Toe Pressure Measurements in Patients Suspected of Critical Limb Ischemia

Angiology ◽  
2021 ◽  
pp. 000331972110636
Author(s):  
Loubna Dari ◽  
Damien Barcat ◽  
Benjamin Ally ◽  
David Lagarde ◽  
Carine Boulon ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Pressure Measurement ◽  
Limb Ischemia ◽  
Scatter Plot ◽  
Reference Test ◽  
Transcutaneous Oxygen ◽  
Hemodynamic Assessment ◽  
Coefficient Corrélation ◽  
Transcutaneous Oxygen Pressure ◽  
Toe Pressure

An objective hemodynamic assessment is mandatory to confirm Critical Limb Ischemia (CLI). Toe pressure measurement is recommended. We compared toe measurements obtained using the Laser Doppler method (LD) (PERIMED PeriFlux, Sweden) considered as the reference test, with those obtained with a portable device using photoplethysmography (PPG) (Sys Toe Atys Medical, France). A total of 93 (123 legs) patients from 3 French hospitals with a clinical suspicion of CLI were included and had measurements with each device carried out by skilled operators. PPG was unable to provide a measurement in 10 patients. Lin’s Coefficient correlation concordance (CCC) and Bland and Altman’s scatter plot were analyzed for the 83 remaining patients, CCC was .84 95%CI (.77–.89). For detection of CLI, Cohen’s kappa was .67 95%CI (.53–.81). The PPG device is fairly reliable for toe pressure measurement in patients suspected of CLI and could be useful when LD is not available. However, it fails to deliver a measurement in approximately 10% of cases. No conclusion should be made about CLI for these patients when no measurement is obtainable and other methods should be used (LD, transcutaneous oxygen pressure) to assess perfusion of the limbs.

Comparison of Ankle Pressure, Systolic Toe Pressure, and Transcutaneous Oxygen Pressure to Predict Major Amputation After 1 Year in the COPART Cohort

Angiology ◽  
2018 ◽  
Vol 70 (3) ◽  
pp. 229-236 ◽  
Author(s):  
Pierre Salaun ◽  
Ileana Desormais ◽  
François-Xavier Lapébie ◽  
Alessandra Bura Rivière ◽  
Victor Aboyans ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Oxygen Pressure ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Major Amputation ◽  
Transcutaneous Oxygen ◽  
Ankle Pressure ◽  
Transcutaneous Oxygen Pressure ◽  
Peripheral Arterial ◽  
Toe Pressure

The hemodynamic definition of critical limb ischemia (CLI) has evolved over time but remains controversial. We compared the prediction of major amputation by 3 hemodynamic methods. Patients were selected from the Cohorte des Patients ARTériopathes cohort of patients hospitalized for peripheral arterial disease. Patients with CLI were enrolled according to the Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease II definition and followed up for at least 1 year. We compared the major amputation rate according to initial ankle pressure (AP), systolic toe pressure (STP), and forefoot transcutaneous oxygen pressure (TcPO2); 556 patients were included and divided into surgical (264) and medical (292) groups. The AP failed to identify 42% of patients with CLI. After 1 year, 27% of medical and 17% of surgical patients had undergone major amputation. The TP <30 mm Hg predicted major amputation in the whole sample and in the medical group (odds ratio [OR] 3.5 [1.7-7.1] and OR 5 [2-12.4], respectively), but AP did not. The TcPO2 <10 mm Hg also predicted major amputation (OR 2.3 [1.5-3.5] and OR 3.8 [2.1-6.8]). The best predictive thresholds to predict major amputation were STP <30 mm Hg and TcPO2 <10 mm Hg. None of these methods performed before surgery was able to predict outcome in the revascularized patients.

scholarly journals Simultaneous pain intensity rating and quantification of ischemia throughout exercise and recovery in proximal versus distal arterial claudication

2017 ◽  
Vol 22 (6) ◽  
pp. 490-497 ◽  
Author(s):  
Alban Fouasson-Chailloux ◽  
Pierre Abraham ◽  
Christophe Colas-Ribas ◽  
Mathieu Feuilloy ◽  
Bruno Vielle ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Oxygen Pressure ◽  
Limb Ischemia ◽  
Constant Load ◽  
Pain Rating ◽  
Transcutaneous Oxygen ◽  
Intensity Rating ◽  
Transcutaneous Oxygen Pressure ◽  
Rating Changes ◽  
Distal Localization

