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Schremmer J, Stern M, Baasen S, Wischmann P, Foerster R, Schillings M, Bódis K, Sansone R, Heiss C, Kelm M, Busch L. Impact of Peripheral Angioplasty on Wound Oxygenation and Healing in Patients with Chronic Limb-Threatening Ischemia Measured by Near-Infrared Spectroscopy. Biomedicines 2024; 12:1805. [PMID: 39200269 PMCID: PMC11351302 DOI: 10.3390/biomedicines12081805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 07/28/2024] [Accepted: 08/05/2024] [Indexed: 09/02/2024] Open
Abstract
Managing chronic limb-threatening ischemia (CLTI) is challenging due to difficulties in assessing tissue oxygen saturation in ulcers. Near-infrared spectroscopy (NIRS) is a non-invasive method for measuring tissue oxygen saturation (StO2). This study evaluated the effects of endovascular treatment (EVT) on StO2 and wound healing in CLTI patients, comparing NIRS to standard ankle-brachial index (ABI) measurements. Using the Duesseldorf PTA Registry, 43 CLTI patients were analyzed: 27 underwent EVT, and 16 received conservative treatment. ABI assessed macrocirculation, while NIRS measured wound, wound area, and mean foot StO2 at baseline, post-EVT, and four-month follow-up. Wound severity was classified by wound area and wound, ischemia, and foot infection (WIfI) score. Wound StO2 increased significantly (median (interquartile range (IQR)), 38 (49.3) to 60 (34.5)%, p = 0.004), as did wound area StO2 (median (IQR), 70.9 (21.6) to 72.8 (18.3)%, p < 0.001), with no significant changes in the control group by four-month follow-up. Wound area decreased significantly after EVT (mean ± SD, 343.1 ± 267.8 to 178.1 ± 268.5 mm2, p = 0.01) but not in the control group. Changes in wound StO2, wound area StO2, and WIfI score correlated with wound area reduction, unlike ABI. This small exploratory study shows that NIRS-measured StO2 improvements after EVT correlate with reduced wound area and WIfI scores, highlighting NIRS as a potential enhancement for CLTI wound management in addition to ABI.
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Affiliation(s)
- Johanna Schremmer
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, 40225 Duesseldorf, Germany; (J.S.); (L.B.)
| | - Manuel Stern
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, 40225 Duesseldorf, Germany; (J.S.); (L.B.)
| | - Sven Baasen
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, 40225 Duesseldorf, Germany; (J.S.); (L.B.)
| | - Patricia Wischmann
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, 40225 Duesseldorf, Germany; (J.S.); (L.B.)
| | - Ramy Foerster
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, 40225 Duesseldorf, Germany; (J.S.); (L.B.)
| | - Miriam Schillings
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, 40225 Duesseldorf, Germany; (J.S.); (L.B.)
| | - Kálmán Bódis
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, 40225 Duesseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, 40225 Duesseldorf, Germany
- German Center for Diabetes Research, Partner Duesseldorf, 85764 München-Neuherberg, Germany
| | - Roberto Sansone
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, 40225 Duesseldorf, Germany; (J.S.); (L.B.)
| | - Christian Heiss
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK;
- Department of Vascular Medicine, Surrey and Sussex NHS Healthcare Trust, Redhill RH1 5RH, UK
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, 40225 Duesseldorf, Germany; (J.S.); (L.B.)
- Cardiovascular Research Institute Duesseldorf (CARID), 40225 Duesseldorf, Germany
| | - Lucas Busch
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, 40225 Duesseldorf, Germany; (J.S.); (L.B.)
