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Effectiveness of Repetitive Hyperbaric Oxygen Therapy for Chronic Limb-Threatening Ischemia
Gen Takagi1, Sonoko Kirinoki-Ichikawa1, Shuhei Tara1
1Department of Cardiovascular Medicine, Nippon Medical School.
Insights
Repetitive hyperbaric oxygen therapy (HBOT) improved outcomes for patients with chronic limb-threatening ischemia (CLTI) without revascularization. HBOT was linked to fewer major adverse events and better limb salvage rates.
Area of Science:
- Vascular Surgery
- Hyperbaric Medicine
- Ischemia Research
Background:
- Lower extremity artery disease (LEAD) significantly increases morbidity.
- Revascularization is the typical treatment for LEAD.
- This study evaluates outcomes for chronic limb-threatening ischemia (CLTI) without revascularization, comparing hyperbaric oxygen therapy (HBOT) versus no HBOT.
Purpose of the Study:
- To assess the clinical outcomes of patients with CLTI.
- To compare outcomes between patients who underwent repetitive HBOT and those who did not.
- To identify predictors of major adverse events (MAEs) and limb salvage in CLTI patients.
Main Methods:
- Retrospective evaluation of 58 CLTI patients (Rutherford 4-5) between 2002-2017.
- Patients received HBOT at 2.8 atm oxygen; control group had no HBOT or historical controls.
- Exclusion criteria included poor general health or need for revascularization; MAEs and limb salvage were primary endpoints; multivariate regression analysis was used.
Main Results:
- The study included patients with a mean age of 71±13 years; 67% had diabetes, 43% were on hemodialysis.
- Mean follow-up was 4.3±0.8 years; overall survival rates were 84.5% at 1 year and 81.0% at 3 years.
- HBOT independently predicted absence of MAEs (OR: 0.05) and was a significant predictor for preventing major limb amputation (OR: 0.04).
Conclusions:
- Repetitive, stand-alone hyperbaric oxygen therapy (HBOT) is associated with improved outcomes in CLTI patients.
- HBOT demonstrated a significant association with MAE-free survival.
- HBOT also independently predicted successful limb salvage in this patient cohort.
Background:
Lower extremity artery disease is strongly associated with morbidity and is typically addressed through revascularization interventions. We assessed the clinical outcomes of patients with chronic limb-threatening ischemia (CLTI) without revascularization who did and did not undergo repetitive hyperbaric oxygen therapy (HBOT).
Methods:
Between April 2002 and March 2017, the records of 58 patients with CLTI (Rutherford classification 4 in 19% and 5 in 81%) were evaluated retrospectively. HBOT was performed at 2.8 atm of oxygen (HBOT group). The control group included those who could not continue HBOT and historical controls. Patients in poor general health or with an indication for revascularization therapy were excluded. We examined major adverse events (MAEs) and limb salvage rates. Independent predictors and risk stratification were analyzed using a multivariate regression analysis.
Results:
The mean age was 71±13 years. Of all patients, 67% had diabetes and 43% were undergoing hemodialysis. The mean follow-up period was 4.3±0.8 years. The overall survival rate was 84.5% and 81.0% at 1 and 3 years, respectively. The Cox regression analysis indicated that high body mass index (odds ratio [OR]: 0.86; 95% confidence interval [CI]: 0.76-0.97; p=0.01), well-nourished (OR: 1.21; 95% CI: 1.01-1.45), and HBOT (OR: 0.05; 95% CI: 0.01-0.26; p<0.001) independently predicted absence of MAEs. For major limb amputation, the ankle-brachial index (OR: 0.2; 95% CI: 0.05-0.86; p=0.03) and HBOT (OR: 0.04; 95% CI: 0.004-0.32; p=0.003) were independent predictors.
Conclusions:
Repetitive, stand-alone HBOT was associated with MAE-free survival and limb salvage in patients with CLTI.
