Comparison of transcutaneous oximetry, vascular hemodynamic measurements, angiography, and clinical findings to predict the success of peripheral vascular reconstruction.
The present study examined prospectively the prognostic value of preoperative clinical findings, angiography, and conventional vascular hemodynamic and transcutaneous oximetry measurements in a consecutive series of patients undergoing lower extremity vascular reconstruction. A total of 25 variables were independently evaluated in each limb. Follow-up at least 6 months after operation was carried out in all patients. The postocclusive transcutaneous oxygen recovery time was found to be the most accurate predictor of short-term femoropopliteal bypass graft success. Preoperative foot transcutaneous oxygen recovery time values were significantly worse in patients whose femoropopliteal bypass grafts failed than in those in whom the outcome was successful (p less than 0.03). Transcutaneous oxygen recovery time values were also valuable in patients who underwent aortofemoral bypass; patients with isolated aortoiliac disease had significantly better foot transcutaneous oxygen recovery time values than those with combined aortoiliac and femoropopliteal disease (p less than 0.05). Foot transcutaneous oxygen recovery time values were also found to correlate well with the severity of symptoms (p less than 0.01), as did ankle-brachial Doppler pressure indices. Although the other variables analyzed provided useful diagnostic information, none were as accurate as the postocclusive transcutaneous oxygen recovery time in predicting the outcome of peripheral vascular reconstruction. As a means of more accurately classifying patients with peripheral vascular disease, we recommend the complimentary use of clinical findings, angiography, and hemodynamic and transcutaneous oximetry measurements. Because transcutaneous oxygen tension reflects the balance between local oxygen supply and demand, it may help to better define risk factors preoperatively in physiologic terms.
Kram
H B
HB
Department of Surgery, King-Drew Medical Center, Los Angeles, California 90059.
Appel
P L
PL
Shoemaker
W C
WC
D000368:Aged; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D001158:Arteries / Q000503:physiopathology / Q000601:surgery*; D001785:Blood Gas Monitoring, Transcutaneous; D001807:Blood Vessel Prosthesis; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography