Infrapopliteal transcatheter interventions for limb salvage in diabetic patients: Importance of aggressive interventional approach and role of transcutaneous oximetry

George P. Hanna, Kenichi Fujise, Olle Kjellgren, Steven Feld, Caroline Fife, George Schroth, Tom Clanton, Vernon Anderson, Richard W. Smalling

Research output: Contribution to journalArticle

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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. 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. 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. Results. After 12-month follow-up, six patients had persistent 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). 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.

Original languageEnglish (US)
Pages (from-to)664-669
Number of pages6
JournalJournal of the American College of Cardiology
Volume30
Issue number3
DOIs
StatePublished - Jul 1997
Externally publishedYes

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Transcutaneous Blood Gas Monitoring
Limb Salvage
Amputation
Partial Pressure
Wound Healing
Leg
Knee
Arteries
Oxygen

ASJC Scopus subject areas

  • Nursing(all)

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Infrapopliteal transcatheter interventions for limb salvage in diabetic patients : Importance of aggressive interventional approach and role of transcutaneous oximetry. / Hanna, George P.; Fujise, Kenichi; Kjellgren, Olle; Feld, Steven; Fife, Caroline; Schroth, George; Clanton, Tom; Anderson, Vernon; Smalling, Richard W.

In: Journal of the American College of Cardiology, Vol. 30, No. 3, 07.1997, p. 664-669.

Research output: Contribution to journalArticle

Hanna, George P. ; Fujise, Kenichi ; Kjellgren, Olle ; Feld, Steven ; Fife, Caroline ; Schroth, George ; Clanton, Tom ; Anderson, Vernon ; Smalling, Richard W. / Infrapopliteal transcatheter interventions for limb salvage in diabetic patients : Importance of aggressive interventional approach and role of transcutaneous oximetry. In: Journal of the American College of Cardiology. 1997 ; Vol. 30, No. 3. pp. 664-669.
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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. 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. 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. Results. After 12-month follow-up, six patients had persistent 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). 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.",
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AU - Feld, Steven

AU - Fife, Caroline

AU - Schroth, George

AU - Clanton, Tom

AU - Anderson, Vernon

AU - Smalling, Richard W.

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N2 - 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. 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. 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. Results. After 12-month follow-up, six patients had persistent 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). 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.

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