title: Immersing Feet in Carbon Dioxide-enriched Water Prevents Expansion and Formation of Ischemic Ulcers after Surgical Revascularization in Diabetic Patients with Critical Limb Ischemia.
abstract: OBJECTIVE
  We investigated the effect of immersion of feet in CO2-enriched water for preventing expansion and formation of ischemic ulcer in critical limb ischemia of diabetic patients after surgical revascularization.
  
  
  METHODS
  Eligible patients were allocated CO2 group (CO2 immersion plus standard care) or control group (standard care alone) and were followed up for 3 months after surgical revascularization. The end point is defined as an expansion of a target ulcer (more than 101% of original size) or the formation of new ulcers during the follow-up period.
  
  
  RESULTS
  Fifty-nine patients out of originally enrolled 66 patients with type II diabetes were included in intention-to-treat population. The cumulative prevention rate for ischemic ulcer after 3 months was 97.1% in the CO2 group, while, in the control group, it was 77.8%, i.e., significantly lower than the CO2 group (P = 0.012, log-rank test). The transcutaneous oxygen pressure increased significantly only in the CO2 group, from 56 ± 14 to 63 ± 15 mmHg (P < 0.01, Wilcoxon signed rank test), in 3 months.
  
  
  CONCLUSIONS
  These results suggest that addition of CO2 immersion to standard care of critical limb ischemia in diabetic patients improves early postoperative outcome after vascular surgery.
authors.affiliation: Program in Physical and Occupational Therapy, Graduate School of Medicine, Nagoya University, Nagoya, Japan ; Department of Rehabilitation, Nagoya Kyoritsu Hospital, Nagoya, Japan.
authors.forename: Hisae
authors.initials: H
authors.lastname: Hayashi
authors.forename: Sumio
authors.initials: S
authors.lastname: Yamada
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kumada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsuo
authors.forename: Takanobu
authors.initials: T
authors.lastname: Toriyama
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Kawahara
keywords: adjunctive treatments; carbon dioxide; critical limb ischemia; revascularization; transcutaneous oxygen pressure
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