BACKGROUND: All diagnostic procedures of peripheral arterial disease (PAD) in diabetic foot (DF) are complicated due to diabetes mellitus and its late complications.The aim of our study is to enhance diagnosis of PAD using a novel transcutaneous oximetry (TcPO2) stimulation test. METHODS: The study comprised patients with mild-to-moderate PAD(WIfI-I 1 or 2) and baseline TcPO2 values of 30-50 mmHg.TcPO2 was measured across 107 different angiosomes. Stimulation examination involved a modification of the Ratschow test. All patients underwent PAD assessment (systolic blood pressures (SBP), toe pressures (TP), the ankle-brachial indexes (ABI) and toe-brachial indexes (TBI), duplex ultrasound of circulation). Angiosomes were divided into two groups based on ultrasound findings: group M(n=60) with monophasic flow; group T(n=47) with triphasic flow. Large vessel parameters and TcPO2 at rest and after exercise (minimal TcPO2, changes in TcPO2 from baseline (Δ,%), TcPO2 recovery time) measured during the stimulation test were compared between study groups. RESULTS: During the TcPO2 stimulation exercise test, group M exhibited significantly lower minimal TcPO2 (26.2 ± 11.1 vs. 31.4 ± 9.4 mmHg; p<0.01), greater Δ and percentage decreases from resting TcPO2 (p=0.014 and p=0.007, respectively) and longer TcPO2 recovery times (446 ± 134 vs. 370 ± 81ms;p=0.0005) compared to group T. SBPs, TPs and indexes were significantly lower in group M compared to group T. Sensitivity and specificity of TcPO2 stimulation parameters during PAD detection increased significantly to the level of SBP, ABI, TP and TBI. CONCLUSION: Compared to resting TcPO2, TcPO2 measured during stimulation improves detection of latent forms of PAD and restenosis/obliterations of previously treated arteries in diabetic foot patients. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov [https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009V7W&selectaction=Edit&uid=U0005381&ts=2&cx=3j24u2], identifier NCT04404699.
- Klíčová slova
- PAD - peripheral arterial disease, TcPO2 and TcPCO2 measurement, diabetic foot, diagnosis, microcirculation,
- MeSH
- cvičení fyziologie MeSH
- diabetická noha komplikace diagnostické zobrazování MeSH
- dolní končetina krevní zásobení MeSH
- duplexní dopplerovská ultrasonografie MeSH
- krevní tlak MeSH
- lidé středního věku MeSH
- lidé MeSH
- onemocnění periferních arterií diagnóza diagnostické zobrazování etiologie MeSH
- prsty nohy krevní zásobení MeSH
- regionální krevní průtok MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- tlakový index kotník-paže MeSH
- transkutánní měření krevních plynů metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Critical limb ischemia in patients with diabetes at the organ complication stage represents a considerable challenge in vascular medicine. Because of the complexity of the disease and the often symmetric involvement of both lower limbs, a discrepancy between suitable vascular conduit availability and the actual requirement can occur: notably, the prevalence of multilevel and diffuse arterial disease often limits the possibilities of endovascular treatment, and, in surgical cases, frequently prohibits the effective use of prosthetic material. In our patient with bilateral critical limb ischemia and previous coronary artery bypass graft followed by cardiac transplantation, only one great saphenous vein remained available. That was used in its entirety to salvage one limb as a sequential femorocrural bypass. A similar surgical procedure with a fresh arterial allograft retrieved from a deceased donor was performed on the other extremity . ABO compatibility as well as the chronic immunosuppressive therapy in a heart transplant recipient may have contributed to the favorable long-term clinical outcome of the allogeneic arterial reconstruction.
- MeSH
- arteria femoralis patofyziologie chirurgie MeSH
- arterie transplantace MeSH
- časové faktory MeSH
- diabetické angiopatie etiologie patofyziologie chirurgie MeSH
- dolní končetina krevní zásobení MeSH
- homologní transplantace MeSH
- imunosupresiva aplikace a dávkování MeSH
- ischemie etiologie patofyziologie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční angiografie MeSH
- onemocnění periferních arterií etiologie patofyziologie chirurgie MeSH
- průchodnost cév * MeSH
- transplantace cév * MeSH
- transplantace srdce * MeSH
- vena saphena transplantace MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- Názvy látek
- imunosupresiva MeSH
