). Prolonged pleural drainage is associated with a transthoracic approach and is seen more often in patients after a microscopically radical dissection. Prolonged drainage is a sign of adequate dissection on the site of the primary tumor, probably due to the more extensive trauma to the lymphatic vessels in the mediastinum.

Adenocarcinoma↗
PubMed2006

A systematic review on the significance of extracapsular lymph node involvement in gastrointestinal malignancies.

AIMS: The impact of extracapsular lymph node involvement (LNI) has been studied for several malignancies, including gastrointestinal malignancies. Aim of this study was to assess the current evidence on extracapsular LNI as a prognostic factor for recurrence in gastrointestinal malignancies. METHODS: The Cochrane Database of systematic reviews, the Cochrane central register of controlled trials, and MEDLINE databases were searched using a combination of keywords relating to extracapsular LNI in gastrointestinal malignancies. Primary outcome parameters were incidence of extracapsular LNI and overall five-year survival rates. FINDINGS: Fourteen manuscripts were included, concerning seven oesophageal, three gastric, one colorectal, and three rectal cancer series with a total of 1528 node positive patients. The pooled incidence of extracapsular LNI was 57% (95% CI: 53-61%) for oesophageal cancer, 41% (95% CI: 36-47%) for gastric cancer, and 35% (95% CI: 31-40%) for rectal cancer. In nine of the 14 studies a multivariate analysis was performed. In eight of these nine studies extracapsular LNI was identified as an independent risk factor for recurrence. CONCLUSION: Extracapsular LNI is a common phenomenon in patients with gastrointestinal malignancies. It identifies a subgroup of patients with a significantly worse long-term survival. This systematic review highlights the importance of assessing extracapsular LNI as a valuable prognostic factor. Pathologists and clinicians should be aware of this important feature.

Chi-Square Distribution↗
PubMed2006

Meta-analysis of the clinical effectiveness of venous arterialization for salvage of critically ischaemic limbs.

OBJECTIVE: The aim of this study is to assess the clinical effectiveness of venous arterialization in patients with critical limb ischaemia not reconstructable by conventional bypass. DESIGN: Meta-analysis of observational studies. MATERIALS: Eligible studies concerning treatment by venous arterialization for chronic critical leg ischaemia were identified from electronic database, cross-reference search and pertinent articles. There was no language restriction. METHODS: All relevant studies were systematically reviewed and data extracted by two independent reviewers. Study endpoints were foot preservation, secondary graft patency, postoperative clinical improvement and complications. RESULTS: A total of 56 studies were selected for comprehensive review. No RCTs were identified. Seven patient series, comprising 228 patients, matched the selection criteria. Overall 1-year foot preservation was 71% (95% CI: 64-77%) and 1-year secondary patency was 46% (95% CI: 39-53%). The large majority of patients in whom major amputation was avoided experienced successful wound healing, disappearance of rest pain and absence of serious complications. CONCLUSION: On the basis of limited evidence, venous arterialization may be considered as a viable alternative before major amputation is undertaken in patients with 'inoperable' chronic critical leg ischaemia.

Arteriovenous Shunt, Surgical↗
PubMed2006

Systematic review of enhanced recovery programmes in colonic surgery.

BACKGROUND: Fast track (FT) programmes optimize perioperative care in an attempt to accelerate recovery, reduce morbidity and shorten hospital stay. The aim of this review was to assess FT programmes for elective segmental colonic resections. METHODS: A systematic review was performed of all randomized controlled trials and controlled clinical trials on FT colonic surgery. The main endpoints were number of applied FT elements, hospital stay, readmission rate, morbidity and mortality. Quality assessment and data extraction were performed independently by three observers. RESULTS: Six papers were eligible for analysis (three randomized controlled and three controlled clinical trials), including 512 patients. FT programmes contained a mean of nine (range four to 12) of the 17 FT elements as defined in the literature. Primary hospital stay (weighted mean difference - 1.56 days, 95 per cent confidence interval (c.i.) - 2.61 to - 0.50 days) and morbidity (relative risk 0.54, 95 per cent c.i. 0.42 to 0.69) were significantly lower for FT programmes. Readmission rates were not significantly different (relative risk 1.17, 95 per cent c.i. 0.73 to 1.86). No increase in mortality was found. CONCLUSIONS: FT appears to be safe and shortens hospital stay after elective colorectal surgery. However, as the evidence is limited, a multicentre randomized trial seems justified.

