Methods for Diagnostic and Surgery in Microvascular Diseases

**171**

**Chapter 11**

**Abstract**

**1. Introduction**

The Impact of Nailfold

*Vera Bernardino, Ana Rodrigues, Ana Lladó,* 

*Melissa Fernandes and António Panarra*

applied in systemic disorders with vascular involvement.

connective tissue autoimmune disorders, vasculitides

Microcirculation

Capillaroscopy in the Approach of

Nailfold capillaroscopy (NFC) is a simple, validated, and noninvasive method to assess the microcirculation, through direct visualization of the capillaries. Main patterns are classified, according to Cutolo et al., as scleroderma, further divided into early, active, or late patterns, or nonscleroderma. NFC findings include dilated loops, tortuosities, meandering or bushy capillaries, hemorrhage, or architectural distortion. NFC use has been indicated for the evaluation of Raynaud's phenomenon (RP), once it permits the distinction between primary and secondary RP. NFC results accounts for diagnostic criteria of systemic sclerosis, but they can also be useful in staging other connective tissue autoimmune diseases, like systemic lupus erythematosus, inflammatory myositis, or vasculitis. The CSURI index uses NFC for prediction of digital ulcer relapse. Recent evidence revealed NFC can also be

**Keywords:** nailfold capillaroscopy, microcirculation, Raynaud's phenomenon,

Nailfold capillaroscopy (NFC) is a noninvasive, simple, and highly sensitive technique used in the study of microcirculation, as it permits direct visualization of nailfold capillaries [1, 2]. The understanding of NFC results from years of research in Raynaud's phenomenon (RP) in rheumatic diseases. In fact, this method is a paramount tool to differentiate between primary and secondary RP and, associated with autoantibodies, contributes for an early detection of systemic autoimmune connective tissue disorders (AICTD), as microcirculation abnormalities can arise as first manifestations of these diseases [3–5]. Its importance has reached a global recognition and validation as it became a classification criterion for systemic sclerosis,

Ensuing studies have been disclosing the relationship between NFC abnormalities and some clinical syndromes or diseases, as digital ulcers, myositis, pulmonary hypertension, heart failure severity, diabetes mellitus, and arterial hypertension, among others [7–13]. Capillaroscopy can also be useful in monitoring the microvascular impact of certain drugs, as systemic vasodilators [2]. A role of NCF as a prognostic tool has been established with the Capillaroscopic Skin Ulcer Risk Index

pointing 2 out of a minimum of 9 points to perform the diagnosis [6].
