Increase in skin perfusion pressure predicts amputation-free survival after lower extremity bypass surgery for critical limb ischemia

Yamamoto, Kota; Kawahara, Takuya; Akai, Atsushi; Isaji, Toshihiko; Akagi, Daisuke; Miyahara, Takuya; Hoshina, Katsuyuki

doi:10.1177/1358863x18760181

Cited by 6 publications

(10 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For endpoints dependent upon macrovascular function, such as the likelihood of major amputation, limb salvage, and overall survival, the predictive ability of SPP is less consistent. While some studies 16 have demonstrated an association of post-procedural SPP to AFS, other studies, 15 including the present study by Yamamoto and colleagues, 14 have not. Such discrepancies reflect the challenge in predicting major amputation and AFS among a complex population with many factors influencing such outcomes.…”

contrasting

confidence: 53%

“…In this edition of Vascular Medicine , Yamamoto and colleagues explore the utility of SPP in a real-world, single-center, retrospective experience of 192 Japanese patients with SPP assessment before and after 223 consecutive lower extremity bypass surgeries. 14 Patients with CLI, as confirmed by a SPP < 40 mmHg, were offered open surgical revascularization. Baseline SPP was indicated by the lower of a plantar and dorsal SPP measurement on the ipsilateral foot.…”

mentioning

confidence: 99%

“…Endpoints of the analysis included AFS, limb salvage, and survival estimated out to 5 years. 14 Endpoints were analyzed among a selected population of 163 patients receiving 189 bypass surgeries for TASC C or D stenosis with confirmed postoperative graft patency. Post-revascularization SPP ≥ 40 mmHg was, in fact, not associated with improvement in any of these outcomes.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Resolving the high stakes of limb salvage with skin perfusion pressure

Bunte

Shishehbor

2018

Vasc Med

View full text Add to dashboard Cite

Perfusion assessment is a cornerstone of the management of critical limb ischemia (CLI), and is recommended by contemporary guidelines to direct treatment. 1 However, important limitations exist when applying physiologic vascular testing suitable for the evaluation of claudication (i.e. ankle-brachial index [ABI]) to assess perfusion for the patient with CLI. Indeed, the shortcomings of ankle systolic assessment for CLI have been well established. [2][3][4] Therefore, perfusion assessment for CLI requires unique physiologic testing sensitive to regional blood flow while remaining reliable despite arterial calcification.Medial arterial calcification, common to patients with CLI-associated diabetes and chronic kidney disease, falsely elevates the ankle systolic blood pressure and represents the greatest limitation to non-invasive testing. Toe systolic pressure, transcutaneous oximetry (TCOM), and skin perfusion pressure (SPP) are the currently recommended tests to assess limb perfusion in CLI. 1 However, these tests favored for CLI are inconsistently available and preference for one test over the other is not explicitly directed by current guidelines. But which of these tests might offer the most meaningful information to save a threatened limb from CLI?Skin perfusion pressure (SPP) is a non-invasive test of regional perfusion able to assess the severity of tissue ischemia, the prognosis for ulcer healing, and as a predictor for the appropriate level of amputation. 5,6 As a measure of microperfusion at a depth 1-2 mm below the skin's surface, SPP is unaffected by medial arterial calcification, making the measure particularly suitable among patients with complex peripheral artery disease (PAD). 6,7 SPP is defined as the minimal external pressure on the skin at which capillary blood flow is present during external cuff pressure applied immediately proximal to the local zone of flow assessment. 7 During stepwise reduction in external compression, the pressure at which microcirculatory flow resumes, which is assumed to represent SPP, can then be detected by one of three techniques, including radioisotope clearance, photoplethysmography, and laser Doppler. 8 In contemporary practice, laser Doppler SPP serves as a reasonable surrogate for toe systolic pressure when the latter is not attainable, such as in the case of transmetatarsal amputation. 9 SPP values above 30 mmHg, 5,6,10 and more generally above 40 mmHg, [11][12][13] have been proposed as a mark of adequate perfusion, above which healing is more likely. The combination of SPP > 40 mmHg and toe systolic pressure > 30 mmHg is associated with particularly high rates of healing. 12 While SPP also correlates with TCOM, significant variability exists in the results of TCOM at low perfusion pressure. 7,8,12 So, is SPP the under-promoted answer to assessing limb perfusion in CLI?To help understand that question, the results of several important studies have recently been published. In this edition of Vascular Medicine, Yamamoto and colleagues explore the utility of SPP i...

show abstract

contrasting

confidence: 53%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Resolving the high stakes of limb salvage with skin perfusion pressure

Bunte

Shishehbor

2018

Vasc Med

View full text Add to dashboard Cite

show abstract

“…54 In a study by Yamamoto et al, the authors have found that an increase in SPP of 20 mm Hg after bypass surgery was associated with better limb prognosis. 55 Novel noninvasive techniques include the oxygen-to-see method, which is an optical measuring technique that combines white light spectrometry and laser Doppler flowmetry, mapping oxygen saturation, relative hemoglobin, and blood flow in target tissues. More interestingly, indocyanine green fluorescence imaging (ICG-FI) enables the visualization of perfusion of the entire foot and quantifies the washout of ICG in the peripheral tissues.…”

