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INTERNATIONAL ANGIOLOGY

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Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2003 Dicembre;22(4):356-63

lingua: Inglese

The best TcpO2 parameters to predict the efficacy of spinal cord stimulation to improve limb salvage in patients with inoperable critical leg ischemia

Ubbink D. Th. 1, Gersbach Ph. A. 2, Berg P. 3, Amann W. 4, Gamain J. 5

1 Depart­ment of Vas­cu­lar Sur­gery, Aca­dem­ic Med­i­cal Cen­ter, Amster­dam, The Neth­er­lands
2 Depart­ment of Car­di­o­vas­cu­lar Sur­gery, Uni­ver­sity Hos­pi­tal, Lau­sanne, Swit­zer­land
3 Depart­ment of Vas­cu­lar Sur­gery, Hos­pi­tal Center of Lux­em­bourg, Lux­em­burg
4 Depart­ment of Vas­cu­lar Sur­gery, Uni­ver­sity Hos­pi­tal, Graz, Aus­tria
5 Depart­ment of Anes­the­sio­lo­gy, Uni­ver­sity Hos­pi­tal, Ami­ens, ­France


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Aim. Spi­nal cord stim­u­la­tion (SCS) is avail­able as an alter­na­tive ther­a­py for ­patients suf­fer­ing from inop­er­able crit­i­cal limb ische­mia (CLI). Selec­tion of ­patients is essen­tial to ­achieve the best treat­ment ­effect. For this pur­pose trans­cu­ta­ne­ous oxy­gen (TcpO2) meas­ure­ments have fre­quent­ly been ­applied. So far, it is ­unclear which TcpO2 param­e­ters serve this pur­pose best.
Meth­ods. Stud­ies in which inop­er­able CLI ­patients were treat­ed with con­ser­va­tive treat­ment with or with­out SCS, and in whom var­i­ous TcpO2 meas­ure­ments were per­formed ­before and dur­ing treat­ment were ­pooled to inves­ti­gate which TcpO2 param­e­ter(s) were best to ­detect ­patients who ben­e­fit most from SCS treat­ment as to limb sal­vage.
­Results. TcpO2 in the ­supine posi­tion ­increased sig­nif­i­cant­ly (p<0.001) in ­patients after a short peri­od of SCS treat­ment (from 9 to 22 mmHg), but not in those treat­ed con­ser­va­tive­ly (from 7 to 7 mmHg). Base­line supi­neTc­pO2 (using a cut-off value of 10 mmHg), the base­line sit­ting-­supine TcpO2 dif­fer­ence (cut-off value: 17 mmHg), and the dif­fer­ence in TcpO2 ­before and after test stim­u­la­tion (cut-off value: 4 mmHg) were relat­ed to a sig­nif­i­cant­ly ­increased limb sal­vage. SCS ­patients with a sit­ting-­supine TcpO2 dif­fer­ence of >17 mmHg had a 1-year limb sal­vage of 83% vs 68% in the whole SCS-treat­ed group irre­spec­tive of TcpO2 selec­tion.
Con­clu­sion. The TcpO2 param­e­ters men­tioned above are ­capable of detect­ing the ­effect of SCS treat­ment. Selec­tion using (a com­bi­na­tion of) TcpO2 meas­ure­ments sub­stan­tial­ly ­improves limb sal­vage of ­patients treat­ed with SCS for inop­er­able CLI.

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