Transcutaneous oxygen tension msonitoring after successful revascularization in diabetic patients with ischaemic foot ulcers

Caselli, Antonella; Latini, V.; Lapenna, A.; Carlo, Sara Di; Pirozzi, Flora; Benvenuto, Arianna; Uccioli, Luigi

doi:10.1111/j.1464-5491.2005.01446.x

Cited by 86 publications

(63 citation statements)

References 20 publications

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“…Patients were selected on the ability to be revascularized and treatment was successful in more than two thirds of patients who were able to leave the stage of CLI after one month. It is striking that TcPO2 and toe pressure increased as expected as already shown in literature [20][21][22], whereas we could not show any signifi cant diff erence regarding any of the CEUS parameters before and after revascularization, even if it was performed upstream of the measurement area.…”

Section: Correlationssupporting

confidence: 62%

“…Other parameters such as time intensity curve refl ecting blood volume and blood fl ow in the muscular interest zone did not change as well. It is known that improvement of microcirculation after revascularization may be prolonged as shown by delayed increase after one month of TcPO2 [21]. Delay cannot be the cause since the second measure was made one month into our study, whereas change was immediate in the study by Duerschmied et al [11] but with less seriously ill patients [4,18].…”

Section: Correlationsmentioning

confidence: 50%

“…In the 21 patients with comparative measurements, mean TcPO2 improved from 20 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) to 43 (27-56) mm Hg at one month (P = 0.007) and mean toe pressure from 32 to 54 mm Hg (P = 0.002) (Figure 2). …”

Section: Discussionmentioning

confidence: 99%

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Is contrast enhanced ultrasonography a useful tool for the evaluation of muscular microcirculation in patients with critical limb ischaemia?

Seinturier

Blaise

Pichot

et al. 2017

Vasa

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Summary:Background: Evaluation of skin microcirculation in patients with critical limb ischemia (CLI) may be achieved by the measurement of transcutaneous oxygen pressure or skin perfusion pressure, but there is no practical method available for the evaluation of muscle microcirculation. Contrast enhanced ultrasonography (CEUS) has been used to assess muscle perfusion in patients with peripheral arterial disease. We conducted a monocentric pilot study evaluating the ability of CEUS to assess the impact of arterial revascularization on the perfusion of the calf muscle in patients with CLI. Patients and methods: Patients with CLI (TASC II criteria) and a possibility of proximal or medial revascularization were included. In addition to TcPO2 and toe systolic blood pressure measurements, CEUS of the calf muscle was performed just before and one month after the therapeutic procedure. Parameters derived from muscular perfusion curves were evaluated in a blinded fashion and compared with the clinical outcome. Results: Thirty eight patients were included (74 % men, median age 71 years, 53 % diabetics). Thirty benefi ted from revascularization with a clinical success rate of 70 %. Twenty three patients could benefi t from analysis before and after revascularization. No signifi cant difference was shown in time to peak (22.3 s vs 24.0 s, P = 0.61) nor in peak intensity (2.30 dB vs 1.27 db, P = 0,26), contrasting with signifi cant improvements of TcPO2 (43 mm Hg vs 20 mm Hg, P = 0.007) and toe systolic blood pressure (54 mm Hg vs 32 mm Hg, P = 0.002). Conclusions: The evaluation of muscular microvascular perfusion by CEUS as performed in this study is not enough sensitive to change to allow a clinically relevant evaluation of the improvement in muscle microvascular perfusion in patients with CLI benefi ting from revascularization procedures.

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Section: Correlationssupporting

confidence: 62%

Section: Correlationsmentioning

confidence: 50%

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Is contrast enhanced ultrasonography a useful tool for the evaluation of muscular microcirculation in patients with critical limb ischaemia?

