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.