Stimulation TcPO2 Testing Improves Diagnosis of Peripheral Arterial Disease in Patients With Diabetic Foot

Abstract

BackgroundAll diagnostic procedures of peripheral arterial disease (PAD) in diabetic foot (DF) are complicated due to diabetes mellitus and its late complications.The aim of our study is to enhance diagnosis of PAD using a novel transcutaneous oximetry (TcPO2) stimulation test.MethodsThe study comprised patients with mild-to-moderate PAD(WIfI–I 1 or 2) and baseline TcPO2 values of 30-50 mmHg.TcPO2 was measured across 107 different angiosomes. Stimulation examination involved a modification of the Ratschow test. All patients underwent PAD assessment (systolic blood pressures (SBP), toe pressures (TP), the ankle-brachial indexes (ABI) and toe-brachial indexes (TBI), duplex ultrasound of circulation). Angiosomes were divided into two groups based on ultrasound findings: group M(n=60) with monophasic flow; group T(n=47) with triphasic flow. Large vessel parameters and TcPO2 at rest and after exercise (minimal TcPO2, changes in TcPO2 from baseline (Δ,%), TcPO2 recovery time) measured during the stimulation test were compared between study groups.ResultsDuring the TcPO2 stimulation exercise test, group M exhibited significantly lower minimal TcPO2 (26.2 ± 11.1 vs. 31.4 ± 9.4 mmHg; p<0.01), greater Δ and percentage decreases from resting TcPO2 (p=0.014 and p=0.007, respectively) and longer TcPO2 recovery times (446 ± 134 vs. 370 ± 81ms;p=0.0005) compared to group T. SBPs, TPs and indexes were significantly lower in group M compared to group T. Sensitivity and specificity of TcPO2 stimulation parameters during PAD detection increased significantly to the level of SBP, ABI, TP and TBI.ConclusionCompared to resting TcPO2, TcPO2 measured during stimulation improves detection of latent forms of PAD and restenosis/obliterations of previously treated arteries in diabetic foot patients.Clinical Trial RegistrationClinicalTrials.gov [https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009V7W&selectaction=Edit&uid=U0005381&ts=2&cx=3j24u2], identifier NCT04404699

Clinical Characteristics of Lower-Limb Ischemia in Japanese Patients with Type 2 Diabetes and Usefulness of the Great Toe Blood Flow as a Predictive Indicator of Leg Arterial Obstruction

“…In addition, the difference in TcPO 2 was not detected among the three groups. Fejfarová et al [ 21 ] performed a similar study using a transcutaneous O 2 /CO 2 gas monitor against 107 diabetic patients with mild-to-moderate PAD and reported a mild ischemic foot with a TcPO 2 value of 41.0 mmHg. They also employed TcPO 2 measurement after the modified Ratschow stimulation test to elucidate an impairment of lower-leg blood flow, including latent PAD and restenosis/obliteration.…”

“…The Ratschow test included elevating the lower limbs (30 cm above the bed), followed by rhythmic maximal plantarflexion and extension of the talocrural joints for 2 min to decrease O 2 supply and increase O 2 consumption of the limbs. The percentage of TcPO 2 reduction after the modified Ratschow stimulation test was 30.7%, and the duration of TcPO 2 recovery was 4415 s [ 21 ]. The sensitivity of resting TcPO 2 was very low for PAD diagnosis; however, when the TcPO 2 measurement was augmented by the modified Ratschow test, the sensitivity and specificity of all TcPO 2 stimulation parameters increased significantly by up to 25% and 11%, respectively [ 21 ].…”

“…The percentage of TcPO 2 reduction after the modified Ratschow stimulation test was 30.7%, and the duration of TcPO 2 recovery was 4415 s [ 21 ]. The sensitivity of resting TcPO 2 was very low for PAD diagnosis; however, when the TcPO 2 measurement was augmented by the modified Ratschow test, the sensitivity and specificity of all TcPO 2 stimulation parameters increased significantly by up to 25% and 11%, respectively [ 21 ]. We verified the significance of TcPO 2 after the modified Ratschow stimulation, however the Ratschow stimulation is difficult to use in nursing science and daily clinical practice because the test carries a high risk to aggravate the leg ischemia.…”

Diagnosis of Skin Vascular Complications Revealed by Time-Frequency Analysis and Laser Doppler Spectrum Decomposition

“…At the moment, several techniques with evaluated efficiency have been developed. Transcutaneous oximetry (TcPO 2 ) and techniques based on the use of coherent light, such as LDF and laser speckle contrast imaging (LSCI), can be accepted as the closest diagnostic technologies which can be directly compared with the presented results [59]. The application of TcPO 2 measurements has been demonstrated for the detection of circulatory problems leading to peripheral artery disease (PAD) and diabetic foot ulcers.…”

Guide for the non-invasive study of chronic ischemia of the lower limbs

“…La TcPO 2 proporciona información de la macrocirculación y fundamentalmente de la microcirculación, porque refleja el estado metabólico tisular, ya que determina la cantidad de oxígeno arterial, el consumo de oxígeno, la presión arterial, la presión de perfusión y la función neurovascular de los tejidos estudiados, principalmente de la piel (11,(17)(18)(19). Su valor depende del flujo sanguíneo, de la actividad metabólica, de la disociación de la oxihemoglobina y de la difusión del oxígeno a través de los tejidos (1,2).…”