Regions of Arterial Stenosis and Clinical Factors Determining Transcutaneous Oxygen Tension in Patients with Peripheral Arterial Disease

Abstract

Aims: 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.J Atheroscler Thromb, 2010; 17:858-869.

No Association of Diabetic Duration or Insulin Use with the Prognosis of Critical Limb Ischemia after Endovascular Therapy

“…One year after the onset of CLI, 25% patients have died and another 25% have had the limb amputated; amputation-free survival after one year is estimated to be as low as 50%. Despite such a poor prognosis of CLI patients, its prognostic risk factors remains to be elucidated, which is in contrast to other cardiovascular diseases, including PAD other than CLI [2][3][4][5][6] . Diabetes mellitus (DM), one of the major risk factors for other cardiovascular diseases, is prevalent among the CLI population and its presence has been believed to have some association with the prognosis of CLI.…”

Transcutaneous oximetry monitoring in patients with type 2 diabetes mellitus and critical limb ischemia

“…В дальнейшем при динамическом наблюдении максимальный рост TcpO 2 наблюдался в течение 1 месяца. Объяснением таких колебаний уровня TcpO 2 после ангиопластики может служить наличие постоперационного преходящего отека стопы и голени [13,14]. Другой причиной отсроченного повышения уровня TcpO 2 , возможно, является постепенная адаптация микроциркуляторного русла к восстановленному кровотоку.…”

“…Среди клинических факторов, влияющих на TcpO 2 , ведущую роль играет артериальная гипертензия, ИБС, тяжелая инфекция на стопе, уровень креатинина, отек мягких тканей стопы [11,13]. Наибольшая ассоциация показателей транскутанной оксиметрии в нашем исследовании была выявлена у пациентов с тяжелой инфекцией мягких тканей стопы и ИБС, а также артериальной гипертензией, реперфузионным отеком конечности, креатинином сыворотки крови.…”

“…Так, известно, что проходимость подвздошных и в меньшей степени бедренной, подколенной и ЗББА определяют насыщение кислородом в проксимальной области голени. Окклюзии ПББА и малоберцовой артерии (МБА) не оказывают влияния на результаты исследования на данном уровне [13]. При оценке параметров чрескожной оксиметрии на тыле стопы в покое значения ТсрО 2 определялись в большей степени проходимостью ПББА и ТАС.…”

Resting TcPO2 levels decrease during liner wear in persons with a transtibial amputation

“…With skin warming to 43 to 44˚C and capillary dilatation in the skin for induction of arterial blood inflow, the oxygen tension in this skin region approaches the peripheral tissue arterial blood oxygen tension. This permits noninvasive evaluation of microcirculation in a local region through analysis of TcPO2 [14][15][16]. TcPO2 is commonly used as a predictor for wound healing potential in ulcer cases or for the determination of adequate amputation levels [17][18][19][20][21][22][23][24][25].…”