Aged↗
PubMed2005

Near-infrared spectroscopy in the routine diagnostic work-up of patients with leg ischaemia.

OBJECTIVE: To examine the reproducibility and clinical applicability of near-infrared spectroscopy (NIRS) in patients with leg ischaemia. DESIGN: Prospective comparative diagnostic study. MATERIALS AND METHODS: Routinely measured peripheral blood pressure and microcirculatory parameters were compared with tissue oxygen saturation (TsO(2)) measurements using a new NIRS device on the calf muscle and the foot. Healthy subjects (n=20) and patients in different stages of leg ischaemia (n=45) were investigated at rest and after provocation: a treadmill test, arterial occlusion and a change in posture. Healthy volunteers were used as an age-matched reference population. RESULTS: Reproducibility of the NIRS was excellent (intraclass correlation coefficient at rest was 0.91 (95% confidence interval: 80-99). Resting TsO(2) (65%) in healthy controls did not differ significantly from that in patients (Fontaine 2: 66%; F3/4: 68%). After exercise, a significant reduction in TsO(2) was observed only in patients: Fontaine 1: 60%; Fontaine 2: 21%, Fontaine 3/4: 29%. The ankle/brachial index after exercise showed a good correlation (R=0.73) with TsO(2) at the end of the treadmill test. No correlation between NIRS and other micro- or macrocirculatory parameters was found. CONCLUSION: NIRS is a very reproducible tool to assess tissue oxygen saturation, but is not useful for the routine work-up of patients with leg ischaemia.

Adult↗
PubMed2005

Spinal cord stimulation for non-reconstructable chronic critical leg ischaemia.

BACKGROUND: Patients suffering from inoperable chronic critical leg ischaemia (NR-CCLI), face amputation of the leg. Spinal cord stimulation (SCS) has been proposed as a helpful treatment in addition to standard conservative treatment. OBJECTIVES: To find evidence for an improvement of limb salvage, pain relief and clinical situation using SCS compared to conservative treatment alone. SEARCH STRATEGY: We searched the Cochrane Peripheral Vascular Diseases Group's Specialised Register, (last searched May 2005), and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 2, 2005). Additional data were obtained from research institutes. SELECTION CRITERIA: Controlled studies comparing additional SCS with any form of conservative treatment in patients with NR-CCLI. DATA COLLECTION AND ANALYSIS: Both authors independently assessed the quality of the studies and extracted data. MAIN RESULTS: Six studies comprising nearly 450 patients were included. In general, the quality of the studies was good. None was blinded due to the nature of the intervention. Limb salvage after 12 months was significantly higher in the SCS group (relative risk (RR) 0.71, 95% confidence interval (CI) 0.56 to 0.90; risk difference (RD) -0.11, 95% CI -0.20 to -0.02). Significant pain relief occurred in both treatment groups, but was more prominent in the SCS group, in which the patients required significantly less analgesics. In the SCS group, significantly more patients reached Fontaine stage II than in the conservative group (RR 4.9, 95% CI 2.0 to 11.9; RD 0.33, 95% CI 0.19 to 0.47). Overall, no significantly different effect on ulcer healing was observed between the two treatments. Complications of SCS treatment consisted of implantation problems (9%, 95% CI 4 to 15%) and changes in stimulation requiring re-intervention (15%, 95% CI 10 to 20%). Infections of the lead or pulse generator pocket occurred less frequently (3%, 95% CI 0 to 6%). The overall risk of complications of additional SCS treatment was 17% (95% CI 12 to 22%), indicating a number needed to harm of 6 (95% CI 5 to 8).A cost comparison was made in only one study. The average overall costs at two years were 36,500 Euros, (SCS group) and 28,600 Euros, (conservative group). The difference (7900 Euros) was significant (P<0.009). AUTHORS' CONCLUSIONS: There is evidence to favour SCS over standard conservative treatment to improve limb salvage and clinical situation in patients with NR-CCLI. The benefits of SCS against the possible harm of relatively mild complications and costs must be considered.

Amputation, Surgical↗
PubMed2005

Systematic review of dressings and topical agents for surgical wounds healing by secondary intention.

