Near Infrared Spectroscopy and Toe Flexion in the Dynamic Assessment of Diabetic Foot Perfusion

Abstract

implantation of left vertebral artery onto the left carotid artery was not possible due to the unusually short cervical portion of the pre-foraminal VA due to its early entry into foramen transversarium of C7 instead of C6. It was therefore decided to proceed with left carotid to left vertebral artery and left carotico-subclavian artery bypass prior to TEVAR of the descending aorta. Methods-Using a transverse left cervical approach the left VA was dissected out as it ascended towards the foramen transversarium of C7. Using the great saphenous vein an interposition graft was raised between the left common carotid and left VA using 7/0 prolene. Intraoperative Doppler assessment confirmed satisfactory flow. An ipsilateral carotico-subclavian bypass was then performed with Dacron graft using 6/0 prolene. TEVAR was then performed with a 26 mm x100 mm C-Tag Ò stent. Results-CT angiography on the 2nd postoperative day confirmed patency of both carotico-vertebral and caroticosubclavian grafts and satisfactory placement of the TEVAR stent. The patient was noted to have a left Horner's syndrome but otherwise made an uneventful recovery. He was discharged on the 3rd postoperative day. At follow up one month later he remained well with no complications and complete resolution of Horner's syndrome. Conclusion-Patients with traumatic Aortic tears undergoing emergency TEVAR and in whom a proximal landing zone will seal the origin of an aberrant dominant left vertebral artery arising from aortic arch (proximal or distal to the LSA) should have vertebral artery revascularization prior to deployment of the TEVAR. References P-001 Near Infrared Spectroscopy and Toe Flexion in the Dynamic Assessment of Diabetic Foot Perfusion

Near infrared spectroscopy in peripheral artery disease and the diabetic foot: A systematic review

“…The toe‐flexion area, previously introduced by Manfredi et al., 22 was calculated and recorded during a 3‐min dynamic test while toes were flexed repeatedly. It differed between diabetic foot ulcer patients and non‐diabetic controls 59 . Within the six DFU patients, three healed patients had a toe‐flexion area 0.5 unit sec while non‐healed had −8.6 unit sec 59 .…”

“…Joseph et al 59 . published early results of a study with six diabetic foot ulcer (DFU) patients and three non‐DM controls recruited.…”

“…published early results of a study with six diabetic foot ulcer (DFU) patients and three non‐DM controls recruited. DFU patients and non‐DM controls demonstrated similar mean toe systolic blood pressures (119 vs. 124 mmHg) 59 . The toe‐flexion area, previously introduced by Manfredi et al., 22 was calculated and recorded during a 3‐min dynamic test while toes were flexed repeatedly.…”

“…It differed between diabetic foot ulcer patients and nondiabetic controls. 59 Within the six DFU patients, three healed patients had a toe-flexion area 0.5 unit sec while non-healed had −8.6 unit sec. 59 There was no significance testing performed in this small sample size study.…”