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Larin IV, Shchanitsyn IN, Tolstokorov AS, Arakelyan VS. [Evaluation of revascularization efficiency using near-infrared oximetry in patients with diabetic foot syndrome]. Khirurgiia (Mosk) 2024:20-27. [PMID: 38888015 DOI: 10.17116/hirurgia202406120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
OBJECTIVE To evaluate prognostic significance of tissue oximetry in healing of trophic defects in patients with diabetic foot syndrome (DFS) after endovascular revascularization. MATERIAL AND METHODS In 42 patients with DFS, tissue oximetry was performed in angiosome projection with the FORE-SIGHT MC-2000 (CASMED) device before and the next day after revascularization of lower limb arteries. The 1st group included 30 patients with wound healing throughout 3 months, the 2nd group included 12 patients with amputation or no healing of trophic defects. RESULTS Direct revascularization was more common in the 1st group (p=0.001). On the day after intervention, oxygen saturation (StO2) increased in all angiosomes in both groups (p<0.05). StO2 increment differed significantly between groups in all angiosomes except for point I (p<0.05). According to ROC analysis, StO2 increment by 4.5% in absolute values and 7.9% in percentage leads to trophic defect healing within 3 months (sensitivity and specificity were 76.7% and 66.7% for absolute values, 80% and 58.3% for percentage, respectively). CONCLUSION Evaluation of StO2 in target angiosome may be valuable to predict trophic defect healing after endovascular surgery.
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Affiliation(s)
- I V Larin
- Razumovsky Saratov State Medical University, Saratov, Russia
- Regional Clinical Hospital, Saratov, Russia
| | - I N Shchanitsyn
- Research Institute of Traumatology, Orthopedics and Neurosurgery - Razumovsky Saratov State Medical University, Saratov, Russia
| | - A S Tolstokorov
- Razumovsky Saratov State Medical University, Saratov, Russia
| | - V S Arakelyan
- Bakoulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russia
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Suto Y, Sato W, Yamanaka T, Unuma M, Kobayashi Y, Aokawa M, Watanabe H. Utility of Superb Microvascular Imaging in the Assessment of Foot Perfusion in Patients with Critical Limb Ischemia. Diagnostics (Basel) 2022; 12:2577. [PMID: 36359422 PMCID: PMC9689443 DOI: 10.3390/diagnostics12112577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 09/08/2024] Open
Abstract
(1) Background: Although the ankle-brachial index (ABI) and skin perfusion pressure (SPP) are commonly used to evaluate the peripheral circulation in critical limb ischemia (CLI), they often cannot be performed on sore areas. We investigated the utility of superb microvascular imaging (SMI) for assessing foot perfusion in CLI patients. (2) Methods: We measured the SMI-based vascular index (SMI-VI) at six sites in the foot before and after endovascular treatment (EVT) in 50 patients with CLI who underwent EVT of the superficial femoral artery and compared the results with SPP values and the ABI. (3) Results: SMI visualized foot perfusion in all subjects in accordance with the angiosome, including the toe areas, while the ABI was unmeasurable in three patients on hemodialysis and SPP failed in four patients. SMI-VI values were significantly lower in the CLI group than in controls, and the plantar SMI-VI had the highest diagnostic performance for CLI (sensitivity 88.6%, specificity 95.6%). After EVT, the increase in the SMI-VI was positively correlated with the increase in SPP but not that in the ABI, implying that the SMI-VI reflects foot microcirculation. (4) Conclusions: SMI enables the visualization and quantification of foot microcirculation based on the angiosome. SMI has high utility as a tool for assessing foot perfusion in CLI.