BACKGROUND: The best dressing for postoperative wounds healing by secondary intention is unknown. METHODS: A systematic review was conducted to assess the effectiveness of dressings and topical agents on such wounds. Main endpoints were wound healing, pain, patient satisfaction, costs and hospital stay. Systematic methodological appraisal and data extraction were performed by independent reviewers. RESULTS: Fourteen reports of 13 randomized clinical trials on dressings or topical agents (gauze, foam, bead, alginate and hydrocolloid dressing) for postoperative wounds healing by secondary intention were identified; they were of weak methodological quality. In general, no statistically significant differences in wound healing were found for various dressing comparisons (11 of 13 trials). Patients experienced significantly more pain (four of six trials) and were less satisfied when gauze was used (three of six trials). Gauze was inexpensive, but its use was associated with significantly more nursing time than dressing with foam (two of three trials). No substantial differences in hospital stay were found (four of five trials). CONCLUSIONS: Only small, poor-quality trials exist, rendering the evidence insufficient. Foam is best studied as an alternative to gauze and appears to be preferable in terms of pain reduction, patient satisfaction and nursing time.

Administration, Topical↗
PubMed2004

Systematic review and meta-analysis of controlled trials assessing spinal cord stimulation for inoperable critical leg ischaemia.

BACKGROUND: Spinal cord stimulation (SCS) may have a place in the treatment of patients with inoperable chronic critical leg ischaemia. METHODS: A systematic review and meta-analysis was performed of all controlled studies comparing SCS in addition to any form of conservative treatment for inoperable chronic critical leg ischaemia. Main endpoints were limb salvage, pain relief and clinical situation. Systematic methodological appraisal and data extraction were performed by independent reviewers. RESULTS: Of the 18 reports found, nine trials, comprising 444 patients, matched the selection criteria. After pooling, limb salvage at 12 months appeared significantly greater in the SCS group (risk difference (RD) -0.13 (95 per cent confidence interval (c.i.) -0.04 to -0.22)). Significant pain relief occurred in both treatment groups, but patients who received SCS required significantly less analgesia and reached Fontaine stage 2 more often than those who did not have SCS (RD 0.33 (95 per cent c.i. 0.19 to 0.47)). Complications of SCS were problems of implantation (8.2 per cent), changes in stimulation requiring reintervention (14.8 per cent) and infection (2.9 per cent). CONCLUSION: The addition of SCS to standard conservative treatment improves limb salvage, ischaemic pain and the general clinical situation in patients with inoperable chronic critical leg ischaemia. These benefits should be weighed against the cost and the (minor) complications associated with the technique.

Ankle↗
PubMed2003

Spinal cord stimulation for non-reconstructable chronic critical leg ischaemia.

BACKGROUND: Patients suffering from inoperable chronic critical leg ischaemia (NR-CCLI), face amputation of the leg. Spinal cord stimulation (SCS) has been proposed as a helpful treatment in addition to standard conservative treatment. OBJECTIVES: To find evidence for an improvement of limb salvage, pain relief and clinical situation by means of SCS over conservative treatment alone. SEARCH STRATEGY: The reviewers searched the Cochrane Peripheral Vascular Diseases Group Specialised Register, (last searched November 2002), the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 4, 2002). Additional data were obtained from research institutes. SELECTION CRITERIA: Controlled studies comparing additional SCS with any form of conservative treatment in patients with NR-CCLI. DATA COLLECTION AND ANALYSIS: Two reviewers (DU, HV), independently assessed the quality of the studies and extracted the data. MAIN RESULTS: Six studies comprising nearly 450 patients were included. In general the quality of the studies was good, although none of them was blinded due to the nature of the intervention. Limb salvage after 12 months was significantly higher in the SCS group (RR 0.71, 95%CI: 0.56 to 0.90; RD -0.13, 95%CI: -0.22 to -0.04). Significant pain relief occurred in both treatment groups, but was more prominent in the SCS group, in which the patients required significantly less analgesics. In the SCS group significantly more patients reached Fontaine stage II than in the conservative group (RR 4.9, 95%CI: 2.0 to 11.9; RD 0.33, 95%CI: 0.19 to 0.47). Overall, no significantly different effect on ulcer healing was observed between the two treatments. Complications of SCS treatment consisted of implantation problems (9%; 95%CI: 4 to 15%) and changes in stimulation requiring reintervention, (15%; 95%CI: 10 to 20%). Infections of the lead or pulse generator pocket occurred less frequently (3%; 95%CI: 0 to 6%). The overall risk of complications of additional SCS treatment was 17%, 95%CI: 12 to 22%, indicating a number needed to harm of six (95%CI: 5 to 8).A cost comparison was made in only one study. The average overall costs at two years were 36,500 euros, in the SCS group and 28,600 euros, in the conservative group. The difference (7,900 euros) was significant (p<0.009). REVIEWER'S CONCLUSIONS: There is evidence to favour SCS over standard conservative treatment to improve limb salvage and clinical situation in patients with NR-CCLI. The benefits of SCS against the possible harm of relatively mild complications, and costs must be considered.

