Reference value of transcutaneous oxygen measurement in diabetic patients compared with nondiabetic patients

Meijer, Vincent E de; Sant, Hans Pieter van't; Spronk, Sandra; Kusters, Freek J.; Hoed, P.T. den

doi:10.1016/j.jvs.2008.03.010

Cited by 44 publications

(54 citation statements)

References 31 publications

(27 reference statements)

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“…TcPO2 is a noninvasive and highly reproducible measure of skin oxygenation and reflects very well the metabolic state of lower limbs (10–12). Given that TcPO2 measurement is not affected by arterial calcification, it is particularly useful in evaluating and managing vascular disease in diabetic patients (13).…”

Section: Discussionmentioning

confidence: 99%

“…Given that TcPO2 measurement is not affected by arterial calcification, it is particularly useful in evaluating and managing vascular disease in diabetic patients (13). Several studies have analyzed the use of TcPO2 measurement in determining amputation level, the need of revascularization (11,12,26), and wound healing evaluation (11,12,27), but no studies are available in the literature about the use of TcPO2 as a predictor of cardiovascular events. The main original findings of our investigation are that there is a strong independent association between TcPO2 and future occurrence of MACE and that this association is stronger than that between ABI and MACE.…”

Section: Discussionmentioning

confidence: 99%

“…Transcutaneous oxygen tension (TcPO2) is a noninvasive method to measure tissue perfusion: it reflects very well the metabolic state of lower limbs (10,11). TcPO2 is currently used in clinical practice in the management of the vascular diabetic foot (11,12); in particular, it is important in determining amputation level, wound healing evaluation, and revascularization procedures (11,12). TcPO2 is not affected by arterial calcification and is particularly useful in evaluating PAD in diabetic patients (13); in addition, it has a good reproducibility (10–12).…”

mentioning

confidence: 99%

“…TcPO2 is currently used in clinical practice in the management of the vascular diabetic foot (11,12); in particular, it is important in determining amputation level, wound healing evaluation, and revascularization procedures (11,12). TcPO2 is not affected by arterial calcification and is particularly useful in evaluating PAD in diabetic patients (13); in addition, it has a good reproducibility (10–12). Nevertheless, there is not thus far a universally recognized specific cutoff of TcPO2 for the diagnosis of PAD (11).…”

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confidence: 99%

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Transcutaneous Oxygen Tension as a Potential Predictor of Cardiovascular Events in Type 2 Diabetes

Gazzaruso

Coppola²,

Falcone

et al. 2013

Diabetes Care

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OBJECTIVETranscutaneous oxygen tension (TcPO2) measures tissue perfusion and is important in the management of peripheral artery disease (PAD). Ankle brachial index (ABI) is used for the diagnosis of PAD and represents a predictor of major adverse cardiovascular events (MACE), even if in diabetes its diagnostic and predictive value seems to be reduced. No study has evaluated TcPO2 as a predictor of cardiovascular events. Aim of this longitudinal study was to assess whether TcPO2 is better than ABI at predicting MACE in type 2 diabetic patients.RESEARCH DESIGN AND METHODSAmong 361 consecutive patients with apparently uncomplicated diabetes, 67 MACE occurred during a follow-up period of 45.8 ± 23.2 months.RESULTSThe percentage of both subjects with low ABI (≤0.9) and subjects with low TcPO2 (≤46 mmHg as measured by a receiver operating characteristic curve) was significantly (<0.001) greater among patients with than among those without MACEs (ABI 64.2 vs. 40.8; TcPO2 58.2 vs. 34%). The Kaplan-Meier method showed that both low ABI (Mantel log-rank test, 4.087; P = 0.043) and low TcPO2 (Mantel log-rank test, 33.748; P > 0.0001) were associated with a higher rate of MACEs. Cox regression analysis showed that low TcPO2 (hazard ratio 1.78 [95% CI 1.44–2.23]; P < 0.001) was a significant predictor of MACE, while ABI did not enter the model.CONCLUSIONSThis longitudinal study showed that TcPO2 may be a potential predictor of MACE among patients with uncomplicated type 2 diabetes and that its predictive value seems to be greater than that of ABI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Transcutaneous Oxygen Tension as a Potential Predictor of Cardiovascular Events in Type 2 Diabetes

Gazzaruso

Coppola²,

Falcone

et al. 2013

Diabetes Care

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“…TcPO 2 will be measured by an electrochemical transducer (TCM 400, Radiometer K.K., Tokyo) as previously described. 26,27) Briefly, skin at the measured site will be shaved and cleaned with alcohol to ensure optimal TcPO 2 electrode contact for skin oxygen diffusion. The TcPO 2 electrodes stabilized at 43°C will then be placed on the skin at the measured site.…”

Section: Measurementsmentioning

confidence: 99%

Effect of a Low-Intensity Pulsed Ultrasound Device, SX-1001, on Clinical Symptoms in Buerger Disease With Limb Ischemia

Higashi

Azuma

Takeishi³

et al. 2015

Int. Heart J.

