Does lower limb revascularization result in an improvement in sensory perception thresholds?
Patients with peripheral vascular disease are susceptible to neuropathy from chronic hypoxia. We wished to determine whether revascularization of chronically ischemic limbs results in any clinical changes in peripheral sensory thresholds. We prospectively measured quantitative vibration perception thresholds (VPT) using a Horwell neurothesiometer (in volts) in patients undergoing infrainguinal bypass, preoperatively and up to 6 month postoperatively. The bypassed limbs' preoperative VPT values were higher (lesser sensory perception) than the contralateral control limbs' preoperative values (mean score differences: 6 +/- 2 and 4 +/- 10 at toe and foot levels respectively; p ? 0.004). Preoperative VPT values were not different from the 6-month postoperative values for the revascularized legs at toe and foot levels for all 55 patients (mean score change of ?0.84 and ?1.32, p > 0.5). The contralateral limbs' VPT values did not change significantly over the 6-month period (mean change scores of 2.9, p > 0.15, and 2, p > 0.30, for toe and foot, respectively). A comparison of preoperative values between limbs that were eventually amputated and saved revealed no statistically significant differences. This study suggests that revascularization does not result in a clinically detectable improvement in sensory neuropathy. It may, however, prevent further degradation. The degree of preoperative neuropathy does not affect outcome in terms of limb salvage.
Toursarkissian
Boulos
B
Section of Vascular Surgery, University of Texas Health Science Center at San Antonio, 78229-3900, USA. toursarkiss@uthscsa.edu
Connaughton
James C
JC
D'Ayala
Marcus
M
Shireman
Paula K
PK
Harrison
Amy
A
Schoolfield
John
J
Sykes
Mellick T
MT
D000368:Aged; D002908:Chronic Disease; D003925:Diabetic Angiopathies / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012678:Sensation Disorders / Q000209:etiology*; D012684:Sensory Thresholds; D014110:Touch; D014732:Vibration