1
|
Gerken ALH, Sigl M, Israel E, Weiß C, Reißfelder C, Schwenke K. The Effect of Revascularization on Lower Limb Circulation Parameters in Symptomatic Peripheral Arterial Disease. J Clin Med 2024; 13:3991. [PMID: 38999555 PMCID: PMC11242648 DOI: 10.3390/jcm13133991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 06/21/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
Background: The prevalence of peripheral arterial disease and the number of revascularization procedures performed in symptomatic patients are steadily increasing. However, uncertainties remain regarding hemodynamic monitoring after revascularization and the prediction of clinical outcomes. This study aimed to investigate hemodynamic parameters with a focus on the microvasculature. Methods: This prospective, single-center study included 29 patients (15 with intermittent claudication [IC] and 14 with chronic limb-threatening ischemia [CLTI]). Before and after the revascularization procedure, in addition to the ankle-brachial index (ABI), microperfusion parameters, including microvascular blood flow, capillary oxygen saturation (SO2), and relative hemoglobin content (rHb), were assessed with lightguide spectrophotometry combined with laser Doppler flowmetry using an oxygen-to-see (O2C) device in the horizontal and elevated leg positions. Results: At baseline, SO2 in the elevated leg position was significantly lower in patients with CLTI than in those with IC (p = 0.0189), whereas the other microcirculatory parameters and ABI values were not significantly different. Patients with diabetes mellitus had a higher flow rate than those without in the horizontal leg position (p = 0.0162) but not in the elevated leg position. After successful revascularization, the flow increased immediately and significantly in both positions, whereas SO2, rHb, and the ABI did not. Conclusions: Elevated leg SO2 was significantly lower in CLTI than in clinically compensated peripheral arterial disease, whereas microvascular flow was a suitable surrogate parameter indicating successful revascularization. In studies using surgical or interventional revascularization procedures, noninvasive hemodynamic monitoring of the microcirculation at the foot level might be beneficial.
Collapse
Affiliation(s)
- Andreas L H Gerken
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany
| | - Martin Sigl
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany
| | - Elisa Israel
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany
| | - Christel Weiß
- Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany
| | - Christoph Reißfelder
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany
| | - Kay Schwenke
- Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany
| |
Collapse
|
2
|
Jávor P, Donka T, Horváth T, Sándor L, Török L, Szabó A, Hartmann P. Impairment of Mesenteric Perfusion as a Marker of Major Bleeding in Trauma Patients. J Clin Med 2023; 12:jcm12103571. [PMID: 37240677 DOI: 10.3390/jcm12103571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
The majority of potentially preventable mortality in trauma patients is related to bleeding; therefore, early recognition and effective treatment of hemorrhagic shock impose a cardinal challenge for trauma teams worldwide. The reduction in mesenteric perfusion (MP) is among the first compensatory responses to blood loss; however, there is no adequate tool for splanchnic hemodynamic monitoring in emergency patient care. In this narrative review, (i) methods based on flowmetry, CT imaging, video microscopy (VM), measurement of laboratory markers, spectroscopy, and tissue capnometry were critically analyzed with respect to their accessibility, and applicability, sensitivity, and specificity. (ii) Then, we demonstrated that derangement of MP is a promising diagnostic indicator of blood loss. (iii) Finally, we discussed a new diagnostic method for the evaluation of hemorrhage based on exhaled methane (CH4) measurement. Conclusions: Monitoring the MP is a feasible option for the evaluation of blood loss. There are a wide range of experimentally used methodologies; however, due to their practical limitations, only a fraction of them could be integrated into routine emergency trauma care. According to our comprehensive review, breath analysis, including exhaled CH4 measurement, would provide the possibility for continuous, non-invasive monitoring of blood loss.