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Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review

Chuter

Schaper

Mills

et al. 2023

Diabetes Metabolism Res

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As a progressive disease process, early diagnosis and ongoing monitoring and treatment of lower limb peripheral artery disease (PAD) is critical to reduce the risk of diabetes‐related foot ulcer (DFU) development, non‐healing of wounds, infection and amputation, in addition to cardiovascular complications. There are a variety of non‐invasive tests available to diagnose PAD at the bedside, but there is no consensus as to the most diagnostically accurate of these bedside investigations or their reliability for use as a method of ongoing monitoring. Therefore, the aim of this systematic review was to first determine the diagnostic accuracy of non‐invasive bedside tests for identifying PAD compared to an imaging reference test and second to determine the intra‐ and inter‐rater reliability of non‐invasive bedside tests in adults with diabetes. A database search of Medline and Embase was conducted from 1980 to 30 November 2022. Prospective and retrospective investigations of the diagnostic accuracy of bedside testing in people with diabetes using an imaging reference standard and reliability studies of bedside testing techniques conducted in people with diabetes were eligible. Included studies of diagnostic accuracy were required to report adequate data to calculate the positive likelihood ratio (PLR) and negative likelihood ratio (NLR) which were the primary endpoints. The quality appraisal was conducted using the Quality Assessment of Diagnostic Accuracy Studies and Quality Appraisal of Reliability quality appraisal tools. From a total of 8517 abstracts retrieved, 40 studies met the inclusion criteria for the diagnostic accuracy component of the review and seven studies met the inclusion criteria for the reliability component of the review. Most studies investigated the diagnostic accuracy of ankle ‐brachial index (ABI) (N = 38). In people with and without DFU, PLRs ranged from 1.69 to 19.9 and NLRs from 0.29 to 0.84 indicating an ABI <0.9 increases the likelihood of disease (but the extent of the increase ranges from a small to large amount) and an ABI within the normal range (≥0.90 and <1.3) does not exclude PAD. For toe‐brachial index (TBI), a threshold of <0.70 has a moderate ability to rule PAD in and out; however, this is based on limited evidence. Similarly, a small number of studies indicate that one or more monophasic Doppler waveforms in the pedal arteries is associated with the presence of PAD, whereas tri‐ or biphasic waveform suggests that PAD is less likely. Several forms of bedside testing may also be useful as adjunct tests and 7 studies were identified that investigated the reliability of bedside tests including ABI, toe pressure, TBI, transcutaneous oxygen pressure (TcPO2) and pulse palpation. Inter‐rater reliability was poor for pulse palpation and moderate for TcPO2. The ABI, toe pressure and TBI may have good inter‐ and intra‐rater reliability, but margins of error are wide, requiring a large change in the measurement for it to be considered a true change rather than error. There is currently no single bedside test or a combination of bedside tests that has been shown to have superior diagnostic accuracy for PAD in people with diabetes with or without DFU. However, an ABI <0.9 or >1.3, TBI of <0.70, and absent or monophasic pedal Doppler waveforms are useful to identify the presence of disease. The ability of the tests to exclude disease is variable and although reliability may be acceptable, evidence of error in the measurements means test results that are within normal limits should be considered with caution and in the context of other vascular assessment findings (e.g., pedal pulse palpation and clinical signs) and progress of DFU healing.

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Reference value of transcutaneous oxygen measurement in diabetic patients compared with nondiabetic patients

Cited by 44 publications

References 31 publications

Transcutaneous Oxygen Tension as a Potential Predictor of Cardiovascular Events in Type 2 Diabetes

Transcutaneous Oxygen Tension as a Potential Predictor of Cardiovascular Events in Type 2 Diabetes

Effect of a Low-Intensity Pulsed Ultrasound Device, SX-1001, on Clinical Symptoms in Buerger Disease With Limb Ischemia

Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review

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