Haemodynamics of patients with severe lower limb arterial disease: the critical aspects of critical ischaemia.
OBJECTIVE
To compare the value of ankle and toe pressures as regards the diagnosis of critical ischaemia, its prognosis, and the need for vascular surgery.


METHODS
University hospital-based retrospective study.


METHODS
Fifty-seven patients (23 women and 34 men) with gangrene or rest pain had a haemodynamic evaluation combining ankle systolic pressure, toe pressure and cutaneous oximetry (tcPO2) with long-term follow-up (until death, for 44%).


RESULTS
After 2 years of follow-up, actuarial rates were 49 and 79% for survival and limb salvage, respectively. Ankle and toe pressures gave rise to different subsets of patients, p < 0.001, mainly because of the existence of a group of patients with very distal foot arterial disease. Low ankle pressure was linked to the risk of major amputation. Low toe pressure was linked to a great need for vascular surgery. Diabetes increased the risk of minor amputation.


CONCLUSIONS
The concept of critical ischaemia remains clinically relevant. Haemodynamic quantitative data strengthen this concept, but ankle and toe pressures are not interchangeable parameters. For these reasons, toe pressures should be changed from a recommended to a mandatory haemodynamic parameter in the definition of critical ischaemia.
Vayssariat
M
M
Laboratory of Microcirculation, Tenon Hospital, University of Paris VI, France.
Gouny
P
P
Cheynel
C
C
Gaitz
J P
JP
Baudot
N
N
Nussaume
O
O
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000401:mortality / Q000503:physiopathology*; D016638:Critical Illness; D005260:Female; D005734:Gangrene / Q000401:mortality / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate