A total of 261 diabetic patients were admitted because of rest pain and/or foot ulcer in 1 limb. Ankle pressure (AP) and transcutaneous oxygen tension (TcPO2) were measured, and digital subtraction arteriography was performed. Transcutaneous oxygen tension was <30 mm Hg in 213 patients and ≥30<50 mm Hg in 48 patients. Ankle pressure could not be measured in 109 patients. In 50 patients, AP was <70 mm Hg and in 102 patients, it was ≥70 mm Hg. Arteriography showed evidence of stenoses >50% of vessel lumen diameter in all patients. Major amputation was performed in 16 patients; AP was <70 mm Hg in 4 patients and ≥70 mm Hg in 6. It was not practicable in the remaining 6 patients. Transcutaneous oxygen tension was <30 mm Hg in 15 patients and ≥30 mm Hg in 1 patient. For diagnosis of critical limb ischemia (CLI) in diabetic patients presenting with rest pain or foot ulcer, measurement of TcPO 2 is essential not only when AP is not measurable but also when this value is ≥70 mm Hg.
Norgren L., Hiatt WR, Dormandy JA, et al, for the TASC II Working Group.Inter-Society Consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg. 2007; 33(suppl):S73-S108.
3.
Caruana MF, Bradbury AW, Adam DJThe validity, reliability, reproducibility and extended utility of ankle to brachial pressure index in current vascular surgical practice. Eur J Vasc Endovasc Surg. 2005;29(5):443-451.
4.
Emanuele MA, Bauchanan BJ, Abraira C.Elevated leg systolic pressure and arterial calcifications in diabetic occlusive vascular disease. Diabetes Care. 1981;4(2):289-292.
5.
van der Feen C., Neijens FS, Kanters SD, Mali WP, Stolk RP, Banga JDAngiographic distribution of lower extremity atherosclerosis in patients with and without diabetes. Diabet Med. 2002;19(5):366-370.
6.
Gibbons GW, Wheelock Fc Jr, Hoar CS Jr, Rowbotham JL, Siembieda C.Predictive success of forefoot amputations in diabetics by noninvasive testing . Arch Surg. 1979;114(9):1034-1036.
7.
Stone PA, Back MR, Armstrong PA, et al. Midfoot amputations expand limb salvage rates for diabetic foot infections. Ann Vasc Surg. 2005;19(6):805-811.
8.
Dalla Paola L. , Faglia E., Caminiti M., Clerici G., Ninkovic S., Deanesi V.Ulcer recurrence following first ray amputation in diabetic patients: a cohort prospective study. Diabetes Care. 2003; 26(6):1874-1878.
9.
Reiber E., Pecoraro E., Koepsell TDRisk factors for amputation in patients with diabetes mellitus. A case-control study. Ann Intern Med. 1992;117(2):97-104.
10.
Adler AI, Boyko EJ, Ahroni JH, Smith DGLower-extremity amputation in diabetes. The independent effects of peripheral vascular disease, sensory neuropathy, and foot ulcers. Diabetes Care. 1999;22(7):1029-1035.
11.
Garbalosa JC, Cavanagh PR, Wu G., et al. Foot function in diabetic patients after partial amputation . Foot Ankle Int. 1996;17(1):43-48.
12.
Hallett JW Jr , Byrne J. , Gayari MM, Ilstrup DM, Jacobsen SJ, Gray DTImpact of arterial surgery and balloon angioplasty on amputation: a population-based study of 1155 procedures between 1973 and 1992. J Vasc Surg. 1997;25(1):29-38.
13.
Jude EB, Oyibo SO, Chalmers N., Boulton AJPeripheral arterial disease in diabetic and nondiabetic patients. A comparison of severity and outcome. Diabetes Care. 2001;24(8):1433-1437.
14.
Young MJ, Adams JE, Anderson GF, Boulton AJ, Cavanagh PRMedial arterial calcification in the feet of diabetic patients and matched non-diabetic control subjects. Diabetologia. 1993; 36(7):615-621.
15.
Goss DE, de Trafford J., Roberts VC, Flynn MD, Edmonds ME, Watkins PJRaised ankle/brachial pressure index in insulin-treated diabetic patients . Diabet Med. 1989;6(7):576-578.
16.
Criqui MH, Fronek A., Klauber MR, Barrett-Connor E., Gabriel S.The sensitivity, specificity, and predictive value of traditional clinical evaluation of peripheral arterial disease: results from non-invasive testing in a defined population. Circulation. 1985 ; 71(3):516-522.
17.
Williams DT , Harding KG, Price P.An evaluation of the efficacy of methods used in screening for lower-limb arterial disease in diabetes. Diabetes Care. 2005;28(9):2206-2210.
