INFRAPOPLITEAL TRANSCATHETER INTERVENTIONS FOR LIMB SALVAGE IN DIABETIC-PATIENTS - IMPORTANCE OF AGGRESSIVE INTERVENTIONAL APPROACH AND ROLE OF TRANSCUTANEOUS OXIMETRY

Objectives. This study sought to determine whether infrapopliteal tran scatheter interventions can salvage ischemic limbs in diabetic patient s referred for below the knee amputation at our institution. Backgroun d. The value of transcatheter interventions in diabetic crural arterie s is controversial, Tissue oxygen partial pressure (TcO2) levels <40 m m Hg predict poor wound healing. Methods. Percutaneous interventions w ere performed in 29 consecutive diabetic patients in need of limb salv age, Technical success was defined as <20% residual vessel stenosis. C linical success was defined as the avoidance of amputation and achieve ment of wound healing, At hospital discharge, patients were treated wi th Coumadin and aspirin, Ankle-brachial index (ABI) and TcO2 measureme nts were obtained before and after the intervention. Results. After 12 -month follow-up, six patients had persistent wounds, whereas 23 exper ienced wound healing, Forty of the 50 infrapopliteal arteries successf ully dilated were occluded, with a mean (+/-SD) lesion length of 18.0 +/- 3.5 cm, After the procedure, TcO2 improved from 27.82 +/- 9.97 mm Hg (95% confidence interval [CI] 23.95 to 31.69) to 54.5 +/- 14.73 mm Hg (95% CI 48.79 to 60.21, p < 0.0001), whereas the ABI did not (p > 0 .2), TcO2 predicted procedural and clinical success (p < 0.0182). Conc lusions. Infrapopliteal transcatheter interventions in diabetic patien ts may salvage the majority of limbs doomed to amputation. Although Tc O2 measurements are valuable in predicting wound healing and success a fter interventions, ABI measurements are not. (C) 1997 by the American College of Cardiology.