Revascularized diabetic limbs: positional changes in regional perfusion index

Area of Science:

• Vascular Surgery
• Dermatology
• Diabetology

Background:

• Peripheral artery disease (PAD) significantly impacts lower limb perfusion, necessitating accurate diagnostic tools.
• Ankle-brachial index (ABI) is a standard measure, but its efficacy in complex cases, especially with diabetes, is debated.
• Regional perfusion index (RPI) offers a potential alternative or complementary method for assessing tissue oxygenation.

Purpose of the Study:

• To compare the effectiveness of ABI and RPI in quantifying lower limb perfusion.
• To analyze perioperative changes in RPI, particularly concerning limb elevation.
• To investigate the influence of diabetes on RPI measurements and positional changes.

Main Methods:

• Prospective measurement of ABI and RPI (foot/chest transcutaneous oxygen tension) in 20 patients with 22 ischemic lower extremities.
• Comparison of pre- and postoperative measurements, including RPI variation with limb elevation.
• Statistical analysis (t-tests) based on ischemia severity and diabetes status.

Main Results:

• Both ABI and RPI demonstrated equal effectiveness in preoperative ischemia assessment and showed increased perfusion postoperatively.
• All limbs exhibited greater RPI decrements with elevation postoperatively compared to preoperatively.
• Diabetic patients showed a significantly larger postoperative RPI decrease with elevation than non-diabetics (P < 0.05).

Conclusions:

• ABI and RPI are reliable indicators of lower limb perfusion, valuable for assessing ischemia and post-revascularization outcomes.
• Limb elevation can significantly impact RPI, indicating reduced skin blood flow, especially after surgery.
• Postoperative limb elevation in diabetic patients with ischemic lesions should be approached cautiously due to pronounced blood flow reduction.