Collapse
Affiliation(s)
- Péter Jávor
- Department of Traumatology, University of Szeged, H-6725 Szeged, Hungary
| | - Tibor Donka
- Department of Traumatology, University of Szeged, H-6725 Szeged, Hungary
| | - Tamara Horváth
- Institute of Surgical Research, University of Szeged, H-6724 Szeged, Hungary
| | - Lilla Sándor
- Department of Traumatology, University of Szeged, H-6725 Szeged, Hungary
| | - László Török
- Department of Traumatology, University of Szeged, H-6725 Szeged, Hungary
- Department of Sports Medicine, University of Szeged, H-6725 Szeged, Hungary
| | - Andrea Szabó
- Institute of Surgical Research, University of Szeged, H-6724 Szeged, Hungary
| | - Petra Hartmann
- Department of Traumatology, University of Szeged, H-6725 Szeged, Hungary
| |
Collapse
|
3
|
Waddell A, Seed S, Broom DR, McGregor G, Birkett ST, Harwood AE. Safety of home-based exercise for people with intermittent claudication: A systematic review. Vasc Med 2021; 27:186-192. [PMID: 34930062 PMCID: PMC8996308 DOI: 10.1177/1358863x211060388] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intermittent claudication (IC) is a classic symptom of peripheral artery disease,
with first line treatment being supervised exercise therapy (SET). Despite this,
SET is frequently underutilised, and adherence is often poor. An alternative
option are home-based exercise programmes (HBEP). Although HBEPs are well
tolerated, to the authors’ knowledge, no research has assessed their safety. The
aim of this review was to assess the safety of HBEPs in people living with IC.
We performed an electronic search of the MEDLINE, CINAHL, and Cochrane Library
databases. The main parameter of interest was complication rate, calculated as
the number of related adverse events per patient-hours. Subanalysis was
undertaken to determine differences in safety for studies that did and did not
include pre-exercise cardiac screening, and for studies with exercise at low,
moderate, and high levels of claudication pain. Our search strategy identified
8693 results, of which 27 studies were included for full review. Studies
included 1642 participants completing 147,810 patient-hours of home-based
exercise. Four related adverse events were reported, three of which were cardiac
in origin, giving an all-cause complication rate of one event per 36,953
patient-hours. Three of these events occurred following exercise to high levels
of claudication pain, and one occurred with pain-free exercise. One event
occured in a study without cardiac screening. Based on the low number of related
adverse events, HBEPs appear to be a safe method of exercise prescription for
people with IC. Our results strengthen the rationale for providing alternative
exercise options for this population. PROSPERO Registration No.:
CRD42021254581
Collapse
Affiliation(s)
- Alexander Waddell
- Centre for Sport, Exercise and Life Sciences, Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Sally Seed
- School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - David R Broom
- Centre for Sport, Exercise and Life Sciences, Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Gordon McGregor
- Centre for Sport, Exercise and Life Sciences, Institute of Health and Wellbeing, Coventry University, Coventry, UK.,Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK.,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Stefan T Birkett
- School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Amy E Harwood
- Centre for Sport, Exercise and Life Sciences, Institute of Health and Wellbeing, Coventry University, Coventry, UK
| |
Collapse
|
4
|
Bedside determination of microcirculatory oxygen delivery and uptake: a prospective observational clinical study for proof of principle. Sci Rep 2021; 11:24516. [PMID: 34972827 PMCID: PMC8720096 DOI: 10.1038/s41598-021-03922-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/06/2021] [Indexed: 11/09/2022] Open
Abstract
Assessment of microcirculatory functional capacity is considered to be of prime importance for therapy guidance and outcome prediction in critically ill intensive care patients. Here, we show determination of skin microcirculatory oxygen delivery and consumption rates to be a feasible approach at the patient’s bedside. Real time laser-doppler flowmetry (LDF) and white light spectrophotometry (WLS) were used for assessment of thenar skin microperfusion, regional Hb and postcapillary venous oxygen saturation before and after forearm ischemia. Adapted Fick’s principle equations allowed for calculation of microcirculatory oxygen delivery and uptake. Patient groups with expected different microcirculatory status were compared [control (n = 20), sepsis-1/2 definition criteria identified SIRS (n = 10) and septic shock patients (n = 20), and the latter group further classified according to sepsis-3 definition criteria in sepsis (n = 10) and septic shock (n = 10)], respectively. In otherwise healthy controls, microcirculatory oxygen delivery and uptake approximately doubled after ischemia with maximum values (mDO2max and mVO2max) significantly lower in SIRS or septic patient groups, respectively. Scatter plots of mVO2max and mDO2max values defined a region of unphysiological low values not observed in control but in critically ill patients with the percentage of dots within this region being highest in septic shock patients. LDF and WLS combined with vasoocclusive testing reveals significant differences in microcirculatory oxygen delivery and uptake capacity between control and critically ill patients. As a clinically feasible technique for bedside determination of microcirculatory oxygen delivery and uptake, LDF and WLS combined with vasoocclusive testing holds promise for monitoring of disease progression and/or guidance of therapy at the microcirculatory level to be tested in further clinical trials. ClinicalTrials.gov: NCT01530932.
