Use of Transcutaneous Oxygen Tension Before,During,and After Arterial Reconstructive Surgery

Abstract

The diagnostic and predictive value of transcutaneous oxygen tension (tcPO₂) measurements in patients undergoing lower extremity arterial recon structive surgery were evaluated. Foot tcPO₂ was measured preoperatively in 114 patients, intraoperatively in 59 patients, and again seven days after surgery in 82 patients. Preoperative tcPO ₂ values less than 30 mmHg were indicative of severe limb ischemia in 90% of patients with rest pain, impending gangrene, or ischemic ulcer. Fifteen minutes after revascularization, tcPO₂ greater than 30 mmHg was predictive of a "good" result (determined clinically at one month) in 94% of patients, whereas values less than 30 mmHg predicted a "poor" result in 70% of patients. Measurements obtained seven days postoperatively exhibited an improved negative predictive tcPO₂ value (85%) as compared with those ob tained intraoperatively. TCPO₂ changes induced by oxygen inhalation were the most promising predictor of the outcome of surgery. TCPO₂ was uniformly more reliable than hemodynamic tests (pulse volume recording and Doppler systolic pressure) when more severe disease was present and vice versa; their comple mentary nature suggests the two techniques can be used together to maximize noninvasive diagnostic value.