Amputation, Surgical↗
PubMed2001

The diagnosis of deep venous thrombosis using laser Doppler skin perfusion measurements.

Compression ultrasonography (CUS) falls short in the diagnosis of deep venous thrombosis in asymptomatic patients and thrombi limited to the calf veins. Alternatively, laser Doppler fluxmetry (LDF) may be useful for this purpose, as it can measure the peripheral vasoconstriction response upon an increase in venous pressure, which is hypothetically preactivated upon venous damming by a thrombus. We investigated the merits of LDF in the diagnosis of DVT. In 81 outpatients, referred with clinically suspected unilateral DVT, skin perfusion in the symptomatic and contralateral legs was measured in the big toe by measuring resting flux (RF) before and during an increase in venous pressure by inflating an ankle cuff to 50 mm Hg. The percentage of LDF reduction (LDFr) was used as a parameter to detect DVT and compared with an independent gold standard (a combination of CUS, D-dimer testing, and 3-month clinical follow-up). The prevalence of DVT was 31%. LDFr in symptomatic legs with DVT [24%; interquartile range (IQR) 8-44%] was significantly (P < 0.001) lower than in symptomatic legs without DVT (60%; IQR 44-70%). Assessment of the diagnostic accuracy of LDF yielded an area under the ROC curve of 0.79. The optimum cutoff value resulted in a sensitivity and a specificity of 80 and 72%, respectively. LDFr is reduced in legs with DVT, supporting the hypothesis of preactivation of the peripheral vasoconstriction response. The diagnostic value of LDF measurements is not likely to surpass that of CUS in symptomatic patients, but may be of additional use in situations where CUS is less sensitive.

Aged↗
PubMed2001

The results of spinal cord stimulation in critical limb ischaemia: a review.

OBJECTIVES: to determine which patients with unreconstructible critical limb ischaemia (CLI) might benefit from spinal cord stimulation (SCS). METHODS: literature review. RESULTS: limb salvage in patients with an intermediate transcutaneous oxygen pressure (TcpO2) was not significantly higher with SCS (76%) than with conservative therapy (p=0.08). However, a limb salvage of 88% was achieved with SCS if the difference between the supine and sitting TcpO2 baseline values (DeltaTcpO2) was > or =15 mmHg. A rise in TcpO2 after trial stimulation of at least 15% resulted in a limb salvage of 77% at 18 months (p<0.01). CONCLUSION: randomised studies show no benefit of SCS over conservative therapy in patients with non-reconstructible CLI. However, data from experimental and non-randomised studies suggest this may be due to sub-optimal patient selection for SCS. Further trials are needed to identify subgroups who may benefit from SCS.

Algorithms↗
PubMed2001

The value of the peak systolic velocity ratio in the assessment of the haemodynamic significance of subcritical iliac artery stenoses.

