Predictive Values of Transcutaneous Oxygen Tension for Above-the-ankle Amputation in Diabetic Patients with Critical Limb Ischemia

E. Faglia, G. Clerici, M. Caminiti, A. Quarantiello, V. Curci, A. Morabito

Research output: Contribution to journalArticle

Abstract

Objective: To assess the values of transcutaneous oxygen tension (TcPO2) capable of predicting above-the-ankle amputation in diabetic patients diagnosed for critical limb ischemia (CLI) according to the criteria of the TransAtlantic Inter-Society Consensus. Design: Retrospective study. Methods: From January 1999 to December 2003, 564 diabetic patients were consecutively hospitalized for CLI in one limb. Revascularization with angioplasty or bypass graft was performed when possible and, if not possible, prostanoid therapy was used. In patients in whom therapies did not relieve the rest pain or the gangrene was extended above the Chopart joint, an above-the-ankle-amputation was performed. After treatment TcPO2 values were evaluated in all patients at the dorsum of the foot. Results: Fifty-five (9.8%) patients underwent an above-the-ankle amputation: 22 of 420 patients who underwent angioplasty, 17 of 117 patients who underwent bypass (14.5%) and 16 of 27 patients in whom revascularization was not possible. Post-treatment TcPO2, measured by a receiver operating characteristic (ROC) curve, showed a value 34 mmHg as the best threshold for determining the need for revascularization, with an area under the curve of 0.89 (95%CI 0.85-0.94). Using logistic regression analysis the probability of above-the-ankle amputation for this threshold is 9.7% and reduces to 3% for TcPO2 > 40 mmHg. Conclusion: TcPO2 levels <34 mmHg indicate the need for revascularization, while for values ≥ 34 <40 mmHg this need appears less pressing, although there remains a considerable probability of amputation. TcPO2 levels greater than 40 mmHg suggest that revascularization is dependent on the severity of tissue loss and possible morbidity caused by the procedure.

Original languageEnglish
Pages (from-to)731-736
Number of pages6
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume33
Issue number6
DOIs
Publication statusPublished - Jun 2007

Keywords

  • Critical limb ischemia
  • Diabetic foot
  • Major amputation
  • Peripheral arterial occlusive disease
  • Revascularization
  • TransAtlantic Inter-Society Consensus parameters
  • Transcutaneous oxygen tension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Surgery

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