Data on simultaneous hemodynamic changes and pain rating estimation in arterial claudication while walking are lacking. This study was conducted to determine if a difference in transcutaneous oxygen pressure (tc pO2) exists between proximal and distal localization at pain appearance (PAINapp), maximal pain (PAINmax) and pain relief (PAINrel) in proximal or distal claudication and if a relationship exists between tc pO2 changes and pain intensity. We analyzed the pain rating (Visual Analog Scale (VAS)) to lower limb ischemia, measured with the decrease from rest of oxygen pressure (DROP) tc pO2 index during constant-load treadmill tests in patients with calf ( n = 41) or buttock ( n = 19) claudication. Calves versus buttocks results were analyzed with ANOVA tests. The R2 correlation coefficient between individual VAS versus DROP was calculated. Ischemia intensity versus pain rating changes were correlated. Significant ischemia was required for pain appearance, but pain disappeared despite the persistence of ischemia. We observed no statistical difference for DROP at PAINapp, PAINmax or PAINrel between proximal or distal claudication. A significant correlation between pain rating versus DROP was found: from PAINapp to PAINmax, R2 = 0.750 (calves) and 0.829 (buttocks), and from PAINmax to PAINrel, R2 = 0.608 (calves) and 0.560 (buttocks); p<0.05. Pain appeared after a significant decrease of hemodynamic parameters but disappeared while parameters were not normalized. No difference in pain rating was found in proximal versus distal claudication.

scholarly journals Skin perfusion pressure measurement is valuable in the diagnosis of critical limb ischemia

1997 ◽  
Vol 26 (4) ◽  
pp. 629-637 ◽  
Author(s):  
John J. Castronuovo ◽  
Habtu M. Adera ◽  
Janice M. Smiell ◽  
Ray M. Price
Keyword(s):  
Critical Limb Ischemia ◽  
Pressure Measurement ◽  
Perfusion Pressure ◽  
Limb Ischemia ◽  
Skin Perfusion ◽  
Skin Perfusion Pressure

scholarly journals Clinical and (31)P magnetic resonance spectroscopy characterization of patients with critical limb ischemia before and after autologous cell therapy

2019 ◽  
pp. 559-566
Author(s):  
M. Dubský ◽  
P. Šedivý ◽  
A. Němcová ◽  
M. Drobný ◽  
J. Hazdrová ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Spectroscopy ◽  
Cell Therapy ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Resonance Spectroscopy ◽  
Diabetic Patients ◽  
Transcutaneous Oxygen ◽  
Autologous Cell ◽  
Autologous Cell Therapy

Autologous cell therapy (ACT) is a new treatment method for diabetic patients with critical limb ischemia (CLI) not eligible for standard revascularization. After intramuscular injection of bone marrow-derived mononuclear cells local arteriogenesis in the ischemic tissue occurs. Studies assessing visualization of this therapeutic vasculogenesis after ACT by novel imaging techniques are lacking. The aim of our study was to assess the effect of ACT on possible metabolic changes and perfusion of critically ischemic limbs using (31)P magnetic resonance spectroscopy ((31)P MRS) and its possible correlation with changes of transcutaneous oxygen pressure (TcPO2). Twenty-one patients with diabetes and no-option CLI treated by ACT in our foot clinic over 8 years were included in the study. TcPO2 as well as rest (phosphocreatine, adenosine triphosphate and inorganic phosphate) and dynamic (mitochondrial capacity and phosphocreatine recovery time) (31)P-MRS parameters were evaluated at baseline and 3 months after cell treatment. TcPO2 increased significantly after 3 months compared with baseline (from 22.4±8.2 to 37.6±13.3 mm Hg, p=0.0002). Rest and dynamic (31)P MRS parameters were not significantly different after ACT in comparison with baseline values. Our study showed a significant increase of TcPO2 on the dorsum of the foot after ACT. We did not observe any changes of rest or dynamic (31)P MRS parameters in the area of the proximal calf where the cell suspension has been injected into.

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