Section: Risk Stratification Models and Time To Heal Predictors Aftermentioning

confidence: 99%

“…54 In a study by Yamamoto et al, the authors have found that an increase in SPP of ≥20 mm Hg after bypass surgery was associated with better limb prognosis. 55…”

Section: Introductionmentioning

confidence: 99%

Predictors of Wound Healing Following Revascularization for Chronic Limb-Threatening Ischemia

Antonopoulos

Lazaris

Venermo

et al. 2019

Vasc Endovascular Surg

View full text Add to dashboard Cite

Objectives: After surgical or endovascular revascularization, some ischemic lesions will not heal, while some others will heal at a variable period of time from the intervention, indicating a multifactorial interaction between local and systematic “wound healing–promoting” factors. Our objective was to identify predictors of wound healing following revascularization for chronic limb-threatening ischemia (CLTI). Methods: A literature review was performed to identify published research concerning clinical, biochemical, and noninvasive methods as predictors of wound healing time and wound-free period after surgical and endovascular revascularization for CLTI. Results: Our review indicated that potential predictors included local wound factors, wound depth, patient’s comorbidities, medications, smoking and alcohol abuse, poor vessel runoff, and direct versus indirect revascularization. Among the clinical biomarkers, platelet-derived growth factor, transforming growth factor β, basic fibroblast growth factor, tumor necrosis factor α, interleukin (IL) 1, and IL-6 have been proposed as potential predictors. Furthermore, the potential of noninvasive microcirculation assessment to predict proper wound healing has been the topic of extensive investigation. Among the novel methods, transcutaneous measurement of oxygen partial pressure, skin perfusion pressure, oxygen-to-see method, indocyanine green fluorescence imaging, and multispectral optoacoustic tomography have shown promising results. Conclusions: The risk factor profile of an ischemic lesion in the lower extremities with a delayed/failed healing response, following a successful revascularization, is not fully clarified. Although many predictors have been assessed so far, further research needs to be done to identify the optimal clinical and biochemical indices and the noninvasive technique assessing the microcirculation that is associated with complete wound healing.

show abstract

Blood Oxygen Level‐Dependent MR Imaging of Lower Extremities in Peripheral Artery Disease and Its Correlation With Walking Performance

Liu

Shao

et al. 2023

Magnetic Resonance Imaging

View full text Add to dashboard Cite

BackgroundA noninvasive and reliable approach to quantitatively measure muscle perfusion of lower extremity is needed to aid the diagnosis and treatment of peripheral artery disease (PAD).PurposeTo verify the reproductivity of using blood oxygen level‐dependent (BOLD) imaging to evaluate perfusion in lower extremities, and explore its correlation with walking performance in patients with PAD.Study TypeProspective observational study.SubjectsSeventeen patients with lower extremity PAD (mean age: 67 ± 6 years, 15 males) and eight older adults (controls).Field Strength/SequenceDynamic multi‐echo gradient echo T2* weighted imaging at 3T.AssessmentPerfusion was analyzed in regions of interest according to muscle groups. Perfusion parameters were measured, such as minimum ischemia value (MIV), time to peak (TTP), and gradient during reactive hyperemia (Grad) by two independent users. Walking performance experiments including short physical performance battery (SPPB) and 6‐minute walk were tested in patients.Statistical TestsBOLD parameters were compared using Mann–Whitney U test and Kruskal–Wallis test. Relations between parameters and walking performance were assessed by Mann–Whitney U test and Spearman's correlation coefficient.ResultsGood to perfect agreement was demonstrated for all perfusion parameters of interuser reproducibility, and the interscan reproducibility of MIV, TTP, and Grad was good. The TTP of the patients was longer than that of the controls (87.85 ± 38.85 s vs. 36.54 ± 7.27 s), while the Grad of patients was smaller (0.16 ± 0.12 msec/s vs. 0.24 ± 0.11 msec/s). Among PAD patients, the MIV was significantly lower in the low SPPB subgroup (score 6–8) than in the high SPPB group (score 9–12), and the TTP was negatively correlated with 6‐minute walk distance (ρ = −0.549).Data ConclusionBOLD imaging method had overall good reproducibility for the perfusion assessment of calf muscles. The perfusion parameters were different between PAD patients and controls, and were correlated with lower extremity function.Evidence Level2Technical EfficacyStage 2

show abstract

Increase in skin perfusion pressure predicts amputation-free survival after lower extremity bypass surgery for critical limb ischemia

Cited by 6 publications

References 38 publications

Resolving the high stakes of limb salvage with skin perfusion pressure

Resolving the high stakes of limb salvage with skin perfusion pressure

Predictors of Wound Healing Following Revascularization for Chronic Limb-Threatening Ischemia

Blood Oxygen Level‐Dependent MR Imaging of Lower Extremities in Peripheral Artery Disease and Its Correlation With Walking Performance

Contact Info

Product

Resources

About