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International Angiology 2002 December;21(4):367-73


language: English

Effect of artificial carbon dioxide foot bathing on critical limb ischemia (Fontaine IV) in peripheral arterial disease patients

Toriyama T. 1, Kumada Y. 2, Matsubara T. 1, Murata A. 1, Ogino A. 1, Hayashi H. 1, Nakashima H. 1, Takahashi H. 1, Matsuo H. 3, Kawahara H. 1

1 Division of Cardiology, Cardiovascular Center, Nagoya Kyoritsu Hospital, Nagoya, Japan 2 Division of Cardiovascular Surgery, Cardiovascular Center, Nagoya Kyoritsu Hospital, Nagoya, Japan 3 Division of Cardiovascular Medicine, National Cardiovascular Center, Nagoya, Japan


Background. It has been report­ed that arti­fi­cial car­bon diox­ide (CO2) foot bath­ing ­improves sub­cu­ta­ne­ous micro­cir­cu­la­tion in periph­er­al arte­ri­al dis­ease (PAD) ­patients. However, the ­effect for crit­i­cal limb ische­mia (CLI) with ulcer­a­tion or gan­grene (Fontaine stage IV) is not iden­ti­fied. The phys­io­log­i­cal ­effects of CO2 bath­ing and the out­come of limb sal­vage in such ­patients were stud­ied.
Methods. In 18 ­healthy vol­un­teers (Study I), the dor­sal pedis periph­er­al blood flow was meas­ured by a laser Doppler flow-meter dur­ing CO2 foot bath­ing (1000 ppm, 37°C) for 10 min. A Holter elec­tro­car­di­o­gram was also record­ing in the same peri­od. Blood flow and cell vol­ume sig­nif­i­cant­ly ­increased dur­ing bath­ing. Eighty-three CLI limbs (Fontaine IV) in 68 PAD ­patients (Study II) under­went arti­fi­cial CO2 foot bath­ing (for 10 min­utes twice daily >2 ­months) were fol­lowed up >6 ­months.
Results. In Study I, anal­y­sis of heart rate var­i­abil­ity ­showed that high fre­quen­cy ampli­tude (HFA) con­sid­er­ably ­increased and the ratio of low fre­quen­cy ampli­tude to HFA (LF/HF) notice­ably ­decreased dur­ing bath­ing. In Study II, 69 limbs (83.1%) could be sal­vaged. Twenty-seven of 28 limbs (96.4%) which have ulcer and gan­grene in only one toe, 13/16 limbs (81.2%) in mul­ti­ple toes and 29/39 limbs (74.4%) in all toes and/or heel respec­tive­ly were saved.
Conclusions. The ­effect of CO2 ­enriched water on the sub­cu­ta­ne­ous micro­cir­cu­la­tion might be ­brought about by periph­er­al vasod­i­la­tion reflect­ed by ­increased par­a­sym­pa­thet­ic and ­decreased sym­pa­thet­ic activ­ity, and the arti­fi­cial CO2 foot bath­ing is clin­i­cal­ly effec­tive on sal­vage of CLI (Fontaine stage IV) limbs.

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