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Articles in PresS, published online ahead of print October 5, 2001
J Appl Physiol, 10.1152/jap.00758.2001
Submitted on July 23, 2001
Accepted on October 2, 2001
1 Anesthesiology, Mayo Clinic, Rochester, MN, USA
2 Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
3 Neurology, Mayo Clinic, Rochester, MN, USA
* To whom correspondence should be addressed. E-mail: charkoudian.nisha{at}mayo.edu.
Evidence from animal studies suggests blunted endothelium-dependent vasodilation following chronic sympathectomy, but it is not clear whether this is true in the human cutaneous circulation. In human skin, the vasodilator response to local heating includes a sensory nerve-dependent peak followed by a nadir and then a slower, nitric oxide-mediated, endothelium dependent vasodilation. To investigate whether chronic sympathectomy diminishes this endothelium-dependent vasodilation, we studied individuals (n = 9) who had previously undergone surgical sympathectomy of the upper extremities. We measured skin blood flow using laser Doppler flowmetry on the ventral forearm (no sympathetic innervation) and the lower leg (sympathetic nerves intact). Similar studies were conducted in healthy control subjects (n = 8). Local temperature was controlled over a 12 cm2 area at each site. The cutaneous vascular response to 30 minutes of local warming to 42.5 °C was assessed. Lower body negative pressure was conducted to confirm sympathetic denervation. During local warming in sympathectomized individuals, vascular conductance increased rapidly over the first 1-2 minutes at both sites [achieving 1.73 ± 0.22 laser Doppler units (LDU)/mmHg in the forearm and 1.92 ± 0.21 LDU/mmHg in the leg]. It then decreased to a nadir in the innervated leg [to 1.77 ± 0.23 LDU/mmHg (P < 0.05)], but not in the sympathectomized arm (1.69 ± 0.21 LDU/mmHg, P > 0.10). The maximal vasodilation seen during the slower phase was not different between limbs or between groups. Furthermore, LBNP caused a 44% reduction in forearm vascular conductance (FVC) in control subjects, but FVC did not decrease significantly in sympathectomized individuals, confirming sympathetic denervation. These data indicate that endothelial function in human skin is largely preserved following sympathectomy. Although the absolute extent of the vasodilation to local warming was not changed, the altered pattern of the response suggests that the nitric oxide-dependent portion may be accelerated in sympathectomized limbs.
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