Microvascular Dysfunction in Peripheral Artery Disease: Is Heat Therapy a Viable Treatment?
Open Access
- 1 March 2021
- journal article
- review article
- Published by MDPI AG in International Journal of Environmental Research and Public Health
- Vol. 18 (5), 2384
- https://doi.org/10.3390/ijerph18052384
Abstract
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.Keywords
Funding Information
- National Institutes of Health COBRE Pilot Grant (P20GM109090, ID #3444)
- NASA Nebraska Space Grant (N/A)
This publication has 50 references indexed in Scilit:
- Impaired Vascular Endothelial Growth Factor A and Inflammation in Patients With Peripheral Artery DiseaseAngiology, 2013
- Endothelial Dysfunction in the Apolipoprotein E-deficient Mouse: insights into the influence of diet, gender and agingLipids in Health and Disease, 2011
- Lower Extremity Nerve Function, Calf Skeletal Muscle Characteristics, and Functional Performance in Peripheral Arterial DiseaseJournal of the American Geriatrics Society, 2011
- Marvels, Mysteries, and Misconceptions of Vascular Compensation to Peripheral Artery OcclusionMicrocirculation, 2010
- Lower Extremity Nerve Function in Patients With Lower Extremity IschemiaArchives of Internal Medicine, 2006
- Dynamic autoregulation of cutaneous circulation: differential control in glabrous versus nonglabrous skinAmerican Journal of Physiology-Heart and Circulatory Physiology, 2005
- Marriage of resistance and conduit arteries breeds critical limb ischemiaAmerican Journal of Physiology-Heart and Circulatory Physiology, 2005
- The Cutaneous MicrocirculationJournal of Investigative Dermatology Symposium Proceedings, 2000
- ULTRASTRUCTURE OF THE HUMAN DERMAL MICROCIRCULATIONJournal of Investigative Dermatology, 1977
- Ultrastructure Of The Human Dermal Microcirculation: The Horizontal Plexus Of The Papillary DermisJournal of Investigative Dermatology, 1976