18.
American Diabetes Association.Peripheral arterial disease in people with diabetes. Diabetes Care. 2003;26(12):333-341.
19.
Faglia E., Caravaggi C., Marchetti R., et al. Screening for peripheral arterial disease by means of the ankle-brachial index in newly diagnosed type 2 diabetic patients. Diabetic Med. 2005;22(10): 1310-1314.
20.
Armstrong DG , Lavery LA, Harkless LB, Van Houtum WHAmputation and reamputation of the diabetic foot. J Am Podiatr Med Assoc. 1997;87(6):255-259.
21.
Treiman GS, Oderich Gustavo SC, Schneider PAManagement of ischemic heel ulceration and gangrene: an evaluation of factors associated with successful healing. J Vasc Surg. 2003;31(6): 1110-1118.
22.
Silvestro A. , Diehm N., Savolainen H., et al. Falsely high anklebrachial index predicts major amputation in critical limb ischemia. Vasc Med. 2006;11(2):69-74.
23.
Sanders LJ, Dunlap G.Transmetatarsal amputation: a successful approach to limb salvage. J Am Podiatr Med Assoc. 1992;82(3): 129-135.
24.
Larson J., Apelqvist J., Castenfors J., Agardh CD, Stenström A.Distal blood pressure as a predictor for the level of amputation in diabetic patients with foot ulcer. Foot Ankle. 1993 ;14(5): 247-253.
25.
Brooks B., Dean R., Patel S., Wu B., Molyneaux L., Yue DKTBI or not TBI: that is the question. Is it better to measure toe pressure than ankle pressure in diabetic patients? Diabet Med. 2001; 18(7):528-532.
26.
Williams DT , Price P., Harding KGThe influence of diabetes and lower limb arterial disease on cutaneous foot perfusion. J Vasc Surg. 2006;44(4):770-775.
27.
Pecoraro E. , Reiber E., Burges M.Pathways to diabetic limb amputation. Basis for prevention. Diabetes Care. 1990;13(5): 513-521.
28.
Kalani M., Brismar K., Fagrell B., Ostergren J., Jörneskog G.Transcutaneous oxygen tension and toe blood pressure as predictor for outcome of diabetic foot ulcers. Diabetes Care. 1999 ;22(1): 147-151.
29.
Bunt TJ, Hollowey GATcPO2 as an accurate predictor of therapy in limb salvage. Ann Vasc Surg. 1996;10(3):227-237.
30.
Wutschert R. , Bounamaux H.Determination of amputation level in ischemic limbs. Rappresail of the measurement of TcPO2. Diabetes Care . 1997;20(8):1315-1318.
31.
Wyss CR, Robertson C., Love SJ, Harrington RM, Matsen FA 3rd.Relationship between transcutaneous oxygen tension, ankle blood pressure, and clinical outcome of vascular surgery in diabetic and nondiabetic patients . Surgery. 1987;101(1):56-62.
32.
Padberg FT, Back TL, Thompson PN, Hobson RW 2nd.Transcutaneous oxygen (TcPO2) estimates probability of healing in the ischemic extremity. J Surg Res. 1996;60(2):365-369.
33.
Ballard JL, Eke CC, Bunt TJ, Killeen JDA prospective evaluation of transcutaneous oxygen measurements in the management of diabetic foot problems. J Vasc Surg. 1995 ;22(4): 485-490.
34.
Campbell WB , Ponette D., Sugiono M.Long-term results following operation for diabetic foot problems: arterial disease confers a poor prognosis. Eur J Vasc Endovasc Surg. 2000; 19(2):174-177.
35.
La Fontaine J., Reyzelman A., Rothenberg G., et al. The role of revascularization in transmetatarsal amputations. J Am Podiatr Med Assoc. 2001;91(10):533-535.
36.
Faglia E., Clerici G., Caminiti M., Quarantiello A., Curci V., Morabito A.Predictive values of transcutaneous oxygen tension for above-the-ankle amputation in diabetic patients with critical limb ischemia. Eur J Vasc Endovasc Surg. 2007; 33(6):731-736.
37.
Rosenblum BI , Pomposelli FB Jr, Giurini JM, et al. Maximizing foot salvage by a combined approach to foot ischemia and neuropathic ulceration in patients with diabetes. A 5-year experience. Diabetes Care. 1994;17(9):983-987.
38.
Armstrong DG , Lavery LA, Harkless LBValidation of a diabetic wound classification system. The contribution of depth, infection, and ischemia to risk of amputation . Diabetes Care. 1998;21(5): 855-859.
