Clinical Significance Of Transcutaneous Oxygen Pressure Measurement In Evaluating The Efficacy Of Percutaneous Transluminal Angioplasty In Patients With Lower Arteriosclerosis Obliteran

Objective: By the comparison of transcutaneous oxygen pressure,ankle brachial index and toe brachial index changes before and after percutaneous transluminal angioplasty,to evaluate the clinical value of transcutaneous oxygen pressure in evaluating the curative effect of percutaneous endovascular angioplasty in patients with lower extremity arteriosclerosis occlusive disease,and to find a more sensitive and effective evaluation index.Methods:59 inpatients diagnosed with lower arteriosclerosis obliteran in the 1st affiliated hospital of Dalian Medical University were investigated.Enrolled patients completed computed tomographic angiography,transcutaneous oxygen pressure measurement,ankle brachial index and toe brachial index.ALL patients underwent successful revascularization by percutaneous transluminal angioplasty,transcutaneous oxygen pressure,ankle brachial index and toe brachial index were performed in 2~9days after operation,to analysis the changes of these measurements before and aftet revascularization.Results:1.A total of 59 cases of the patients,male 46 cases,female 13 cases.68 ca ses of limbs were successful PTA(balloon angioplasty,stenting),9 cases of bothlower limbs underwent PTA,50 single routine lower extremity underwent PTA.Balloon dilatation in 32 cases(47.06%),20 cases of balloon angioplasty and stent implantation(29.41%),stent implantation 16(23.53%).The mean age(70.03 ± 8.75)years;ASO duration(22.90 ± 36.48)months;have a history of smoking in 25 cases(42.37%).33 patients with diabetes;26 cases of non-diabetic patient;DM group and non-DM group DM group and non-DM group BMI(kg/m2)(25.25±2.34 vs.23.11±3.26,P=0.005)higher,FPG(mmol/l)(8.52±2.86 vs.5.73±1.76,P=0.000)higher,smoking(cases)(9 vs.16,P=0.008),the difference was statistically signifi cant;TcPO2(mmHg)(28.88±16.96 vs.35.92±21.45,P=0.164),ABI(0.57±0.33 vs.0.63± 0.37,P=0.482),TBI(0.32±0.28 vs.0.37 ± 0.24,P=0.515),two group showed no significant difference.2.A total of 68 patients underwent PTA,and the TcPO2 of the patients after the surgery wasTcPO2(mmHg)(40.47 ± 13.60 vs.31.09 ± 19.16,P = 0.000),the ABI after the surgery was ABI(0.89 ± 0.27 vs.0.60 ± 0.36,P = 0.000)and TBI(0.49 ± 0.29 vs.0.33 ±0.26,P=0.000).All parameters were significantly increased compared with preoperative,the difference was statistically significant.According to TcPO2 level before surgery,divided into three groups: 21 patien ts with TcPO2 <20mmHg was severe ischemic group;22 patients with TcPO2 be tween 20 mmHg ~ 40 mmHg mild degree of ischemia;normal group of 25 patient s with TcPO2>40mmHg.All group compared preoperative with postoperative resp ective,found that the severe ischemic group TcPO2(mmHg)(29.76 ± 11.39 vs.6.43 ± 4.23,P = 0.000),ABI(0.84±0.34 vs.0.47±0.51,P = 0.001),TBI(0.23 ± 0.24 vs.0.07 ± 0.12,P=0.001),postoperative all increased than preoperative,the difference was statistically significant;mild degree of ischemia group TcPO2(mm Hg)(42.73±11.60 vs.32.68 ± 6.81,P = 0.001),ABI(0.88 ± 0.16 vs.0.60 ± 0.27,P = 0.000),T BI(0.59 ± 0.21 vs.0.38 ± 0.23,P = 0.000),postoperative all increased than preop erative,the difference was statistically significant;normal group TcPO2(mmHg)(46.12 ± 14.80 vs.(50.40 ± 6.85,P = 0.240),ABI(0.93 ± 0.28 vs.0.70 ± 0.24,P =0.005),TBI(0.62 ± 0.26 vs.0.51 ± 0.18,P = 0.084),postoperative all increased than preoperative,in ABI the difference was statistically significant,but in TcPO2?T BI,the difference has no statistically significant.Each index of preoperative pairwise comparison among the three groups,in severe group the level of preoperative TcPO2 was induced than mild degree of ischemia group and normal groupTcPO2(mmHg)(6.43± 4.23 vs.32.68 ± 6.81,P = 0.000;50.40 ± 6.85,P =0.000);mild degree of ischemia group was induced than normal group(P=0.000),the difference was statistically significant.In severe group the level of preoperative ABI was induced than