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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

  • Clinical Investigation
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Abstract

Purpose

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.

Results

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.

Conclusion

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.

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Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany

    Ulf Redlich, Yan Y. Xiong, Maciej Pech, Jens Ricke & Oliver Dudeck

  2. Department of Radiology, Harz Klinikum Wernigerode, Ilsenburger Strasse 15, 38855, Wernigerode, Germany

    Ulf Redlich

  3. Department of Vascular Surgery, University of Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany

    Jörg Tautenhahn & Zuhir Halloul

  4. Department of Endocrinology, University of Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany

    Ralf Lobmann

  5. Department of Endocrinology, Diabetology, and Geriaty, Klinikum Stuttgart, Bürgerhospital, Tunzhofer Str. 14–16, 70191, Stuttgart, Germany

    Ralf Lobmann

  6. Institute of Biometry and Medical Informatics, University of Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany

    Daniela Adolf

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  1. Ulf Redlich
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  2. Yan Y. Xiong
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  9. Oliver Dudeck
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Correspondence to Oliver Dudeck.

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Redlich, U., Xiong, Y.Y., Pech, M. et al. 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. Cardiovasc Intervent Radiol 34, 271–279 (2011). https://doi.org/10.1007/s00270-010-9968-x

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