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Notes: venoarterial reflex (VAR) restricts arterial inflow, and avoids an excessive rise in capillary pressure. This study tests the hypothesis that there is microcirculatory compensation to atherosclerotic disease of increasing severity. Foot skin perfusion (FSP) was measured in 100 limbs with a laser Doppler placed on the plantar aspect of the great toe. Limbs were categorized as normal (n= 31) with an ankle brackial index (ABI) ≥ 0.96, claudicants (n= 42) ABI 0.5–0.86, and critical ischemia (n= 27) with an ABI 〈*leq〉 0.49 or a pulse volume recording consistent with severe peripheral vascular disease and symptoms of rest pain or tissue loss. Segmental Doppler pressures and pulse volume recordings were performed prior to laser Doppler measurements. Subjects with clinical signs or symptoms of chronic venous insufficiency were excluded. The resting foot skin perfusion was measured in the horizontal and dependent position, with the patient supine and sitting. Comparisons within categories were done using Wilcoxon matched pairs signed rank test and between groups with Mann–Whitney U test for unpaired data. Differences were considered significant if they exceeded the 95% confidence level (p value 〈*leq〉0.05). Resting supine skin perfusion was similar between nondiabetic normals and claudicants and diabetic normals and claudicants. There was a significant decrease in the foot skin perfusion (mean FSP ± SEM) in the normal limb with a change from the supine (7.8 ± 2.2 ml/min/100 g) to the dependent (2.8 ± 0.6 ml/min/100 g) position indicating an intact VAR. This was absent in 33% of the limbs with claudication. Limbs with critical ischemia demonstrated an increase in FSP with dependency (supine 4.0 ± 1.0 ml/min/100 g) versus dependent (8.4 ± 1.8 ml/min/100 g) and was present in both diabetic and nondiabetic limbs. Microcirculatory compensation occurs early in atherosclerotic limbs. Although supine FSP is similar in normals and claudicants, a greater percentage of claudicants demonstrate a loss of the VAR. Critically ischemic limbs have increased FSP in the dependent position. These observations indicate that there are microcirculatory alterations in limbs with claudication and assist in explaining why patients with ischemic rest pain obtain relief and develop edema with dependency.

Notes: Abstract In an attempt to eliminate the morbidity, mortality, and cost associated with arteriography, surgeons are relying increasingly on duplex scanning of the extracranial arteries as the primary preoperative evaluation prior to carotid endarterectomy (CEA). This study was initiated to evaluate the need for cerebral arteriography in the preoperative evaluation of patients for CEA. One hundred five patients undergoing 114 CEA procedures are included in a retrospective review to determine whether the addition of cerebral arteriography changed the operative management of these patients. In 58 of 105 patients (55%), color-flow duplex scanning and cerebral arteriography were performed in the workup prior to CEA. In four patients a discrepancy was found between the duplex results and the arteriogram, leading to a change in the operative approach in two. The remaining 47 patients (45%) underwent color-flow duplex scanning as the definitive preoperative study; the surgical management was altered because of the operative findings in one patient. Although color-flow duplex scanning does not provide absolute concordance with cerebral arteriography, in most instances it can be used as the definitive preoperative study prior to CEA. We define the indications for cerebral arteriography in patients undergoing CEA.

Notes: Abstract We report a case of retrograde aortic dissection after bilateral iliac artery stenting. A 63-year-old black woman underwent aortography with balloon angioplasty of bilateral common iliac artery lesions and subsequent vascular stent placement. The patient developed an acute aortic dissection from the level of the aortic bifurcation to the left subclavian artery. This case is presented to call attention to the previously unreported complication of retrograde aortic dissection after bilateral iliac artery angioplasty and stent placement presenting as acute chest pain.