mild degree of ischemia group and normal group ABI(0.47±0.51 vs.0.60±0.27,P=0.234;0.70±0.24;P=0.034);mild degree of ischemia group was induced than normal group(P=0.351),the difference between severe group and normal group was statistically significant.In severe group the level of preoperative TBI was induced than mild degree of ischemia group and normal groupTBI(0.07±0.12 vs.0.38±0.23,P=0.000;0.51±0.18,P=0.000),mild degree of ischemia group was induced than normal groupTBI(P=0.022),the difference was statistically significant.Each index of postoperative pairwise comparison among the three groups,fo und that in severe group the level of preoperative TcPO2 was induced than mild degree of ischemia group and normal group: TcPO2(mmHg)(29.76±11.39 vs.42.73±11.60,P=0.001;46.12±14.80,P=0.000),mild degree of ischemia group was induced t han normal group(P=0.368),the difference between severe ischemia group and mild degree group was statistically significant,the difference between severe isch emia group and normal group was statistically significant,the difference between mild degree group and normal group has no statistically significant.In severe gr oup the level of preoperative ABI was induced than mild degree of ischemia gro up and normal groupABI(0.84±0.34 vs.0.88±0.16,P=0.650;0.93±0.28,P=0.290),mil d degree of ischemia group was induced than normal group(P=0.548),the differe nce between three groups has no statistically significant.In severe group the leve l of preoperative ABI was induced than mild degree of ischemia group and nor mal group: TBI(0.23±0.24 vs.0.59±0.21,P=0.000;0.62±0.26,P=0.000),mild degree of ischemia group was induced than normal group(P=0.673},the difference between severe ischemia group and mild degree group was statistically significant,the difference between severe ischemia group and normal group was statistically sig nificant,the difference between mild degree group and normal group has no statis tically significant.Each index postoperative change between the three groups were pairwise com parison,in severe group the level of?TcPO2 was increased than mild degree of i schemia group and normal group:?TcPO2(mmHg)(23.33±10.88 vs.10.00±12.00,P=0.003;-3.48±17.89,P=0.003),mild degree of ischemia group was increased than nor mal group(P=0.002),the difference was statistically significant.In severe group t he level of ?ABI was increased than mild degree of ischemia group and norma l group(0.37±0.44 vs.0.27±0.26,P=0.375;0.23±0.37,P=0.193),mild degree of ischemi a group was increased than normal group(P=0.691),the difference between three groups has no statistically significant.Ins mild degree of ischemia group the leve l of ?TBI was increased than severe ischemia group and normal group(0.20±0.20 vs.0.16±0.18,P=0.552;0.11±0.29,P=0.159),severe ischemia group was increased t han normal group(P=0.431),the difference between three groups has no statistical ly significant.3.We divided the patients into three groups according to the operation metho d,balloon angioplasty group(n = 32),balloon angioplasty and stent implantation group(n = 20),stenting group(n = 16).And we compared the each index preo perative with postoperative,foud that balloon angioplasty group:TcPO2(mmHg)(42.28±15.92 vs.31.56±18.07,P=0.003)?ABI(0.91±0.17 vs.0.71±0.39,P=0.002)?TBI(0.51±0.30 vs.0.37±0.29,P=0.005),postoperative all increased than preoperative,the diff erence was statistically significant;balloon angioplasty and stent implantation gro up: TcPO2(mmHg)(37.90±10.99 vs.31.20±22.50,P=0.145)?ABI(0.91±0.26 vs.0.44±0.25,P=0.000)?TBI(0.46±0.28 vs.0.29±0.21,P=0.010),postoperative all increased t han preoperative,in ABI and TBI the difference was statistically significant,but T cPO2 was not;stenting group: TcPO2(mmHg)(37.94±15.27 vs.30.00±17.96,P=0.044)?ABI(0.81±0.42 vs.0.58±0.37,P=0.012)?TBI(0.49±0.30 vs.0.31±0.26,P=0.001),postoperative all increased than preoperative,the difference was statistically significan t.Each index of preoperative pairwise comparison among the three groups,fou nd that in balloon angioplasty group the level of