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Online ISSN 1827-1847
Wagenhäuser M. U., Duran M., Dueppers P., Witte M., Schelzig H., Oberhuber A.
Department of Vascular and Endovascular Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
AIM: Lower limb peripheral arterial occlusive disease (PAOD) is an increasing problem in Western countries. In critical limb ischaemia (CLI) amputation rate and mortality is high. If an operative or interventional approach is not feasible, conservative options remain. We questioned whether lumbar sympatholysis and prostaglandin E1 infusion therapy influence transcutaneous oxygen pressure (TcPO2) to evaluate short-term effectiveness of these therapies.
METHODS: Fourteen people with an average age of 64±11 years, suffering from PAOD Rutherford stage V and VI, and treated from June 1, 2013 to June 31, 2014, were included in the study. TcPO2 levels were measured at 3 different time points during prostaglandin E1 infusion therapy. Electrodes were placed at a proximal (PMP) and a distal (DMP) measuring point on the affected legs. A Regional Perfusion Index (RPI) was calculated separately for both measuring points to consider the partial pressure of oxygen in systemic arterial blood. If patients underwent lumbar sympathicolysis (LS) between two time points, TcPO2 levels were compared to those without this therapy in the interval. Statistical analysis was performed using the Mann–Whitney U test and P<0.05 was considered statistically significant.
RESULTS: Data before therapy was as follows; PMP: 37.5±24.9 mmHg (RPI 0.56±0.34); DMP: 26.8±24.5 mmHg (RPI 0.43±0.38). 5-7 days during therapy; PMP: 44.2±21.7 mmHg (RPI 0.77±0.23; P<0.05); DMP: 17.6±15.9 mmHg (RPI 0.37±0.35). 10-12 days during therapy; PMP: 44.9±15.1 mmHg (RPI 0.69±0.26) DMP: 20±22.1 mmHg (RPI 0.28±0.32). Comparing the intervals with (w) and without (wo) LS, the differences in TcPO2 levels and RPI were as follows: PMP (w): -1.38 mmHg±35.14 (RPI 0.06±0.43); DMP (w): -2 mmHg±16 (RPI -12±0.26); PMP (wo): 1.83 mmHg±30.07 (RPI: 0.03±0.37); DMP (wo): -5 mmHg±20 (RPI -0.04±0.34). 12 of 14 patients presented with raised C-reactive protein (CRP) levels, 3.8 (mg/dL)±6.1 on admission.
CONCLUSION: Data leads to the conclusion that the RPI is more accurate than the absolute TcpO2 levels. A measuring point about 10 cm proximal to the lesion could be more effective as TcpO2 levels next to the lesion may be overestimated due to hyperperfusion caused by local infection. Data suggests that LS may not have an influence on TcPO2 levels.