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PubMedDate not supplied

Capillaroscopic observations in childhood rheumatic diseases and healthy controls.

OBJECTIVE: To describe, by using video nailfold capillaroscopy (NFC), microvascular abnormalities in children with rheumatic diseases and to evaluate the capillary changes over a follow up period. METHODS: 118 children suffering from rheumatic diseases: 55 juvenile idiopathic arthritis (JIA), 7 mixed connective tissue disease (MCTD), 6 primary Raynaud's phenomenon (PRP), 34 systemic lupus erythematosus (SLE), 8 juvenile systemic sclerosis (JSSc) and 8 juvenile dermatomyositis (JDM) were included in the study. Patients with major capillaries abnormalities or scleroderma pattern were followed up for at least 12 months. 70 age- and sex-matched healthy controls (HC) were also examined. RESULTS: In HC there was a significant correlation between age and capillary length (p = 0.001). JIA patients showed capillary number, size, shape and arrangement similar to HC. Minor abnormalities were frequently observed. The percentage of major abnormalities were significantly increased compared to HC in MCTD (p = 0.008), SLE (p = 0.0002) and JDM patients (p < 0.0001). 5/8 of JSSc had a scleroderma pattern from the onset of the disease. The serial observations in connective tissue diseases also showed that the evolution of capillaroscopic pattern was not unidirectional. In fact, in some nailfolds there was an increase in capillary loss and in avascular areas, whereas sometimes it remained stable on repeated examination. CONCLUSION: NFC can be used as a simple, inexpensive, non-invasive method to evaluate the microvascular abnormalities in childhood rheumatic conditions, and it may be useful in early recognition and monitoring scleroderma spectrum disorders.

Adult↗
PubMedDate not supplied

[Investigation into microcirculation in the vascular bed of healthy people and patients at rest and during the LBNP test].

Computer capillaroscopy during the lower body pressure test (LBNP) provided additional information about the effects of orthostasis on blood microcirculation and separate estimation of blood velocity in arterial, intermediate and venous segments of capillaries. Microcirculation was demonstrated to be sensitive to the LBNP exposure as in healthy volunteered subjects, so in ischemic, including hypertensive, patients. The highest velocity of capillary blood and the lowest Kv were determined in ischemic patients including hypertensive, in whom venous velocity in capillaries prevailed over arterial (Kv < 1), whereas in healthy subjects Kv never fell below 1. 09. Results of the comparative investigations of blood microcirculation in healthy people and patients with various cardiovascular problems can be used in clinical and space medicine for assessment of the CVS functioning and orthostatic tolerance.

Adult↗
PubMed2006

Noninvasive assessment of cutaneous vascular function in vivo using capillaroscopy, plethysmography and laser-Doppler instruments: its strengths and weaknesses.

Given that functional abnormalities of the microcirculation are one of the primary abnormalities in cardiovascular disease pathogenesis, various noninvasive clinical tools have been developed recently to assess the microvascular function, particularly at the skin. The common techniques used to assess cutaneous microvascular function in vivo include capillaroscopy, venous occlusion plethysmography, and laser-Doppler instruments (laser-Doppler fluximetry and laser-Doppler imaging). These noninvasive techniques can be used as an early measure of functional abnormalities within the microvascular tree, predominantly in population at high risk for cardiovascular events. This review discusses some underlying application principle of these techniques, including its clinical significance, method reproducibility and limitations.

Cardiovascular Diseases↗
PubMed1993

Saphenous vein angioscopy: a valuable method to detect unsuspected venous disease.

PURPOSE: The presence of preexisting saphenous vein lesions adversely affects graft patency. Despite careful preoperative venous duplex examination and meticulous intraoperative evaluation, clinically significant saphenous vein disease may remain undetected. We evaluated angioscopy as a means to better detect these vein lesions. METHODS: Ninety saphenous vein remnants, obtained at bypass surgery, were perfusion fixed for subsequent angioscopic and histologic evaluation. The specimens were categorized by independent examiners on the basis of the angioscopic or light microscopic findings. Of the 90 vein remnants, 66 were normal by angioscopic criteria. Fifty-three (80%) of these angioscopically normal vein segments were normal histologically, and all 24 angioscopically abnormal saphenous vein remnants showed disease on microscopic examination. RESULTS: Angioscopy correctly identified sclerotic vein segments (n = 20) by irregular white plaques, whereas postphlebitic veins (n = 3) demonstrated multiple lumens, fibrous strands, and thickened opaque valve cusps on angioscopic evaluation. Absence of an angioscopic lumen was confirmed histologically in occluded veins (n = 2). Angioscopy failed to identify thick-walled (n = 10) and varicose (n = 2) vein segments as abnormal; one sclerotic segment was normal angioscopically, thereby lowering the sensitivity of angioscopy. CONCLUSIONS: Angioscopy detected unsuspected preexisting saphenous vein disease in five patients undergoing arterial reconstruction with saphenous vein. Because the use of angioscopy is a reliable means of prospectively assessing the vein for most preexisting lesions, its routine use may ultimately improve graft patency.

Angioscopy↗
PubMed1994

[Comparison of the value of angioscopy, angiography and ultrasonography in detection of pathologic vascular processes].