preoperative TcPO2 compared with balloon angioplasty and stent implantation group and stenting group:TcPO2(mmHg)(31.56±18.07 vs.31.20±22.50,P=0.948;30.00±17.96,P=0.794),balloon angiop lasty and stent implantation group was increased than stenting group(P=0.855),t he difference has no statistically significant;In balloon angioplasty group the lev el of preoperative ABI was increased than balloon angioplasty and stent implanta tion group and stenting group: ABI(0.71±0.39 vs.0.44±0.25,P=0.01;0.58±0.37,P=0.23),balloon angioplasty and stent implantation group was induced than stenting group: ABI(0.44±0.25 vs.0.58±0.37,P=0.252),the difference between balloon angio plasty group and balloon angioplasty and stent implantation group was statisticall y significant.In balloon angioplasty group the level of preoperative TBI compare d with balloon angioplasty and stent implantation group and stenting group: TBI(0.37±0.29 vs.0.29±0.21,P=0.295;0.31±0.26,P=0.402),balloon angioplasty and stent implantation group compared with stenting group(P=0.899),the difference has no statistically significant.Each index of postoperative pairwise comparison among the three groups,fo und that in balloon angioplasty group the level of preoperative TcPO2 was increa sed than balloon angioplasty and stent implantation group and stenting group:TcP O2(mmHg)(42.28±15.92 vs.37.90±10.99,P=0.293;37.93±15.27,P=0.331),balloon ang ioplasty and stent implantation group compared with stenting group(P=0.994),the difference has no statistically significant.In balloon angioplasty group the level o f preoperative ABI compared with balloon angioplasty and stent implantation gro up and stenting group:ABI(0.91±0.17 vs.0.91±0.26,P=0.980;0.81±0.42,P=0.237),ballo on angioplasty and stent implantation group was increased than stenting group:A BI(P=0.289),the difference has no statistically significant.in balloon angioplasty group the level of preoperative TcPO2 was increased than balloon angioplasty and stent implantation group and stenting group: TBI(0.51±0.30 vs.0.46±0.28,P=0.570;0.49±0.30,P=0.874),balloon angioplasty and stent implantation group was induc ed than stentiEach index postoperative change between the three groups were pairwise com parison,found that in balloon angioplasty group the level of?TcPO2 was increase d than balloon angioplasty and stent implantation group and stenting group?TcP O2(mmHg)(10.84±18.63 vs.6.70±19.74,P=0.425;7.94±14.41,P=0.602),stenting group was increased than balloon angioplasty and stent implantation group(P=0.839),the difference has no statistically significant.In balloon angioplasty and stent implant ation group the level of ?ABI was increased than balloon angioplasty group an d stenting group(0.47±0.35 vs.0.21±0.35,P=0.011;0.20±0.35,P=0.026),the difference has no statistically significant;In balloon angioplasty group ?ABI was increased than stenting group:(P=0.958),the difference has no statistically significant.In ste nt implantation group the level of ?TBI was increased thanballoon angioplasty a nd stent implantation group and balloon angioplasty group(0.19±0.18 vs.0.16±0.25,P=0.777;0.13±0.25,P=0.469).In stenting group the level of ?TBI was increase d than balloon angioplasty group(P=0.656),the difference has no statistically sign ificant.4.The positive rate of CTA was100%.The positive rate of TcPO2 was63.20%;the positive rate of ABI was 82.40%;the positive rate of TBI was 91.20%,P=0.000,TcPO2 respectively comparied with ABI and TBI,P=0.012?P=0.000,the differ ence has statistically significant.TcPO2 positive rate is 73.7% in the DM group,t he non-DM group is 50%,P = 0.044,the difference was statistically significant;A BI positive rate is 84.2% in the DM group,the non-DM group is 80.0%,P = 0.915;TBI positive rate is 92.1% in the DM group,the non-DM group is 90.0%,P= 0.723,there was no statistically significant difference4.Conclusions:1.TcPO2 can be used as a clinical index for evaluating the efficacy of ASO percutaneous endovascular angioplasty in lower extremity.2.TcPO2 was superior to ABI and TBI in the evaluation of microcirculation.