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International Angiology 2003 December;22(4):356-63

Copyright © 2003 EDIZIONI MINERVA MEDICA

language: English

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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