Infrapopliteal transcatheter interventions for limb salvage in diabetic patients: Importance of aggressive interventional approach and role of transcutaneous oximetry

Objectives. This study sought to determine whether infrapopliteal transcatheter interventions can salvage ischemic limbs in diabetic patients referred for below the knee amputation at our institution. Background. The value of transcatheter interventions in diabetic crural arteries is controversial. Tissue oxygen partial pressure (TCO₂) levels <40 mm Hg predict poor wound healing. Methods. Percutaneous interventions were performed in 29 consecutive diabetic patients in need of limb salvage. Technical success was defined as <20% residual vessel stenosis. Clinical success was defined as the avoidance of amputation and achievement of wound healing. At hospital discharge, patients were treated with Coumadin and aspirin. Ankle-brachial index (ABI) and Tco₂ measurements were obtained before and after the intervention. Results. After 12-month follow-up, six patients had persistent wounds, whereas 23 experienced wound healing. Forty of the 50 infrapopliteal arteries successfully dilated were occluded, with a mean (±SD) lesion length of 18.0 ± 3.5 cm. After the procedure, TCO₂ improved from 27.82 ± 9.97 mm Hg (95% confidence interval [CI] 23.95 to 31.69) to 54.5 ± 14.73 mm Hg (95% CI 48.79 to 60.21, p < 0.0001), whereas the ABI did not (p > 0.2). TCO₂ predicted procedural and clinical success (p < 0.0182). Conclusions. Infrapopliteal transcatheter interventions in diabetic patients may salvage the majority of limbs doomed to amputation. Although TCO₂ measurements are valuable in predicting wound healing and success after interventions, ABI measurements are not.