OBJECTIVES: iliac stenoses with a PSV ratio between 2.0 and 3.0 in patients with symptomatic arterial obstructive disease of the legs might be misinterpreted when compared with intra-arterial pressure measurements (IAPM). The aim of this study was to compare the value of the PSV ratio with IAPM as the reference standard in the assessment of the haemodynamic significance of subcritical iliac artery stenoses (iliac stenosis with PSV ratio between 1.5 and 3.5). DESIGN, PATIENTS AND METHODS: fifty-eight iliac tracts in 53 consecutive patients with symptomatic arterial obstructive disease of the legs with an isolated stenosis with PSV ratio between 1.5 and 3.5 were studied prospectively. The results of those iliac duplex scanning were compared to IAPM. Results a poor agreement was found between IAPM and PSV ratios. For the PSV ratios > or =2.0, 2.5 and 3.0 the sensitivities were 74%, 37% and 16%, respectively. The specificities were 70%, 90% and 95%, the positive predictive values 82%, 88% and 86%, respectively, and the negative predictive values 58%, 43% and 37%, respectively. CONCLUSION: the results of this study show that the PSV ratio parameter is not accurate enough to evaluate the haemodynamic significance of subcritical iliac artery stenoses.

Adult↗
PubMed2001

Interobserver and intraobserver reproducibility of peripheral blood and oxygen pressure measurements in the assessment of lower extremity arterial disease.

INTRODUCTION: Peripheral blood pressure measurements play a prominent role in the diagnosis and follow-up of patients with peripheral vascular diseases. Toe pressure of the hallux (TP1) and second toe (TP2) and transcutaneous oxygen pressure (TCPO2) measurements are becoming more important. The ankle/brachial pressure index (ABPI) is known to be a reliable parameter, but the toe pressure and TCPO2 are evaluated less thoroughly. Therefore, we evaluated the reproducibility of TP1, TP2, TCPO2, ABPI, ankle pressure (AP), and brachial pressure (BP). PATIENTS AND METHODS: In 54 patients with various stages of peripheral vascular disease, the intraobserver and interobserver reproducibility of BP, AP, ABPI, TP1, TP2, and TCPO2 was investigated by calculating the repeatability coefficient (RC) and the intraclass correlation coefficient (ICC) and by using Bland-Altman plots. RESULTS: The intraobserver and interobserver reproducibility at 1 day and after 1 week of BP, AP, ABPI, and TP1 was substantial and comparable (ICC range, 0.80-0.99), except for the BP after 1 week. The TP2 and TCPO2 were less reproducible (ICC range, 0.62-0.98). The interobserver RC of BP was 31 mm Hg; of AP, 44 mm Hg; of ABPI, 27%; of TP1, 41 mm Hg; of TP2, 67 mm Hg; and of TCPO2; 30 mm Hg. The difference plot showed that the observer variability was equally distributed across the range of pressure in all measurements. CONCLUSION: The BP, AP, ABPI, and TP1 have a substantial intraobserver and interobserver reproducibility, whereas TP2 and TCPO2 show worse reproducibility. Especially when low values (or values around a cutoff value) are measured, the RC should be taken into account, and repetition of the measurement is advocated.

Aged↗
PubMed2001

Interobserver variability in aortoiliac and femoropopliteal duplex scanning.

PURPOSE: The interobserver variability of aortoiliac and femoropopliteal duplex scanning in peripheral arterial occlusive disease was assessed. METHODS: Two experienced, independent vascular technologists investigated in random order 61 consecutive patients sent to the vascular laboratory for investigation of the aortoiliac or femoropopliteal arteries. In each aortoiliac vessel segment, the proximal, mid, and distal peak systolic velocities (PSVs) were measured, and corresponding PSV ratios were calculated. The superficial femoral artery was divided in 10-cm segments with a roll-centimeter taped from the upper patella margin. Interclass correlation coefficients (ICCs) were calculated as a means of appreciating the measurement variability of the PSV ratio values as a continuous variable and the Kappa value for the PSV ratio categories of less than 2.0, 2.0 through 3.0, more than 3.0, and occlusions. RESULTS: The overall ICC and Kappa values were 0.72 (95% CI, 0.63-0.79) and 0.53 for the aortoiliac tract and 0.85 (95% CI, 0.79-0.89) and 0.73 for the femoropopliteal tract. Agreement in the PSV ratio categories was 85% in the aortoiliac and 87% in the femoropopliteal tract. Interobserver variation increased markedly with increasing PSV ratio. In the PSV ratio category between 2.0 to 3.0, indicating a borderline stenosis, a substantial disagreement was found (aortoiliac, 1 of 8 agreement; femoropopliteal, 2 of 8 agreement). CONCLUSION: A moderate interobserver agreement was found in the duplex investigation of the aortoiliac and femoropopliteal arteries. One should be aware of this in clinical decision making, especially in cases of borderline stenoses. In these cases, repetition of the measurement or additional diagnostics is advocated.