Seinturier

Blaise

Pichot

et al. 2017

Vasa

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“…The parameters were derived from experimental values found in the literature or estimated such that the system behaved in a biologically appropriate manner. 10,17,18 We performed several in silico experiments to investigate the effects of (i) varying the amount of initial damage, D(0), and the initial pathogen levels, P(0), and (ii) varying certain parameters such as the tissue oxygenation level O 2 and the rate of fibroblast recruitment s f .…”

Section: Simulationsmentioning

confidence: 99%

“…17,18 If the tissue oxygen level is above the critical value, p growth is fixed at 0.3. This is because the effects of hyperbaric oxygen on wound healing are not included in this model.…”

Section: Pathogen Equationmentioning

confidence: 99%

An in silico approach to the analysis of acute wound healing

Menke¹,

Cain

Reynolds

et al. 2010

Wound Repair and Regeneration

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The complex interactions that characterize acute wound healing have stymied the development of effective therapeutic modalities. The use of computational models holds the promise to improve our basic approach to understanding the process. By modifying an existing ordinary differential equation model of systemic inflammation to simulate local wound healing, we expect to improve the understanding of the underlying complexities of wound healing and thus allow for the development of novel, targeted therapeutic strategies. The modifications in this local acute wound healing model include: evolution from a systemic model to a local model, the incorporation of fibroblast activity, and the effects of tissue oxygenation. Using these modifications we are able to simulate impaired wound healing in hypoxic wounds with varying levels of contamination. Possible therapeutic targets, such as fibroblast death rate and rate of fibroblast recruitment, have been identified by computational analysis. This model is a step toward constructing an integrative systems biology model of human wound healing.A soft tissue injury elicits a well-prescribed wound healing response.1,2 The process of wound healing is designed to restore anatomic and functional characteristics of the tissue; however, little progress has been made in improving the wound healing response time or in preventing complications such as fibrosis, infections, and formation of nonhealing wounds.3 In this paper, we describe a computational model of acute wound healing designed to allow a system-level analysis of the wound healing response using ordinary differential equations (ODEs). As a first step to a more comprehensive model, we have explored the combined effects of bacterial infections, inflammation, and tissue hypoxia on the rate and success of wound healing since these processes are well-known as affecters of healing. As this model matures, it will provide the opportunity to test new mechanisms and novel therapeutics of wound healing strategies in silico.Despite burgeoning interest in the field of computational biology, work of limited scope has been published on modeling the acute wound. Most of these studies show the difficulties of adequately accounting for the myriad of potential interactions. 4 For example, in their respective works on epidermal wound healing, Stekel et al., 5 Walker et al., 6 and Morel et al. 7 do not attempt to simulate healing by fibroblasts and do not implement inflammatory changes in their models. Dallon et al. 8 constructed an ODE model of collagen deposition focusing on the fibroblasts and their relationship to the underlying extracellular matrix, but do not account for inflammation or repair of underlying tissue damage. Schugart et al. 9 recently published a model of wound angiogenesis as a function of tissue oxygen tension but the model does not specifically address the wound healing process.Reynolds et al. 10,11 created an ODE model designed to simulate inflammation and repair on a systemic level in the setting of a systemic ins...

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Indications and clinical outcomes for below knee endovascular therapy: Review article

Graziani

Piaggesi

2009

Cathet Cardio Intervent

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Chronic critical limb ischemia (CLI) still represents the most common cause for amputation and frequently the possibility for peripheral revascularization, particularly in below knee (BK) arteries, is not adequately evaluated before amputation. This may also be due to the fact that even today, there's some confusion about results of the endovascular treatment in this territory. Diabetics, representing the population most frequently affected by CLI, have specific clinical characteristics, the so called diabetic foot syndrome, which cannot be compared with the situation in nondiabetic patients with ischemic ulcers. Measuring the success of BK endovascular therapy can be a difficult issue, considering that it is often the work of a multidisciplinary team. The clinical benefit of BK endovascular therapy often shows a large discrepancy from the primary patency. While ulcer healing, limb salvage, and reintervention rates are usually low after BK endovascular therapy, rates of restenosis remain excessively high. Nevertheless, the positive impact of revascularization on mortality, which mainly depends on the major amputation rate reduction, is also evident. This review article summarizes indications and clinical outcomes after BK endovascular therapy with special attention to the role of diabetes mellitus in patients with CLI.

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Transcutaneous oxygen tension msonitoring after successful revascularization in diabetic patients with ischaemic foot ulcers

Cited by 86 publications

References 20 publications

Is contrast enhanced ultrasonography a useful tool for the evaluation of muscular microcirculation in patients with critical limb ischaemia?

Is contrast enhanced ultrasonography a useful tool for the evaluation of muscular microcirculation in patients with critical limb ischaemia?

An in silico approach to the analysis of acute wound healing

Indications and clinical outcomes for below knee endovascular therapy: Review article

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