Intra-arterial Oxygen in Peripheral Vascular Disease

Abstract

The injection of small quantities of oxygen or of various other gases into the brachial artery of the normal subject is followed by marked vasodilatation in the hand and forearm which persists for an hour or more (Duff, Greenfield, and Whelan, 1953). This observation suggested a possible application in the treatment of patients with ischaemic disorders of the limbs. Much of the disability in these patients is a direct consequence of reduced blood flow to skin and muscle, and it was felt that if vasodilatation could be obtained comparable in degree and duration to that in normal people symptomatic benefit might result. Intra-arterial oxygen has been employed as a mode of therapy in ischaemic disorders of the lower limbs by Lemaire, Loeper, and Housset (1948); they were impressed with its effect in improving symptoms. Since then several workers in Germany (Wernitz and Dorken, 1954; M. Ratschow, personal communication, 1955;Hasse, Koble, and Linker, 1955) have claimed therapeutic benefit from intra-arterial oxygen therapy. This paper presents the results of a detailed study of circulatory changes induced by intra-arterial oxygen injections in patients with peripheral arterial disease involving upper and lower limbs. The changes are compared with those following intra-arterial injection of three potent vasodilator drugs: tolazoline (" priscol "), hydrallazine (" apresoline "), and phenyl-iso-butyl-np-hydroxy ephedrine (" dilatal "). MethodsThe investigations were carried out at a room temperature of 20-24' C. The patient rested on a couch for at least an hour before observations were made. In the case of the upper limb, injections were made into the brachial artery in the antecubital fossa; for the lower limb, they were made into the femoral artery in the groin. The limb into which the injection was made was raised slightly. A continuous infusion of 0.9% saline was maintained into the artery from a mechanically driven syringe, and the gaseous oxygen was added slowly to the stream of saline through a side-arm in the connecting tubing.On most occasions measurements of blood flow were made by the technique of venous occlusion plethysmography (Barcrdft and Edholm, 1943). The segment of limb being investigated was enclosed in a water-filled mechanically stirred plethysmograph (Greenfield, 1954), the water temperature being 31-32' C. for the hand and foot, and [34][35] inflated to a pressure of 200 mm. Hg for one minute before and during the recording of calf and forearm blood flows.After each injection of oxygen or of a vasodilator drug, blood flow records were taken at frequent intervals for one and a half to three hours. If at the end of this time the blood flow was still significantly raised further observations were made at intervals until it had returned to the resting level.On some occasions changes in the skin temperature of the foot following injection were measured by a thermo-electric junction.The dose of oxygen was 10 ml. for the upper limb and 30 ml. for the lower limb, given over a period of 10 to 15 min...

A Trial of Intra-Arterial Oxygen for the Treatment of Arterial Disease in the Legs

“…The paradoxical effect of reduction in blood flow through the foot has already been observed by Marshall and Whelan. 20 Comment has already been made of the inconsistent results found in venous occlusion plethysmography, from which we concluded this method of measurement, is unsuitable for the comparison of rather low muscle and skin blood flows particularly in fairly severely ischemic limbs, over intervals of time. It has also the disadvantage of not separating skin from calf muscle flow.…”

“…The "maximal" calf blood flow levels were unchanged on the pre-injection values. 20 It would be our opinion that there is no 3. There is good evidence that a prolonged skin hyperemia follows the use of this therapy, and it is suggested that the use of intra-arterial oxygen could best be reserved for skin lesions where the ischemic state is not rapidly progressive.…”

Comparison of the Vasodilating Effect of Tolazoline After Intra-Arterial and Intravenous Administration

“…Quantitative blood flow measurements and clinical studies after intra-arterial administration of tolazoline have shown varying results.3-5, ', 11,12,14,16 In a preliminary study' an increase of forefoot blood flow after arterial injection of tolazoline was found. The main reason for this effect was that tolazoline, contrary to other vasodilator agents, caused an increase of the systemic blood pressure, while the collateral pressure gradient and the local peripheral resistance remained virutally unchanged.…”