AIMS: The ability of angioscopy, angiography and sonography to evaluate arteriosclerotic vascular lesions were compared to determine if angioscopy is a valuable addition in the diagnostic armamentarium. METHODS: An in-vitro study was selected to enable microscopic assessment of the arteries. Angiography was followed by sonography and endoscopy and finally the vessels were evaluated macro- and microscopically. RESULTS: The configuration of the vascular stenosis (plaque-shape, semicircular-eccentric, circular-concentric) was more reliably defined with angioscopy as compared to angiography and sonography. Intense calcification of plaque was detected sonographically with a high sensitivity (90%) using the acoustic shadowing and high amplitude criteria. Angioscopy was superior in differentiating between simple and complicated plaques and the assessment of ulcerations, while the visualization of the entire vascular tree with potential collaterals remained the domain of angiography. CONCLUSIONS: Angioscopy seems to be valuable addition in the evaluation of arterial vascular disease. It can be used in the quality control after interventional radiology and surgery.

Angiography↗
PubMed1995

Angiographic, ultrasonic, and angioscopic assessment of the coronary artery wall and lumen area configuration after directional atherectomy: the mechanism revisited.

The purpose of the present study was to use the complementary information of angiography, intravascular ultrasound, and intracoronary angioscopy before and after directional atherectomy to characterize the postatherectomy appearance of vessel wall contours and the mechanism of lumen enlargement. Directional coronary atherectomy aims at debulking rather than dilating a coronary artery lesion. The selective removal of the plaque may potentially minimize the vessel wall damage and lead to subsequent better late outcome. Whether plaque removal is the main mechanism of action has only to be assessed indirectly by angiography and warrants further investigation with detailed analysis of luminal changes and vessel wall damage by ultrasound and direct visualization with angioscopy. Twenty-six patients have been investigated by quantitative angiography, intravascular ultrasound, and intracoronary angioscopy (n = 19) before and after atherectomy. In addition, all retrieved specimens were microscopically examined. Ultrasound imaging showed an increase in lumen area from 1.95 +/- 0.70 mm2 to 7.86 +/- 2.16 mm2 at atherectomy. The achieved gain mainly resulted from plaque removal because plaque plus media area decreased from 18.16 +/- 4.47 mm2 to 13.13 +/- 3.10 mm2. Vessel wall stretching (i.e., change in external elastic lamina area) accounted for only 15% of lumen area gain. Luminal gain was higher in noncalcified (6.52 +/- 2.12 mm2) lesions than in lesions containing deeply located calcium (5.19 +/- 0.99 mm2) and lowest in superficially calcified lesions (5.41 +/- 2.41 mm2). Ultrasound imaging identified an atherectomy byte in 85% of the cases, whereas angioscopy revealed such a crevice in 74%. The complementary use of the three techniques revealed an underestimation of the presence of dissection/tear and new thrombus by angiography (10% and 4%) and ultrasound imaging (12% and 0%) compared with angioscopy (26% and 21%). The combined use of angiography, ultrasound, and angioscopy reveals that the postatherectomy luminal lining is not as regular and smooth as that seen by angiography. Luminal enlargement with atherectomy is achieved by plaque excision rather than arterial expansion.

Aged↗
PubMed1991

True ablation of atheromatous plaques with laser energy. A phase I safety study.

A laser system coupling pulsed dye laser to a 2-mm fiberoptic catheter with incorporated angioscope has been developed for recanalization of occluded arteries. Nine patients with superficial femoral artery occlusions of 4.5 to 49 cm in length were operated on and the recanalized artery harvested for pathologic examination. There were two arterial perforations. The ease of recanalization was determined by plaque composition. Heavily calcified and yellow fibro-fatty lesions were rapidly removed. Smooth white fibrous lesions resisted laser ablation. Direct angioscopy often disclosed discontinuous areas of occlusion that were more susceptible to recanalization. These were not seen on preoperative arteriograms. Microscopic examination of the specimens showed a central core of ablation. There was no evidence of acute damage to the vessel wall, with intact internal elastic lamina demonstrated in the recanalized segments. It appears that fibrous lesions will require a different laser for ablation; however, the delivery/angioscope systems function satisfactorily.

Arteriosclerosis↗
PubMed2005

New device for endoscopic image display during microsurgical clipping of cerebral aneurysms--technical note--.

Endoscopy in microsurgery is most effective when a single surgeon can monitor both endoscopic and microscopic images simultaneously. However, monitoring systems of this kind, such as a contemporary microscope equipped with a picture-in-mode function, are expensive. The present display system is connected to the endoscope video camera and mounted on the surgeon's head. The liquid crystal display is positioned just under the microscope eyepieces, so reducing the need for the surgeon to refocus and redirect the gaze during surgery. This system allows nearly simultaneous endoscopic and microscopic monitoring. No changes to the surgical microscope are necessary.

Angioscopy↗
PubMed1993

Dynamic capillaroscopy: a minimally invasive technique for assessing photodynamic effects in vivo.

A noninvasive method for visualizing the microvasculature in the mouse tail is described, consisting of a custom-built microscope with through-lens illumination. The microscope is fitted with a television camera and images can be recorded on videotape and displayed on a television monitor. Blood vessels are imaged as columns of red blood cells, in which flow is clearly observed. Administration of photosensitizers and illumination with the standard light source produces no observable photodynamic effect on blood flow. The combination of photosensitizer and a more intense light source (either broadband light from a filtered mercury arc or red light from a laser) causes photodynamic cessation of flow within a few minutes. The magnitude of the effect is dependent on the dose and nature of the photosensitizer, the delay after photosensitization and the match between the laser light and the absorption spectra of the photosensitizers in the red region. We conclude that the technique yields results consistent with the known photodynamic effects of the photosensitizers in tumors and propose its use as an initial screening method in vivo, as a means of conducting pharmacokinetic experiments and as an assay of prolonged cutaneous photosensitivity.

Angioscopy↗