CAPILLARY MICROSCOPY IS A DIAGNOSTIC-AID IN PATIENTS WITH ACRAL ISCHEMIA

The diagnosis of peripheral ischemic diseases is a challenge to the va scular specialist, since discrimination of the different entities on c linical grounds is not always clear. Capillary microscopy is a noninva sive diagnostic technique that can visualize in particular the morphol ogy and perfusion of the digital capillaries. The authors investigated all 522 patients who were referred to the vascular laboratory over a six-year period, in an attempt to obtain more certainty about the diag nosis of their acral ischemic complaints. Patients with clinically man ifest Raynaud's phenomenon and control subjects were compared to obtai n differentiation criteria. Thus, capillary microscopy scored a sensit ivity of 67%, a specificity of 84%, and an accuracy of 81% to detect R aynaud's phenomenon. A disturbed capillary morphology was virtually pa thognomonic in Raynaud's disease secondary to systemic disorders (spec ificity 100%); the accuracy was but 74%. In 69% of the patients with c linically atypical acral ischemia, capillary microscopy yielded a diag nosis. Digital blood pressure measurements, however, appeared of no us e in the diagnosis of Raynaud's phenomenon. Hence, capillary microscop y appears to be a useful aid in the diagnosis of acral ischemic syndro mes.