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Intraprocedural Transcutaneous Oxygen Pressure and Systolic Toe Pressure Measurements During and After Endovascular Intervention in Patients with Chronic Limb Threatening Ischaemia

Gunnarsson, Thordur LU ; Lindgren, Hans LU ; Gottsäter, Anders LU and Pärsson, Håkan LU (2021) In European Journal of Vascular and Endovascular Surgery 62(4). p.583-589
Abstract

Objective: The aim of this study was to evaluate changes in transcutaneous oxygen pressure (tcpO2) and systolic toe pressure (TP) during endovascular intervention. Methods: This was a single centre prospective, non-randomised, observational feasibility study. Patients with chronic limb threatening ischaemia (CLTI) due to infrainguinal disease scheduled for endovascular treatment were included between March 2018 and December 2019. TcpO2 was measured continuously bilaterally at foot level throughout the procedure and at follow up. Specific time points during the intervention were chosen for comparison to baseline (before arterial puncture): average tcpO2 level five minutes prior to percutaneous... (More)

Objective: The aim of this study was to evaluate changes in transcutaneous oxygen pressure (tcpO2) and systolic toe pressure (TP) during endovascular intervention. Methods: This was a single centre prospective, non-randomised, observational feasibility study. Patients with chronic limb threatening ischaemia (CLTI) due to infrainguinal disease scheduled for endovascular treatment were included between March 2018 and December 2019. TcpO2 was measured continuously bilaterally at foot level throughout the procedure and at follow up. Specific time points during the intervention were chosen for comparison to baseline (before arterial puncture): average tcpO2 level five minutes prior to percutaneous transluminal angioplasty (PTA); 10 minutes after PTA; and at completion. Bilateral TP was recorded using laser Doppler flowmetry before arterial puncture, at completion, and at clinical follow up. Angiograms were analysed for successful revascularisation and vascular lesions classified according to the Global Limb Anatomical Scoring System (GLASS). Rutherford and WIfI (Wound, Ischaemia, and foot Infection) classifications were registered, as well as clinical outcome. Results: Twenty-one patients completed the study. Completion angiograms showed inline flow to the foot in all but two patients. Median time to follow up was 10 weeks (range 8 – 13 weeks) and all patients except one improved clinically. TcpO2 decreased during the initial stage of the intervention, from before arterial puncture to five minute average before PTA (p < .001) and did not recover to above baseline values at the end of intervention. TcpO2 increased significantly at follow up (p < .001). TP increased statistically significantly during intervention (p < .001) and at follow up (p < .001) compared with baseline. Conclusion: TcpO2 and TP measurements are safe and feasible non-invasive techniques for haemodynamic monitoring during endovascular revascularisation. TP increased significantly immediately after completion of the successful intervention, whereas tcpO2 did not. Both TP and tcpO2 demonstrated a significant increase at the 10 week follow up.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Chronic limb threatening ischaemia, Critical limb ischaemia, Endovascular intervention, Systolic toe pressure, Transcutaneous oxygen pressure
in
European Journal of Vascular and Endovascular Surgery
volume
62
issue
4
pages
583 - 589
publisher
Elsevier
external identifiers
  • scopus:85111479783
  • pmid:34334314
ISSN
1078-5884
DOI
10.1016/j.ejvs.2021.06.009
language
English
LU publication?
yes
id
59e498a7-a99e-4862-92c9-3511bc888614
date added to LUP
2021-08-31 11:12:15
date last changed
2024-06-15 15:23:16
@article{59e498a7-a99e-4862-92c9-3511bc888614,
  abstract     = {{<p>Objective: The aim of this study was to evaluate changes in transcutaneous oxygen pressure (tcpO<sub>2</sub>) and systolic toe pressure (TP) during endovascular intervention. Methods: This was a single centre prospective, non-randomised, observational feasibility study. Patients with chronic limb threatening ischaemia (CLTI) due to infrainguinal disease scheduled for endovascular treatment were included between March 2018 and December 2019. TcpO<sub>2</sub> was measured continuously bilaterally at foot level throughout the procedure and at follow up. Specific time points during the intervention were chosen for comparison to baseline (before arterial puncture): average tcpO<sub>2</sub> level five minutes prior to percutaneous transluminal angioplasty (PTA); 10 minutes after PTA; and at completion. Bilateral TP was recorded using laser Doppler flowmetry before arterial puncture, at completion, and at clinical follow up. Angiograms were analysed for successful revascularisation and vascular lesions classified according to the Global Limb Anatomical Scoring System (GLASS). Rutherford and WIfI (Wound, Ischaemia, and foot Infection) classifications were registered, as well as clinical outcome. Results: Twenty-one patients completed the study. Completion angiograms showed inline flow to the foot in all but two patients. Median time to follow up was 10 weeks (range 8 – 13 weeks) and all patients except one improved clinically. TcpO<sub>2</sub> decreased during the initial stage of the intervention, from before arterial puncture to five minute average before PTA (p &lt; .001) and did not recover to above baseline values at the end of intervention. TcpO<sub>2</sub> increased significantly at follow up (p &lt; .001). TP increased statistically significantly during intervention (p &lt; .001) and at follow up (p &lt; .001) compared with baseline. Conclusion: TcpO<sub>2</sub> and TP measurements are safe and feasible non-invasive techniques for haemodynamic monitoring during endovascular revascularisation. TP increased significantly immediately after completion of the successful intervention, whereas tcpO<sub>2</sub> did not. Both TP and tcpO<sub>2</sub> demonstrated a significant increase at the 10 week follow up.</p>}},
  author       = {{Gunnarsson, Thordur and Lindgren, Hans and Gottsäter, Anders and Pärsson, Håkan}},
  issn         = {{1078-5884}},
  keywords     = {{Chronic limb threatening ischaemia; Critical limb ischaemia; Endovascular intervention; Systolic toe pressure; Transcutaneous oxygen pressure}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{4}},
  pages        = {{583--589}},
  publisher    = {{Elsevier}},
  series       = {{European Journal of Vascular and Endovascular Surgery}},
  title        = {{Intraprocedural Transcutaneous Oxygen Pressure and Systolic Toe Pressure Measurements During and After Endovascular Intervention in Patients with Chronic Limb Threatening Ischaemia}},
  url          = {{http://dx.doi.org/10.1016/j.ejvs.2021.06.009}},
  doi          = {{10.1016/j.ejvs.2021.06.009}},
  volume       = {{62}},
  year         = {{2021}},
}