Short communication Effects of upper-limb exercise on lower-limb cutaneous microvascular function in post-surgical varicose-vein patients

Regular walking exercise attenuates lower-limb cutaneous microvascular endothelial dysfunction in post-surgical varicose-vein patients. This study assessed the effects of upper-limb exercise training on lower-limb cutaneous microvascular function in this patient group. Six post-surgical (4-5 weeks) varicose-vein patients completed an 8-week arm-crank exercise training programme. Changes in cutaneous microvascular function of the lower leg were assessed using laser Doppler flowmetry and iontophoretic administration of endothelial-dependent and -independent agonists (acetylcholine [ACh] and sodium nitroprusside [SNP], respectively). At eight weeks, median lower-limb cutaneous vasodilator responsives to ACh and SNP remained unchanged relative to baseline (e.g. 6 mC: 37 (interquartile range, 24-63) vs 40 (20-71) PU and 35 (23-48) vs 38 (21-64) PU respectively for the supine position). Upper-limb exercise appears ineffective for improving lower-limb cutaneous microvascular function in post-surgical varicose-vein patients. Therefore, limb specificity appears an important factor in optimal exercise prescription for these patients. Introduction Chronic venous disease is a common cause of lower-limb ulceration (Iabichella et al. 2006). Several factors might affect tissue viability and susceptibility to ulceration, but the structural and functional integrity of the microcirculation to maintain blood flow, tissue oxygenation, and nutrient delivery might be particularly important (Iabichella et al. 2006). Indeed, microcirculatory impairment is involved in all the hypotheses on ulcer pathophysiology (Iabichella et al. 2006), the trophic tissue damage caused by vein insufficiency is preceded by the development of microvascular abnormalities (Iabichella et al. 2006), and skin microvascular abnormalities are a risk factor for chronic ulceration in patients with varicose veins but no history of venous ulcer (Robertson et al. 2009). Therefore, assessment of cutaneous microvascular function in patients with mild-to-moderate venous disease might be useful for identifying those at high risk of venous ulceration. It might also be useful for assessing ulcer risk in patients who have recently had varicose-vein surgery, given that approximately 20% of patients with spontaneous ulcers have previously had varicose-vein surgery (Kulkarni et al. 2008). In recent years, we studied lower-limb cutaneous microvascular function in patients being treated for lower-limb varicosities (Klonizakis et al. 2003, 2009a) using laser Doppler flowmetry