The predictability of the success of arterial reconstruction by means of transcutaneous oxygen tension measurements

The cases of 100 patients with severe peripheral vascular disease were reviewed to determine whether the success or feasibility of arterial reconstruction could be correlated with the increase in transcutaneous tissue oxygen tension (tcPo2) that occurs in all persons when assuming an erect posture from the supine position. Resting supine tcPo2 levels of 20 mm Hg or less at the foot were noted in all patients in this study (normal values 60.10 ± 6.82 mm Hg). Group I patients were defined by an increase of less than 15 mm Hg on standing, whereas group II patients showed an increase of 15 mm Hg or more. Group I patients had a supine tcPo2 value of 4.24 ± 5.31 mm Hg, with an increase of 3.91 ± 4.59 mm Hg on standing. The group II subjects also had a low supine tcPo2 level, 5.73 ± 4.98 mm Hg, but the increase on standing, 36.14 ± 11.41 mm Hg, was significantly higher (p < 0.001). When these levels increased by less than 15 mm Hg on standing in group I (31 patients), only 29% of limbs (10 of 34) were saved or had patent grafts at 3 months and 55% of attempted vascular reconstructions (11 of 20) failed. Amputations were performed in 50% of the limbs (17 of 34). This contrasted in group II (69 patients) with a significantly higher limb salvage and graft patency rate (81%, 57 of 70 limbs), success of reconstruction (79%, 37 of 47 procedures), and a significantly lower rate of amputation (11%, 8 of 70 limbs) (p < 0.001). We conclude that a failure to increase the tcPo2 reading at the foot by at least 15 mm Hg on standing indicates a poor prognosis for arterial reconstruction in patients suffering from gangrenous or pregangrenous lesions of that foot.