Transcutaneous Oxygen Pressure as an Early Prognostic Marker for Wound Healing and Limb Salvage in Revascularization...

The ankle-brachial index (ABI) is frequently unreliable for perfusion assessment in chronic limb-threatening ischemia (CLTI), particularly in patients with medial arterial calcification. This study evaluated the prognostic value of transcutaneous oxygen pressure (TcPO₂) for predicting wound healing and limb salvage following revascularization for peripheral arterial disease (PAD).

This prospective, single-center observational cohort study included 100 patients with PAD undergoing surgical, endovascular, or hybrid revascularization. TcPO₂ and ABI were assessed preoperatively and at 24 hours, 6 months, and 12 months postoperatively. Clinical severity was classified using the Rutherford classification, with WIfI staging in patients with tissue loss and GLASS lesion complexity staging. The primary outcome was the change in TcPO₂ (ΔTcPO₂) from baseline at the defined follow-up intervals. Secondary outcomes included the association of TcPO₂ and ΔTcPO₂ with wound healing in patients with tissue loss.

Ninety-eight patients were analyzed, including 54 with CLTI. Median preoperative TcPO₂ was 31 mm Hg (interquartile range, 22). TcPO₂ increased significantly over time in both CLTI and non-CLTI cohorts (P < 0.001), with more pronounced improvements in patients with CLTI. Absolute TcPO₂ values and changes from baseline (ΔTcPO₂) at 24 hours and 6 months were significantly associated with wound healing (P < 0.05), and TcPO₂ at 24 hours was significantly associated with limb preservation in CLTI patients (P < 0.05). ABI demonstrated weaker and delayed associations. Increasing lesion complexity was associated with lower postoperative TcPO₂, whereas ABI showed no such relationship.

TcPO₂ provides early and clinically relevant prognostic information on tissue-level perfusion recovery after revascularization, outperforming ABI in predicting wound healing and limb salvage in CLTI.