Wildgruber Moritz, Wolf Oliver, Weiss Wolfgang, Berger Hermann, Lutzenberger Werner, Eckstein Hans-Henning, Heider Peter
Department of Vascular Surgery, Technical University of Munich, Ismaninger Strasse 22, D-81675 München, Germany.
Eur J Radiol. 2007 Nov;64(2):302-8. doi: 10.1016/j.ejrad.2007.02.024. Epub 2007 Mar 26.
To investigate transcutaneous oximetry as parameter of the microcirculation is correlated to ankle-brachial-index as parameter of the macrocirculation after peripheral angioplasty procedures.
Prospective study.
60 patients suffering from intermittent claudication were scheduled for angioplasty treatment. 45 patients were considered as eligible for angioplasty after angiographic evaluation, 15 patients underwent angiography only. Transcutaneous oximetry measurements were performed before the procedure, at the end of intervention, 24h as well as 2 and 4 weeks after percutaneous transluminal angioplasty. Ankle-brachial-indices were obtained before intervention, 24h as well as 2 and 4 weeks later.
Ankle-brachial-indices increased significantly at 24h after angioplasty in patients being treated with angioplasty. Transcutaneous oximetry values dropped significantly at the end of the procedure and returned close to the baseline levels at 2 and 4 weeks after angioplasty. Ankle-brachial-indices and transcutaneous oximetry were positively correlated before (r=0.3833, p=0.009) as well as 4 weeks after angioplasty (r=0.4596, p=0.001). Immediately after radiological interventions, ankle-brachial-indices and transcutaneous oximetry are not positively correlated. In patients undergoing angiography only, transcutaneous oximetry levels drop significantly immediately after angiography and remain at decreased levels even at 4 weeks after intervention.
Transcutaneous oximetry as parameter of the microcirculation is positively correlated with ankle-brachial-index as parameter of the macrocirculation before and at 4 weeks after angioplasty. Intraarterial angiography leads to a sudden decrease in skin microcirculation without affecting macrocirculation. As indicated by a lack of recovery in transcutaneous oximetry levels after 4 weeks, angiography alone results in a prolonged impaired microcirculation which may reflect endothelial dysfunction caused by contrast material. The recovery of transcutaneous oximetry levels following angioplasty is counterbalanced by the adverse effects of the contrast material. Ankle-brachial-indices remains the most favourable parameter in evaluating the success of angioplasty procedures while transcutaneous oximetry serves as an indirect method in assessing endothelial dysfunction caused by contrast material.
研究经皮血氧测定作为微循环参数与外周血管成形术后作为大循环参数的踝肱指数之间的相关性。
前瞻性研究。
60例间歇性跛行患者计划接受血管成形术治疗。血管造影评估后，45例患者被认为适合进行血管成形术，15例患者仅接受了血管造影。在经皮腔内血管成形术前、干预结束时、24小时以及术后2周和4周进行经皮血氧测定。在干预前、24小时以及术后2周和4周获取踝肱指数。
接受血管成形术治疗的患者在血管成形术后24小时踝肱指数显著升高。经皮血氧测定值在手术结束时显著下降，并在血管成形术后2周和4周恢复至接近基线水平。血管成形术前（r = 0.3833，p = 0.009）以及术后4周（r = 0.4596，p = 0.001），踝肱指数与经皮血氧测定呈正相关。放射学干预后即刻，踝肱指数与经皮血氧测定无正相关。仅接受血管造影的患者，血管造影后经皮血氧测定水平即刻显著下降，甚至在干预后4周仍维持在较低水平。
经皮血氧测定作为微循环参数在血管成形术前和术后4周与作为大循环参数的踝肱指数呈正相关。动脉内血管造影导致皮肤微循环突然下降而不影响大循环。如4周后经皮血氧测定水平未恢复所示，单纯血管造影导致微循环长期受损，这可能反映了造影剂引起的内皮功能障碍。血管成形术后经皮血氧测定水平的恢复被造影剂的不良反应所抵消。踝肱指数仍然是评估血管成形术成功的最有利参数，而经皮血氧测定作为评估造影剂引起的内皮功能障碍的间接方法。
