RESUMEN
PURPOSE: We evaluated the limitations of the ankle-brachial index (ABI) in the revascularisation of diabetic patients with critical limb ischaemia (CLI) who were undergoing peripheral transluminal angioplasty (PTA) compared with the degree of arterial stenosis and with transcutaneous oxygen tension (TcpO2). MATERIALS AND METHODS: This prospective study assessed 250 consecutive diabetic patients in whom we evaluated results of posterior tibial and dorsalis pedis Doppler, ABI, TcpO2, and duplex scans. In total, 104 patients were considered suitable candidates for PTA. RESULTS: In 42% of the patients studied, ABI could either not be used (9.34% due to no signal; 14.02% because the artery could not be compressed) or was incorrect (18.7% before PTA; 15.9% after PTA). In contrast, TcpO2 was determined in all cases. After PTA, vessel stenosis decreased from 58.33±20.07% to 21.87±13.57% (p<0.001), whereas ABI increased from 0.79±0.57 to 0.95±0.47 (p<0.001) and TcpO2 from 27.37±10.40 mmHg to 38.23±10.25 mmHg (p<0.001). A statistical analysis revealed scant correlation between techniques (TcpO2 and ABI) (r=0.14). CONCLUSIONS: ABI shows significant limitations for the diagnosing and treating CLI patients compared with TcpO2.
Asunto(s)
Angioplastia , Índice Tobillo Braquial , Angiopatías Diabéticas/cirugía , Angiopatías Diabéticas/terapia , Pierna/irrigación sanguínea , Adulto , Anciano , Anciano de 80 o más Años , Angiopatías Diabéticas/diagnóstico por imagen , Femenino , Pie/irrigación sanguínea , Humanos , Pierna/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Prospectivos , UltrasonografíaRESUMEN
BACKGROUND: In recent years, the use of peripheral transluminal angioplasty (PTA) procedures for revascularization of an ischemic limb has increased. Evaluation of reperfusion has been carried out by Doppler scan; however, a successful PTA does not necessarily result in improved oxygen delivery to the distal parts of the limb. PURPOSE: To evaluate the efficacy of the revascularization in diabetic patients with critical limb ischemia after treatment with PTA by comparing transcutaneous oxygen tension (TcpO2) with the ankle-brachial index (ABI) post PTA. MATERIAL AND METHODS: This prospective study included 151 consecutive diabetic patients. We evaluated the posterior tibial and dorsalis pedis Doppler, ABI, TcpO2, and duplex scan results. If two of these four examinations were abnormal, arteriography was carried out and PTA was performed concomitantly. At least 64 patients were considered suitable candidates for PTA. RESULTS: The ABI increased from 0.67±0.25 to 0.84±0.25 following PTA (P<0.001). TcpO2 increased from 27.20±11.10 mm Hg to 40±12.10 mm Hg after PTA (P<0.001). While the TcpO2 could be measured in all patients, the ABI was not measurable in 25.37% pretreatment and in 17.91% post treatment. Statistical analysis revealed a scant correlation between the techniques used: TcpO2 and ABI (P=0.20). CONCLUSION: Our study confirms that the increase in TcpO2 in diabetic patients following PTA points to the physiologic significance of microvascular revascularization achieved in the treated limb and serves to assess functional improvement in tissue oxygenation obtained by PTA. The use of TcpO2 may represent an alternative to traditional assessment of peripheral transluminal angioplasty results.