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Affiliation(s)
| | | | | | | | | | | | - Hiroyuki Watanabe
- Department of Cardiovascular Medicine, Akita University Graduate School of Medicine, Akita 010-8543, Japan
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Unno N, Inuzuka K, Sano M, Niwayama M, Naruse E, Takeuchi H. Real-time assessment of tissue oxygen saturation during endovascular therapy for chronic limb threatening ischemia using a novel oximeter. J Vasc Surg Cases Innov Tech 2022; 8:158-163. [PMID: 35372736 PMCID: PMC8967963 DOI: 10.1016/j.jvscit.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/02/2021] [Indexed: 10/30/2022] Open
Abstract
In the present study, we have introduced a novel real-time, near-infrared spectroscopy oximeter, the TOE-20 (Astem, Co, Ltd, Kawasaki, Japan), which can simultaneously measure the regional tissue oxygen saturation (rSO2) in the skin and subcutaneous tissue at three angiosomes of the foot. Seven patients with chronic limb threatening ischemia who had undergone successful revascularization of the superficial femoral artery were included. The analysis revealed a significant correlation between the rSO2 and skin perfusion pressure. After revascularization, the rSO2 and skin perfusion pressure had both increased at the three regions, although the increase at the plantar foot was insignificant. These results indicate that the TOE-20 can be successfully used to monitor the rSO2 during endovascular treatment.
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Unno N, Inuzuka K, Yamamoto N, Sano M, Katahashi K, Kayama T, Yata T, Yamanaka Y, Tsuyuki H, Endo Y, Ishikawa N, Naruse E, Niwayama M, Takeuchi H. The Patency of Tibial/Peroneal Arteries Affects the Increment of Regional Tissue Saturation of Oxygen in Each Angiosome after Superficial Femoral Artery Revascularization. Ann Vasc Dis 2022; 15:14-21. [PMID: 35432658 PMCID: PMC8958393 DOI: 10.3400/avd.oa.21-00097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/01/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: The angiosome model is a controversial concept in the revascularization of patients with chronic limb-threatening ischemia (CLTI). The aim of this study was to demonstrate the importance of patency of the tibial/peroneal arteries for regional tissue oxygenation in each angiosome during endovascular therapy (EVT) of the superficial femoral artery (SFA). Materials and Methods: We devised a novel near-infrared spectroscopy oximeter, “TOE-20,” for real-time monitoring of regional tissue oxygen saturation (rSO2). Using TOE-20, we prospectively assessed rSO2 at each angiosome in 23 CLTI patients who underwent successful revascularization of the SFA. During EVT, three sensor probes were placed at the dorsal foot, plantar foot, and outer ankle for rSO2 monitoring. Results: At the end of EVT, rSO2 at all angiosomes was significantly elevated by SFA revascularization. The change in rSO2 in each angiosome was larger in patients with patent relevant arteries than in those with occluded relevant arteries (i.e., anterior tibial artery patency, posterior tibial artery patency, and peroneal artery patency). Conclusion: The patency of the tibial/peroneal arteries is important for regional tissue oxygenation in EVT. Using TOE-20 and rSO2-based revascularization, it may possible to anticipate whether an ischemic ulcer will heal or not.
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Affiliation(s)
- Naoki Unno
- Division of Vascular Surgery, Hamamatsu University School of Medicine
| | - Kazunori Inuzuka
- Division of Vascular Surgery, Hamamatsu University School of Medicine
| | | | - Masaki Sano
- Division of Vascular Surgery, Hamamatsu University School of Medicine
| | - Kazuto Katahashi
- Division of Vascular Surgery, Hamamatsu University School of Medicine
| | - Takafumi Kayama
- Division of Vascular Surgery, Hamamatsu University School of Medicine
| | - Tatsuro Yata
- Division of Vascular Surgery, Hamamatsu Medical Center
| | - Yuta Yamanaka
- Division of Vascular Surgery, Hamamatsu University School of Medicine
| | - Hajime Tsuyuki
- Division of Vascular Surgery, Hamamatsu University School of Medicine
| | - Yusuke Endo
- Division of Vascular Surgery, Hamamatsu University School of Medicine
| | - Nozomu Ishikawa
- Division of Vascular Surgery, Hamamatsu University School of Medicine
| | - Ena Naruse
- Division of Vascular Surgery, Hamamatsu University School of Medicine
| | - Masatsugu Niwayama
- Department of Electrical and Electronic Engineering, Shizuoka University
| | - Hiroya Takeuchi
- Second Department of Surgery, Hamamatsu University School of Medicine
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