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

• Published in: Cardiovascular and interventional radiology 2011-04, Vol.34 (2), p.271-279
• Main Authors: Redlich, Ulf, Xiong, Yan Y., Pech, Maciej, Tautenhahn, Jörg, Halloul, Zuhir, Lobmann, Ralf, Adolf, Daniela, Ricke, Jens, Dudeck, Oliver
• Format: Article
• Language: English
• Subjects: Aged; Amputation - statistics & numerical data; ANEMIAS; Angioplasty - methods; ARTERIES; Blood Gas Monitoring, Transcutaneous; BLOOD VESSELS; BODY; BONE JOINTS; Cardiology; CARDIOVASCULAR DISEASES; CARDIOVASCULAR SYSTEM; Clinical Investigation; CONTAINERS; Diabetes Complications - therapy; Diabetic Foot - therapy; DISEASES; ELEMENTS; FEET; Female; HEMIC DISEASES; Humans; Imaging; ISCHEMIA; Ischemia - therapy; Leg - blood supply; LEGS; Limb Salvage - statistics & numerical data; LIMBS; Male; MATERIALS; MEDICINE; Medicine & Public Health; Middle Aged; NONMETALS; Nuclear Medicine; ORGANS; OXYGEN; Oxygen - metabolism; PATIENTS; Predictive Value of Tests; Prospective Studies; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; ROC Curve; SKELETON; SYMPTOMS; THERAPY; Tibial Arteries; Ultrasound; VASCULAR DISEASES
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-010-9968-x

Purpose To assess postprocedural angiograms, the ankle–brachial index (ABI), and transcutaneous oxygen tension (TcPO 2 ) 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 TcPO 2 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. TcPO 2 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, TcPO 2 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. TcPO 2 was a valid predictor for limb salvage, even when angiographic outcome criteria failed.