Kasukabe Chuo General Hospital, Kasukabe, Saitama, Japan.
Int J Low Extrem Wounds. 2022 Dec;21(4):477-482. doi: 10.1177/1534734620959515. Epub 2020 Sep 23.
Recently, the number of patients with peripheral artery disease (PAD), including those with chronic limb-threatening ischemia (CLTI), has increased because of the increasing number of diabetic or dialysis patients worldwide. Revascularization is an important therapy for patients with CLTI. However, we sometimes experience refractory cases with insufficient peripheral circulation or microcirculation after revascularization. In this situation, additional therapy can be administered, such as low-density lipoprotein apheresis, high-pressure oxygen therapy, and spinal cord stimulation. However, they are not effective in some cases. Some reports have also indicated that transdermal isosorbide dinitrate patch (ISDN-P) is a useful therapy for PAD. As the efficacy of ISDN-P for patients with CLTI is not well-known, we examined it in this study. We assessed the skin perfusion pressure (SPP) after affixing an ISDN-P on the foot, because SPP measurement has proved useful in the assessment of PAD and is a good indicator of wound healing potential. The SPP (dorsal and plantar aspects) after ISDN-P application on the foot of healthy volunteers increased (n = 8; mean ± SD, 12.6 ± 7.9 [ = .12], and 21.2 ± 7.7 mm Hg [ < .05], respectively), as did SPP of patients with CLTI (n = 10; mean ± SD, 19.8 ± 2.5 [ < .01], and 14.1 ± 5.9 mm Hg [ < .05], respectively). All the patients who received an ISDN-P on the foot had no major complication, and no significant change in blood pressure. In conclusion, the ISDN-P is one of the effective and safe therapies for patients with CLTI.
最近，由于全球范围内糖尿病或透析患者数量的增加，外周动脉疾病（PAD）患者，包括慢性肢体威胁性缺血（CLTI）患者的数量有所增加。血运重建是 CLTI 患者的重要治疗方法。然而，我们有时会在血运重建后遇到外周循环或微循环不足的难治性病例。在这种情况下，可以给予其他治疗，如低密度脂蛋白吸附、高压氧治疗和脊髓刺激。然而，在某些情况下它们并不有效。一些报告还表明，经皮硝酸异山梨酯贴剂（ISDN-P）是治疗 PAD 的一种有效方法。由于 ISDN-P 对 CLTI 患者的疗效尚不清楚，我们在本研究中对此进行了评估。我们评估了在足部贴上 ISDN-P 后的皮肤灌注压（SPP），因为 SPP 测量已被证明在外周动脉疾病的评估中有用，并且是伤口愈合潜力的良好指标。在健康志愿者的足部贴上 ISDN-P 后，SPP（背侧和足底）增加（n = 8；平均值 ± 标准差，12.6 ± 7.9 [=.12] 和 21.2 ± 7.7 mm Hg [ <.05]），CLTI 患者的 SPP 也增加（n = 10；平均值 ± 标准差，19.8 ± 2.5 [ <.01] 和 14.1 ± 5.9 mm Hg [ <.05]）。所有在足部接受 ISDN-P 的患者均无重大并发症，血压无明显变化。总之，ISDN-P 是治疗 CLTI 患者的有效且安全的治疗方法之一。
