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Does lower limb revascularization result in an improvement in sensory perception thresholds?
Boulos Toursarkissian1, James C Connaughton, Marcus D'Ayala
1Section of Vascular Surgery, University of Texas Health Science Center at San Antonio, 78229-3900, USA. toursarkiss@uthscsa.edu
Annals of Vascular Surgery
|April 17, 2002
Summary
Revascularization surgery for peripheral vascular disease did not improve sensory neuropathy in patients. While it may prevent worsening, it did not clinically detect any sensory threshold improvements in ischemic limbs.
Area of Science:
- Vascular Surgery
- Neurology
- Diabetic Complications
Background:
- Peripheral vascular disease (PVD) commonly causes chronic limb ischemia and neuropathy due to hypoxia.
- Neuropathy in PVD patients leads to reduced sensory perception, increasing risks of injury and poor outcomes.
- Infrainguinal bypass surgery is a common intervention for severe PVD to restore blood flow.
Purpose of the Study:
- To investigate the clinical impact of infrainguinal bypass surgery on peripheral sensory thresholds in patients with PVD.
- To determine if revascularization of chronically ischemic limbs improves vibration perception thresholds (VPT).
- To assess if preoperative neuropathy severity influences limb salvage outcomes after bypass surgery.
Main Methods:
- Prospective study involving 55 patients undergoing infrainguinal bypass for PVD.
- Quantitative measurement of vibration perception thresholds (VPT) using a neurothesiometer (in volts).
- VPT measurements were taken preoperatively and at 6 months postoperatively for both revascularized and contralateral limbs.
Main Results:
- Preoperative VPT was significantly higher in ischemic limbs compared to contralateral limbs, indicating reduced sensory perception.
- No significant difference was observed in VPT between preoperative and 6-month postoperative measurements for revascularized limbs.
- Contralateral limbs showed no significant changes in VPT over the 6-month follow-up period.
- Preoperative neuropathy severity did not predict limb salvage outcomes.
Conclusions:
- Infrainguinal bypass surgery does not lead to clinically detectable improvements in sensory neuropathy for PVD patients.
- Revascularization may potentially prevent further degradation of sensory function rather than reversing existing neuropathy.
- Preoperative sensory neuropathy assessment is not a significant factor in predicting limb salvage success post-revascularization.