Medical and surgical therapy for peripheral vascular disease is designed for the most part to increase the blood supply to the affected part. It is inevitable that an increased blood flow to a portion of an extremity is supported by either an increase in cardiac output or vasoconstriction in other areas. It must always be borne in mind, therefore, that the therapeutic agents and procedures that increase blood flow to one tissue component of an extremity may cause a simultaneous decrease in blood flow in another part of the extremity. The classical clinical example of this is in the treatment of intermittent claudication. It cannot be assumed that therapeutic agents and procedures that increase skin blood flow will benefit patients with intermittent claudication. Friedlander, Silbert, and Bierman1 called attention to this fact by demonstrating that in most instances changes in calf muscle temperature did not parallel changes in skin
Reese HL, Cullen ML, Beyer FD. LOCAL SHIFTING OF BLOOD IN THE LOWER EXTREMITIES. JAMA. 1952;149(9):821–823. doi:10.1001/jama.1952.02930260023007
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