Superiority of Transcutaneous Oxygen Tension Measurements in Predicting Limb Salvage After Below-the-Knee Angioplasty: A Prospective Trial in Diabetic Patients With Critical Limb Ischemia
- 375 Downloads
To assess postprocedural angiograms, the ankle–brachial index (ABI), and transcutaneous oxygen tension (TcPO2) to predict outcome after infrageniculate angioplasty (PTA) in diabetic patients with critical limb ischemia (CLI) scheduled for amputation.
Materials and Methods
PTA was performed in 28 diabetic patients with CLI confined to infrapopliteal vessels. We recorded patency of crural vessels, including the vascular supply of the foot as well as the ABI and TcPO2 of the foot.
Technical success rate was 92.9% (n = 26), and limb-salvage rate at 12 months was 60.7% (n = 17). The number of patent straight vessels above and below the level of the malleoli increased significantly in patients avoiding amputation. Amputation was unnecessary in 88.2% (n = 15) patients when patency of at least one tibial artery was achieved. In 72.7% (n = 8) of patients, patency of the peroneal artery alone was not sufficient for limb salvage. ABI was of no predictive value for limb salvage. TcPO2 values increased significantly only in patients not requiring amputation (P = 0.015). In patients with only one tibial artery supplying the foot or only a patent peroneal artery in postprocedural angiograms, TcPO2 was capable of reliably predicting the outcome.
Below-the-knee PTA as an isolated part of therapy was effective to prevent major amputation in more than a half of diabetic patients with CLI. TcPO2 was a valid predictor for limb salvage, even when angiographic outcome criteria failed.
KeywordsAnkle–brachial index Below-the-knee angioplasty Critical limb ischemia Diabetes Major amputation Postprocedural angiogram Transcutaneous oxygen tension
Conflicts of interest
There are no conflicts of interest.
- 1.Faglia E, Clerici G, Caminiti M et al (2010) Mortality after major amputation in diabetic patients with critical limb ischemia who did and did not undergo previous peripheral revascularization: Data of a cohort study of 564 consecutive diabetic patients. J Diabetes Complications 24:265–269CrossRefPubMedGoogle Scholar
- 2.TransAtlantic Inter-Society Consensus (2000) Management of peripheral arterial disease (PAD). TransAtlantic Inter-Society Consensus (TASC). Section D: Chronic critical limb ischaemia. Eur J Vasc Endovasc Surg 19(Suppl A):144–243Google Scholar
- 4.Ameli FM, Byrne P, Provan JL (1989) Selection of amputation level and prediction of healing using transcutaneous tissue oxygen tension (PtcO2). J Cardiovasc Surg (Torino) 30:220–224Google Scholar
- 7.Faglia E, Dalla PL, Clerici G et al (2003) Peripheral angioplasty as the first-choice revascularization procedure in diabetic patients with critical limb ischemia: prospective study of 993 consecutive patients hospitalized and followed between 1999 and 2003. Eur J Vasc Endovasc Surg 29:620–627CrossRefGoogle Scholar
- 14.Misuri A, Lucertini G, Nanni A et al (2000) Predictive value of transcutaneous oximetry for selection of the amputation level. J Cardiovasc Surg (Torino) 41:83–87Google Scholar
- 17.Manzi M, Fusaro M, Ceccacci T et al (2009) Clinical results of below-the knee intervention using pedal-plantar loop technique for the revascularization of foot arteries. J Cardiovasc Surg (Torino) 50:331–337Google Scholar
- 18.Markose G, Bolia A (2009) Below the knee angioplasty among diabetic patients. J Cardiovasc Surg (Torino) 50:323–329Google Scholar
- 24.Schwarzwalder U, Zeller T (2009) Below-the-knee revascularization. Advanced techniques. J Cardiovasc Surg (Torino) 50:627–634Google Scholar
- 25.Gandini R, Volpi T, Pampana E et al (2009) Applicability and clinical results of percutaneous transluminal angioplasty with a novel, long, conically shaped balloon dedicated for below-the knee interventions. J Cardiovasc Surg (Torino) 50:365–371Google Scholar
- 31.Bakal CW, Sprayregen S, Scheinbaum K et al (1990) Percutaneous transluminal angioplasty of the infrapopliteal arteries: results in 53 patients. Am J Roentgenol 154:171–174Google Scholar