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Rivista di Angiologia
Official Journal of the , the International Union of Phlebology and the
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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International Angiology 2003 December;22(4):356-63
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
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.