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The Journal of Cardiovascular Surgery 2000 February;41(1):83-7

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Predictive value of transcutaneous oximetry for selection of the amputation level

Misuri A., Lucertini G., Nanni A., Viacava A., Belardi P.

From the Section of Vascular Surgery University of Genoa, Genoa, Italy


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Background. Transcutaneous oxim­e­try was stud­ied to ­select the cor­rect ampu­ta­tion lev­el for ­limb ischem­ic necro­sis ­with pos­sible iden­tifi­ca­tion of thresh­old val­ue. Methods. The meth­od was eval­u­at­ed in 30 cas­es (20 ­patients, 5 ­males and 15 ­females, of ­ages rang­ing ­from 61 to 93, aver­age 73.1±8.5) ­where ­patients under­went ampu­ta­tion ­because of ­severe leg ische­mia. Sur­gi­cal oper­a­tions ­were: ­minor ampu­ta­tion (toe or trans­met­a­tar­sal) in 23 cas­es, ­below ­knee ampu­ta­tion in 7. Oxy­gen ten­sion was meas­ured at the dor­sum ­foot and at the ­third super­i­or of the ante­ro­me­di­al ­calf ­aspect.
Results. Results ­were clas­si­fied as suc­cess (pri­mary or ­delayed heal­ing) or fail­ure (necro­sis at the sur­gi­cal ­wound). Amputation was suc­cess­ful in 17/30 cas­es ­with oxy­gen ten­sion of 0-65 mmHg (­mean 32.5±16.1) and ­failed in 13/30 ­with oxy­gen ten­sion of 0-57 mmHg (mean 7.8±17.3). The dif­fer­ence was sta­tis­ti­cal­ly sig­nif­i­cant (p=0.0004). Sensitivity of the meth­od result­ed 88.2%, spec­i­fic­ity 84.6%, diag­nos­tic accu­ra­cy 86.7%, pos­i­tive pre­dic­tive val­ue 88.2% and neg­a­tive pre­dic­tive val­ue 84.6%. A thresh­old of 20 mmHg was iden­ti­fied: 15/17 suc­cess­ful cas­es ­showed val­ues great­er ­than 20 mmHg, ­while 11/13 ­failed cas­es pre­sent­ed val­ues low­er ­than the thresh­old.
Conclusions. Following our obser­va­tions and accord­ing to ­some report­ed stud­ies, we ­believe trans­cu­ta­ne­ous oxim­e­try to be the ­best meth­od for selec­tion of ampu­ta­tion lev­el. This is a sim­ple, non­in­va­sive and accu­rate meth­od, ­which has ­showed ­itself super­i­or to oth­er tech­niques (i.e., Doppler and radio­iso­tope).

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