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Infrapopliteal transcatheter interventions for limb salvage in diabetic patients: importance of aggressive interventional approach and role of transcutaneous oximetry.
- Source :
-
Journal of the American College of Cardiology [J Am Coll Cardiol] 1997 Sep; Vol. 30 (3), pp. 664-9. - Publication Year :
- 1997
-
Abstract
- Objectives: This study sought to determine whether infrapopliteal transcatheter interventions can salvage ischemic limbs in diabetic patients referred for below the knee amputation at our institution.<br />Background: The value of transcatheter interventions in diabetic crural arteries is controversial. Tissue oxygen partial pressure (TCO2) levels < 40 mm Hg predict poor wound healing.<br />Methods: Percutaneous interventions were performed in 29 consecutive diabetic patients in need of limb salvage. Technical success was defined as < 20% residual vessel stenosis. Clinical success was defined as the avoidance of amputation and achievement of wound healing. At hospital discharge, patients were treated with Coumadin and aspirin. Ankle-brachial index (ABI) and TCO2 measurements were obtained before and after the intervention.<br />Results: After 12-month follow-up, six patients had presistent wounds, whereas 23 experienced wound healing. Forty of the 50 infrapopliteal arteries successfully dilated were occluded, with a mean (+/-SD) lesion length of 18.0 +/- 3.5 cm. After the procedure, TCO2 improved from 27.82 +/- 9.97 mm Hg (95% confidence interval [CI] 23.95 to 31.69) to 54.5 +/- 14.73 mm Hg (95% CI 48.79 to 60.21, p < 0.0001), whereas the ABI did not (p > 0.2). TCO2 predicted procedural and clinical success (p < 0.0182).<br />Conclusions: Infrapopliteal transcatheter interventions in diabetic patients may salvage the majority of limbs doomed to amputation. Although TCO2 measurements are valuable in predicting wound healing and success after interventions, ABI measurements are not.
- Subjects :
- Angiography
Blood Pressure
Brachial Artery physiopathology
Diabetic Foot blood
Female
Humans
Ischemia blood
Male
Middle Aged
Peripheral Vascular Diseases blood
Peripheral Vascular Diseases therapy
Prognosis
Treatment Outcome
Angioplasty, Balloon
Blood Gas Monitoring, Transcutaneous
Diabetic Foot therapy
Ischemia therapy
Leg blood supply
Popliteal Artery
Subjects
Details
- Language :
- English
- ISSN :
- 0735-1097
- Volume :
- 30
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of the American College of Cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 9283523
- Full Text :
- https://doi.org/10.1016/s0735-1097(97)00216-7