Aorta, Abdominal↗
PubMed2001

Impaired vascular function in women with pre-eclampsia observed with orthogonal polarisation spectral imaging.

OBJECTIVE: To investigate in vivo the function of the microcirculation of the skin in pregnancy and pregnancy complicated with pre-eclampsia. DESIGN: Case-control study. SETTING: Academic Medical Centre. PARTICIPANTS: A group of 10 women with pre-eclampsia and a healthy control group of 10 pregnant women. METHODS: The microcirculation of the skin of the finger at rest and during venous occlusion was studied with laser Doppler fluxmetry and orthogonal polarisation spectral imaging. By inflating a cuff around the upper arm to a pressure of 50 mmHg, causing venous occlusion, the local sympathetic veno-arteriolar reflex was provoked. With laser Doppler fluxmetry the blood flow of the skin at a depth of 1-2mm was measured at rest and during venous occlusion. Orthogonal polarisation spectral imaging was used to assess red blood cell velocity at rest and during venous occlusion of the nutritive capillaries of the skin. RESULTS: Laser Doppler fluxmetry showed no significant difference between the normotensive group and the group with pre-eclampsia. Using orthogonal polarisation spectral imaging, venous occlusion produced a significantly greater decrease in red blood cell velocity in the control group than in the women with pre-eclampsia: (84% (81-88)(median and interquartile range) vs 58% (45-88), P = 0.0029). No differences in absolute red blood cell velocities were observed between groups either at rest or during venous occlusion. CONCLUSION: This study shows an impaired local veno-arteriolar reflex in pre-eclampsia at the nutritive, but not at the therrmoregulatory, level of the microcirculation of the skin.

Adult↗
PubMed2001

Comparison of OPS imaging and conventional capillary microscopy to study the human microcirculation.

Orthogonal polarization spectral (OPS) imaging is a new clinical technique for observation of the microcirculation of organ surfaces. For validation purposes, we compared OPS images of the nailfold skin with those obtained from conventional capillary microscopy at rest and during venous occlusion in 10 male volunteers. These images were computer analyzed to provide red blood cell velocity and capillary diameters of the same nailfold capillaries at rest and during venous occlusion. Results showed that OPS images provided similar values for red blood cell velocity and capillary diameter as those obtained from capillary microscopy images. OPS imaging, however, provided significantly better image quality, as shown by comparison of image contrast between OPS imaging and capillary microscopy. This made image analysis better and easier to perform. It is anticipated, therefore, that OPS imaging will become a new and powerful technique in the study of the human microcirculation in vivo because it can be used on human internal organs.

Adult↗
PubMed2000

Effects of vacuum compression therapy on skin microcirculation in patients suffering from lower limb ischaemia.

BACKGROUND: We investigated the short-term effect of vacuum compression (VC) treatment on skin microcirculatory perfusion in the foot of patients with lower limb ischaemia and healthy controls. PATIENTS AND METHODS: Ten patients with intermittent claudication or rest pain and 5 healthy controls underwent vacuum-compression treatment for half an hour. The leg was positioned in an air-tight plexiglass cylinder in which hypobaric (-115 mm Hg) and hyperbaric (75 mm Hg) pressure could be generated alternately, in order to improve peripheral circulation. The effect on skin microcirculation was investigated using nailfold capillary microscopy (measuring nutritive perfusion), laser Doppler fluxmetry (LDF) (total skin perfusion) and transcutaneous oxygen tension measurements (TcpO2). RESULTS: A few patients experienced ischaemic symptoms during VC, probably because the leg was pinched off through inflation of the cuff. In both patients and controls capillary microscopic parameters did not change significantly. In some cases, microcirculatory perfusion decreased because the leg had cooled during the treatment. Application of a heating matrass annihilated this effect. Only in the patient group a few LDF- and TcpO2 parameters improved slightly, but significantly. CONCLUSION: Vacuum-compression therapy only slightly improves total skin perfusion and oxygenation, but not the nutritive microcirculation, being an essential factor in the occurrence of ischaemic symptoms. We therefore conclude that this instrument in its present form is not an aid in the treatment of lower limb ischaemia.

Aged↗