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  • Title: [Acral skin circulation following intra-arterial infusion of vasodilating substances in patients with intermittent claudication].
    Author: Scheffler A, Rieger H.
    Journal: Med Klin (Munich); 1990 Jan 15; 85(1):1-5. PubMed ID: 2314351.
    Abstract:
    The value of vasodilator drugs for the conservative treatment of peripheral arterial occlusive disease is widely questioned because clinical and experimental studies have shown paradoxical redistribution phenomena of blood flow in disfavour of an already ischemic peripheral circulation. This paper deals with acute effects of intraarterially infused prostaglandin E1 and buflomedil on the overall foot sole perfusion as well as its distribution patterns. Measurements were performed in patients with sufficiently compensated obstructions of the superficial femoral artery by means of dynamic fluorescein angiography. After i.a. infusion in general an increase of the total blood supply to the feet was found. However, in response to this common vasodilator effect in some patients apparently non-perfused circumscribed skin areas occurred which could never be observed under control conditions. With respect to these results the clinical value of vasodilator drugs as well as the meaning of such adverse redistribution phenomena are discussed from a pathophysiological and pharmacodynamical point of view. It is proposed that the therapeutical concept of pharmacological vasodilation should not be rejected in general. However, special attention should be paid to the development of steal effects.
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