title: Infrapopliteal transcatheter interventions for limb salvage in diabetic patients: importance of aggressive interventional approach and role of transcutaneous oximetry.
abstract: OBJECTIVE
  This study sought to determine whether infrapopliteal transcatheter interventions can salvage ischemic limbs in diabetic patients referred for below the knee amputation at our institution.
  
  
  BACKGROUND
  The value of transcatheter interventions in diabetic crural arteries is controversial. Tissue oxygen partial pressure (TCO2) levels < 40 mm Hg predict poor wound healing.
  
  
  METHODS
  Percutaneous interventions were performed in 29 consecutive diabetic patients in need of limb salvage. Technical success was defined as < 20% residual vessel stenosis. Clinical success was defined as the avoidance of amputation and achievement of wound healing. At hospital discharge, patients were treated with Coumadin and aspirin. Ankle-brachial index (ABI) and TCO2 measurements were obtained before and after the intervention.
  
  
  RESULTS
  After 12-month follow-up, six patients had presistent wounds, whereas 23 experienced wound healing. Forty of the 50 infrapopliteal arteries successfully 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).
  
  
  CONCLUSIONS
  Infrapopliteal transcatheter interventions in diabetic patients may salvage the majority of limbs doomed to amputation. Although TCO2 measurements are valuable in predicting wound healing and success after interventions, ABI measurements are not.
authors.affiliation: Department of Medicine, University of Texas Medical School, Houston 77030, USA.
authors.forename: G P
authors.initials: GP
authors.lastname: Hanna
authors.forename: K
authors.initials: K
authors.lastname: Fujise
authors.forename: O
authors.initials: O
authors.lastname: Kjellgren
authors.forename: S
authors.initials: S
authors.lastname: Feld
authors.forename: C
authors.initials: C
authors.lastname: Fife
authors.forename: G
authors.initials: G
authors.lastname: Schroth
authors.forename: T
authors.initials: T
authors.lastname: Clanton
authors.forename: V
authors.initials: V
authors.lastname: Anderson
authors.forename: R W
authors.initials: RW
authors.lastname: Smalling
mesh_terms: D000792:Angiography; D000800:Angioplasty, Balloon; D001785:Blood Gas Monitoring, Transcutaneous; D001794:Blood Pressure; D001916:Brachial Artery / Q000503:physiopathology; D017719:Diabetic Foot / Q000097:blood / Q000628:therapy*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000097:blood / Q000628:therapy*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000097:blood / Q000628:therapy; D011150:Popliteal Artery; D011379:Prognosis; D016896:Treatment Outcome