Assessment of peripheral vascular disease by postocclusive transcutaneous oxygen recovery time (original) (raw)
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The British Journal of Radiology, 2015
To evaluate the superiority of transcutaneous oxygen pressure (TcPO 2) before, during and after peripheral transluminal angioplasty (PTA) in comparison with ankle brachial index (ABI) in patients with diabetes. Methods: 40 consecutive patients with diabetes treated by PTA where included. This study shows results before, during and after PTA and their progression for 8 weeks. Results: The TcPO 2 increased from 28.11 6 8.1 to 48.03 6 8.4 mmHg, 8 weeks after PTA (p , 0.001). The ABI increased from 0.48 6 0.38 to 0.77 6 0.39 after PTA (p , 0.001). After PTA, the stenosis of the vessel decreased from 58.33 6 20.07% to 21.87 6 13.57% (p , 0.001). TcPO 2 was determined in all the patients, but ABI could not be determined in all patients. Furthermore, we determined patients with "false negatives" with an improvement in ABI and "false positives" in 12.5% of patients. Additionally, in this study, we monitored TcPO 2 while performing PTA, revealing variations in each phase of the radiological procedure. Conclusion: The increase in TcPO 2 measurements following PTA procedure has more specificity and sensitivity than does ABI. The use of TcPO 2 may represent a more accurate alternative than traditional methods (ABI) used in assessing PTA results. The TcPO 2 also allows the radiologist to assess changes in tissue oxygenation during PTA, allowing changes to the procedure and subsequent treatment. Advances in knowledge: This is the first time that a graph is shown with TcPO 2 results during PTA performance in many patients.
Noninvasive evaluation of peripheral vascular disease using transcutaneous oxygen tension
The American Journal of Surgery, 1982
Excessive morbidity and mortality are associated with wound breakdown in ischemic tissues after vascular reconstruction and amputation [I]. Doppler pressure measurements [2], pulse volume recording [3], thermography [4], skin perfusion [5], and xenon-131 clearance [6] have been used to assess wound healing potential and quantitate skin blood flow. Arteriography remains the standard for determining the distribution of vascular lesions, but it does not quantitate local tissue perfusion. This report describes the use of a transcutaneous partial pressure of oxygen (PtcOs) monitoring electrode (Tcomette,
Journal of Vascular Surgery, 1996
Purpose:Although pressure measurements are useful in the assessment of the severity of the arterial obstruction, they do not completely identify limbs with and without critical limb ischemia. Our objective was to test whether addition of the measurements of toe pulse waves (PW), which depend on distal perfusion, to pressure measurements could improve the determination of the severity o£ arterial disease and the presence of critical limb ischemia. Methods:We measured toe pressure (TSP) and ankle/brachial index (ABI) and recorded PW with photoplethysmography in 358 limbs of 182 patients. Results: TSP, ABI, and PW amplitude were lower in 67 limbs with rest pain, skin lesions, or both, with mean differences of 29 mm Hg, 0.12, and 16 mm, respectively ( p < 0.01). Similarly, in the subgroup of 107 limbs with TSP <30 mm Hg, TSP, and PW amplitude, but not ABI, were lower in 53 limbs with rest pain, skin lesions, or both, with mean differences of 10 mm H g and 7 mm ( p < 0.01). Multiple logistic regression showed that after controlling was done for TSP and ABI, the odds ratio for the presence of rest pain, skin lesions, or both associated with PW amplitude <4 mm was 4.3 (95% confidence interval 1.7, 11.0; p < 0.01). In the subgroup with TSP _<30 mm Hg, this odds ratio was 3.5 (95% confidence interval 1.0, 11.6; p < 0.05).
Journal of Atherosclerosis and Thrombosis, 2010
Despite the clinical usefulness of transcutaneous oxygen tension (TcPO2) to assess the severity of limb ischemia, the factors determining TcPO2 in patients with peripheral arterial disease (PAD) have not been fully clarified. We therefore examined the regions of arterial stenosis and clinical factors affecting lower-extremity TcPO2. Methods: Resting TcPO2 (REST-TcPO2) and postexercise TcPO2 (Ex-TcPO2) in the calf region and the dorsalis pedis were measured simultaneously in 66 patients (132 limbs) with clinically suspected PAD, in whom angiography was also performed. Results: The peripheral arteries of the lower extremities were divided into five segments, and the impact of significant stenosis in each segment on ipsilateral TcPO2 was evaluated by multiple regression analysis. In the calf region, significant stenosis of the proximal arteries (common-external iliac artery) revealed stronger involvement determining Ex-TcPO2 than the peripheral segment (posterior tibial artery). In the dorsalis pedis, the peripheral segment (anterior tibial artery) more strongly determined Ex-TcPO2 and REST-TcPO2 than proximal segments. Age, creatinine, and diabetes were associated with REST-TcPO2 of the calf region independent of arterial stenoses, while those of the dorsalis pedis were independently associated with age, and creatinine. In contrast, Ex-TcPO2 in both regions was not independently associated with clinical factors, except for stenosis of the perfusing arteries. Conclusion: The vascular lesions affecting TcPO2 differ between the calf region (proximal peripheral) and the dorsalis pedis (proximal peripheral). In addition postexercise TcPO2 is solely determined by stenosis of the perfusing arteries, while TcPO2 at rest is affected by multiple clinical factors.
BMC Cardiovascular Disorders, 2014
Background: Intermittent pneumatic compression (IPC) improves haemodynamics in peripheral arterial disease (PAD), but its effects on foot perfusion were scarcely studied. In severe PAD patients we measured the foot oxygenation changes evoked by a novel intermittent IPC device (GP), haemodynamics and compliance to the treatment. Reference values were obtained by a sequential foot-calf device (SFC). Methods: Twenty ischemic limbs (Ankle-Brachial Index = 0.5 ± 0.2) of 12 PAD patients (7 male, age: 74.5 ± 10.8 y) with an interval of 48 ± 2 hours received a 35 minute treatment in supine position with two IPC devices: i) a Gradient Pump (GP), which slowly inflates a single thigh special sleeve and ii) an SFC (ArtAssist®, ACI Medical, San Marcos, CA, USA), which rapidly inflates two foot-calf sleeves. Main outcome measure: changes of oxygenated haemoglobin at foot (HbO 2foot ) by continuous near-infrared spectroscopy recording and quantified as area-under-curve (AUC) for periods of 5 minutes. Other measures: haemodynamics by echo-colour Doppler (time average velocity (TAV) and blood flow (BF) in the popliteal artery and in the femoral vein), patient compliance by a properly developed form.
Preamputation evaluation of limb perfusion with laser Doppler imaging and transcutaneous gases
The Journal of Rehabilitation Research and Development, 2006
We studied 31 subjects with severe leg ischemia and 29 age-matched nonischemic control subjects to compare preamputation assessments of leg ischemia using laser Doppler imaging (LDI), transcutaneous partial pressure of oxygen (TcPO 2 ), and transcutaneous partial pressure of carbon dioxide (TcPCO 2 ). TcPO 2 and TcPCO 2 were evaluated with Novametrix Medical Systems, Inc, monitors (Wallingford, Connecticut) and perfusion (flux) of skin topically heated to 44°C, and adjacent nonheated areas were evaluated with a Moor Laser Doppler Imager (Moor Instruments, Ltd; Devon, England). LDI flux of heated areas, its ratio to nonheated areas, and TcPO 2 (not TcPCO 2 ) were lower in ischemic subjects than in control subjects. LDI flux ratio performed better than TcPO 2 in identifying ischemia, with fewer false positive and false negative results. Moreover, LDI flux of heated skin detected a proximal to a distal gradient of perfusion in ischemic subjects, while TcPO 2 did not. LDI was superior to TcPO 2 in discriminating correctly between ischemic and nonischemic skin. The results suggest that an LDI ratio below 5 indicates nonviable skin.
The value of non-invasive techniques for the assessment of critical limb ischaemia
European Journal of Vascular and Endovascular Surgery, 1997
Objective: The European Consensus Document (ECD) defines critical ischaemia (CI) according to clinical (Fontaine) and blood pressure parameters. However, clinical symptoms may be non-specific and CI may exist without severely reduced blood pressures. This study prospectively investigated the additive value of transcutaneous oxygen tension (p02) and toe blood pressure measurements to assess the presence of CI. Methods: Forty-nine patients with 65 legs clinically classified as Fontaine stages III (n=23) and IV (n=26) were studied. Ankle and toe systolic blood pressures and p02 were measured to assess the presence of CI (cut-off values were 50, 30 and 30 mmHg, respectively). The surgeon was blinded for the toe pressure and p02 results. The treatment received within I month after presentation was recorded as being either conservative or invasive (vascular surgery o1" PTA). Results: An ankle pressure of <~50 mmHg classified only 17% of the legs as having CI. By adding toe pressure and p02, significantly more legs (63%; p<O.O001) were classified as CL of which 68% received invasive therapy. Forty-nine percent of the legs with an ankle pressure >50 mmHg were treated invasively, whereas only 32% of the legs classified as not having CI by means of toe pressure and p02 underwent invasive therapy. If the need for invasive treatment is used as the "gold standard" for the presence of CL 54% of the legs would accurately be classified on the basis of the ankle blood pressure. The combination of toe pressure and p02 would have yielded 71% and the ECD criteria 72% accurately classified legs. The odds ratio for invasive therapy given a p02 or toe pressure above the cut-off value was 14. Conclusion: Ankle blood pressure measurements have limited diagnostic value. Adding toe and~or oxygen pressures enhances the detection of CI requiring invasive therapy.
Acta Radiologica, 2010
Background: In recent years, the use of peripheral transluminal angioplasty (PTA) procedures for revascularization of an ischemic limb has increased. Evaluation of reperfusion has been carried out by Doppler scan; however, a successful PTA does not necessarily result in improved oxygen delivery to the distal parts of the limb. Purpose: To evaluate the efficacy of the revascularization in diabetic patients with critical limb ischemia after treatment with PTA by comparing transcutaneous oxygen tension (TcpO2) with the ankle-brachial index (ABI) post PTA. Material and Methods: This prospective study included 151 consecutive diabetic patients. We evaluated the posterior tibial and dorsalis pedis Doppler, ABI, TcpO2, and duplex scan results. If two of these four examinations were abnormal, arteriography was carried out and PTA was performed concomitantly. At least 64 patients were considered suitable candidates for PTA. Results: The ABI increased from 0.67±0.25 to 0.84±0.25 following PTA...