TcPO2 as a Predictor of Limb Salvage or Amputation in Patients of Critical Limb Ischemia

Introduction: Critical limb-threatening ischemia presents a significant challenge in clinical management, often necessitating lower limb amputation if not managed promptly and effectively. A crucial aspect of managing CLTI involves determining the optimal level of amputation to maximize post-surgica...

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Main Authors: Rahul Merkhed, Vikram Patra, Rishi Dhillon, Rohit Mehra, CVNM Dattatreya, Ramandeep Kaur, Gagandeep Singh Vohra, Surjeet Dwivedi
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2024-12-01
Series:Indian Journal of Vascular and Endovascular Surgery
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Online Access:https://journals.lww.com/10.4103/ijves.ijves_79_24
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author Rahul Merkhed
Vikram Patra
Rishi Dhillon
Rohit Mehra
CVNM Dattatreya
Ramandeep Kaur
Gagandeep Singh Vohra
Surjeet Dwivedi
author_facet Rahul Merkhed
Vikram Patra
Rishi Dhillon
Rohit Mehra
CVNM Dattatreya
Ramandeep Kaur
Gagandeep Singh Vohra
Surjeet Dwivedi
author_sort Rahul Merkhed
collection DOAJ
description Introduction: Critical limb-threatening ischemia presents a significant challenge in clinical management, often necessitating lower limb amputation if not managed promptly and effectively. A crucial aspect of managing CLTI involves determining the optimal level of amputation to maximize post-surgical healing and functional outcomes. Among various non-invasive diagnostic tools, Transcutaneous Oximetry (TcPO2) has garnered attention, yet a consensus on predictive cutoff levels remains elusive in the literature. Aim and Objective: This study addresses this gap by investigating the predictive utility of TcPO2 in assessing healing outcomes following amputation or ulcer management, aiming to provide valuable insights for clinical practice and enhance patient outcomes in CLTI management. Methodology: It was conducted at a tertiary care centre in North India . Our study of 128 patients examines TcPO2 as a predictor for ulcer or amputation stump healing. By applying a cutoff of 40 mmHg, informed by previous retrospective studies suggesting its predictive efficacy, our approach seeks to standardise decision-making and optimise tissue oxygenation to improve clinical outcomes. Results: We found that a TcPO2 cutoff of 40 mmHg or higher significantly correlated with increased healing likelihood, whereas values below this threshold, particularly in patients with diabetes mellitus (DM) and chronic kidney disease (CKD), posed greater risks of non-healing outcomes. Discussion And Conclusion: This underscores the critical role of TcPO2 in assessing vascular compromise, especially in cases where conventional methods like ankle-brachial pressure index (ABPI) may be unreliable due to arterial calcifications. In our analysis, CKD and TcPO2 < 40 emerged as independent predictors of non-healing ulcers or stump in univariate regression. Interestingly, DM did not show a significant association with non-healing outcomes in this context. Moreover, in multivariate analysis, DM, CKD, and TcPO2 < 40 retained their significance as predictors of poor healing, with TcPO2 < 40 demonstrating the strongest association. Further prospective studies are warranted to validate these findings and establish robust correlations between TcPO2 values and clinical outcomes. Additionally, exploring the influence of various comorbidities and demographic factors could refine predictive models, offering tailored interventions for patients with CLTI.
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spelling doaj-art-2cd26987b6414573b0a665217555cac12025-01-10T10:35:19ZengWolters Kluwer Medknow PublicationsIndian Journal of Vascular and Endovascular Surgery0972-08202394-09992024-12-0111424925510.4103/ijves.ijves_79_24TcPO2 as a Predictor of Limb Salvage or Amputation in Patients of Critical Limb IschemiaRahul MerkhedVikram PatraRishi DhillonRohit MehraCVNM DattatreyaRamandeep KaurGagandeep Singh VohraSurjeet DwivediIntroduction: Critical limb-threatening ischemia presents a significant challenge in clinical management, often necessitating lower limb amputation if not managed promptly and effectively. A crucial aspect of managing CLTI involves determining the optimal level of amputation to maximize post-surgical healing and functional outcomes. Among various non-invasive diagnostic tools, Transcutaneous Oximetry (TcPO2) has garnered attention, yet a consensus on predictive cutoff levels remains elusive in the literature. Aim and Objective: This study addresses this gap by investigating the predictive utility of TcPO2 in assessing healing outcomes following amputation or ulcer management, aiming to provide valuable insights for clinical practice and enhance patient outcomes in CLTI management. Methodology: It was conducted at a tertiary care centre in North India . Our study of 128 patients examines TcPO2 as a predictor for ulcer or amputation stump healing. By applying a cutoff of 40 mmHg, informed by previous retrospective studies suggesting its predictive efficacy, our approach seeks to standardise decision-making and optimise tissue oxygenation to improve clinical outcomes. Results: We found that a TcPO2 cutoff of 40 mmHg or higher significantly correlated with increased healing likelihood, whereas values below this threshold, particularly in patients with diabetes mellitus (DM) and chronic kidney disease (CKD), posed greater risks of non-healing outcomes. Discussion And Conclusion: This underscores the critical role of TcPO2 in assessing vascular compromise, especially in cases where conventional methods like ankle-brachial pressure index (ABPI) may be unreliable due to arterial calcifications. In our analysis, CKD and TcPO2 < 40 emerged as independent predictors of non-healing ulcers or stump in univariate regression. Interestingly, DM did not show a significant association with non-healing outcomes in this context. Moreover, in multivariate analysis, DM, CKD, and TcPO2 < 40 retained their significance as predictors of poor healing, with TcPO2 < 40 demonstrating the strongest association. Further prospective studies are warranted to validate these findings and establish robust correlations between TcPO2 values and clinical outcomes. Additionally, exploring the influence of various comorbidities and demographic factors could refine predictive models, offering tailored interventions for patients with CLTI.https://journals.lww.com/10.4103/ijves.ijves_79_24amputationankle–brachial pressure indexchronic kidney diseasediabetes mellitushealingtcpo2ulcer
spellingShingle Rahul Merkhed
Vikram Patra
Rishi Dhillon
Rohit Mehra
CVNM Dattatreya
Ramandeep Kaur
Gagandeep Singh Vohra
Surjeet Dwivedi
TcPO2 as a Predictor of Limb Salvage or Amputation in Patients of Critical Limb Ischemia
Indian Journal of Vascular and Endovascular Surgery
amputation
ankle–brachial pressure index
chronic kidney disease
diabetes mellitus
healing
tcpo2
ulcer
title TcPO2 as a Predictor of Limb Salvage or Amputation in Patients of Critical Limb Ischemia
title_full TcPO2 as a Predictor of Limb Salvage or Amputation in Patients of Critical Limb Ischemia
title_fullStr TcPO2 as a Predictor of Limb Salvage or Amputation in Patients of Critical Limb Ischemia
title_full_unstemmed TcPO2 as a Predictor of Limb Salvage or Amputation in Patients of Critical Limb Ischemia
title_short TcPO2 as a Predictor of Limb Salvage or Amputation in Patients of Critical Limb Ischemia
title_sort tcpo2 as a predictor of limb salvage or amputation in patients of critical limb ischemia
topic amputation
ankle–brachial pressure index
chronic kidney disease
diabetes mellitus
healing
tcpo2
ulcer
url https://journals.lww.com/10.4103/ijves.ijves_79_24
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