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An angiosome-centred approach for TcpO2 electrode positioning.

Judith Catella1,2,3, Nellie Della Schiava4,5, Fortunat L'Hoia1

  • 1Service de Médecine Interne et Vasculaire, Hôpital Edouard Herriot, Hospices Civils de Lyon, France.

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Summary

Transcutaneous oxygen pressure (TcpO2) measurements in the foot are crucial for diagnosing chronic limb threatening ischemia (CLTI). This study found that electrode placement significantly impacts TcpO2 readings, suggesting a single measurement point is preferable for accurate assessment.

Keywords:
Chronic limb threatening ischemiaTcpO2angiosomeperipheral arterial disease

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Area of Science:

  • Vascular Medicine
  • Podiatry
  • Medical Diagnostics

Background:

  • Current guidelines suggest a transcutaneous oxygen pressure (TcpO2) threshold of 30 mmHg for diagnosing chronic limb threatening ischemia (CLTI).
  • Standardization of TcpO2 electrode placement remains a challenge.
  • The impact of an angiosome-centered approach on TcpO2 electrode positioning has not been previously assessed.

Purpose of the Study:

  • To retrospectively analyze TcpO2 results and evaluate the influence of electrode placement on different foot angiosomes.
  • To determine the clinical significance of TcpO2 variations across various electrode positions.

Main Methods:

  • Retrospective analysis of TcpO2 measurements in patients suspected of CLTI.
  • Electrodes were placed on the first intermetatarsal space, lateral foot edge, and plantar foot.
  • A TcpO2 variation of ≤8 mmHg was considered not clinically significant, based on reported intra-individual variation.

Main Results:

  • Thirty-four patients (34 ischemic legs) were included in the analysis.
  • Mean TcpO2 was higher at the lateral foot edge (55 mmHg) and plantar side (65 mmHg) compared to the first intermetatarsal space (48 mmHg).
  • No significant TcpO2 variations were observed based on anterior/posterior tibial or fibular artery patency.

Conclusions:

  • Multi-electrode TcpO2 measurements may not be beneficial for assessing tissue oxygenation across different foot angiosomes to guide surgical decisions.
  • A single electrode placement on the first intermetatarsal space is suggested as a preferred method.
  • TcpO2 appears to reflect overall foot tissue oxygenation, but plantar placement may lead to overestimated results and misinterpretation.