Collapse
|
5
|
Wermelink B, Ma KF, Haalboom M, El Moumni M, de Vries JPPM, Geelkerken RH. A Systematic Review and Critical Appraisal of Peri-Procedural Tissue Perfusion Techniques and their Clinical Value in Patients with Peripheral Arterial Disease. Eur J Vasc Endovasc Surg 2021; 62:896-908. [PMID: 34674935 DOI: 10.1016/j.ejvs.2021.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/19/2021] [Accepted: 08/13/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Many techniques have been introduced to enable quantification of tissue perfusion in patients with peripheral arterial disease (PAD). Currently, none of these techniques is widely used to analyse real time tissue perfusion changes during endovascular or surgical revascularisation procedures. The aim of this systematic review was to provide an up to date overview of the peri-procedural applicability of currently available techniques, diagnostic accuracy of assessing tissue perfusion and the relationship with clinical outcomes. DATA SOURCES MEDLINE, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. REVIEW METHODS This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. Four electronic databases were searched up to 31 12 2020 for eligible articles: MEDLINE, Embase, CINAHL and the Cochrane Central Register of Controlled Trials. Eligible articles describing a perfusion measurement technique, used in a peri-procedural setting before and within 24 hours after the revascularisation procedure, with the aim of determining the effect of intervention in patients with PAD, were assessed for inclusion. The QUADAS-2 tool was used to assess the risk of bias and applicability of the studies. RESULTS An overview of 10 techniques found in 26 eligible articles focused on study protocols, research goals, and clinical outcomes is provided. Non-invasive techniques included laser speckle contrast imaging, micro-lightguide spectrophotometry, magnetic resonance imaging perfusion, near infrared spectroscopy, skin perfusion pressure, and plantar thermography. Invasive techniques included two dimensional perfusion angiography, contrast enhanced ultrasound, computed tomography perfusion imaging, and indocyanine green angiography. The results of the 26 eligible studies, which were mostly of poor quality according to QUADAS-2, were without exception, not sufficient to substantiate implementation in daily clinical practice. CONCLUSION This systematic review provides an overview of 10 tissue perfusion assessment techniques for patients with PAD. It seems too early to appoint one of them as a reference standard. The scope of future research in this domain should therefore focus on clinical accuracy, reliability, and validation of the techniques.
Collapse
Affiliation(s)
- Bryan Wermelink
- University of Twente, Multi-Modality Medical Imaging Group, TechMed Centre, Enschede, The Netherlands; Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
| | - Kirsten F Ma
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Marieke Haalboom
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Mostafa El Moumni
- Department of Surgery, Division of Trauma Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Jean-Paul P M de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert H Geelkerken
- University of Twente, Multi-Modality Medical Imaging Group, TechMed Centre, Enschede, The Netherlands; Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| |
Collapse
|
6
|
Evaluation of the optimal cooling temperature for the face measured by the tissue perfusion during hilotherapy using laser Doppler spectrophotometry. Sci Rep 2021; 11:9805. [PMID: 33963203 PMCID: PMC8105374 DOI: 10.1038/s41598-021-89313-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 04/16/2021] [Indexed: 11/23/2022] Open
Abstract
After craniofacial trauma, symptoms like swelling and pain occur. Cooling reduces these symptoms but the optimal cooling temperature for a maximum benefit without adverse effects is unclear. 30 participants were cooled at 10 °C, 15 °C, 20 °C, 25 °C and 30 °C for 30 min. Before cooling and at 15, 30, 45 and 60 min after cooling, the skin blood flow, oxygen saturation (SO) and haemoglobin concentration (Hb) were measured by laser Doppler spectrophotometry at 2 mm and 8 mm depth. The skin temperature was measured, and the participant’s satisfaction was marked on a visual analogue scale. There were significant differences between males and females in the blood flow, SO and Hb (p < 0.0001). After cooling, the blood flow, SO and Hb was reduced. The measured values rose slightly above the initial values 60 min after cooling. Depending on the cooling temperature the decrease in blood flow, SO and Hb was significantly different. Both sexes were most comfortable with a 25 °C cooling temperature and satisfaction decreased with lower temperatures. Significant differences for the satisfaction between both sexes were measured (10 °C: p < 0.0001, 15 °C: p < 0.0001, 20 °C: p = 0.0168, 25 °C: p = 0.0293). After 60 min, the males and females exhibited mild skin hyperthermia. The optimal cooling temperatures their physiological effects and their perception for females and males were different. For females, around 20 °C is an optimal cooling temperature. For males, it is around 15–20 °C.
Collapse
|