ORIGINAL ARTICLES   

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

Copyright © 2003 EDIZIONI MINERVA MEDICA

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

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.