J Surg Ultrasound.  2021 Nov;8(2):25-31. 10.46268/jsu.2021.8.2.25.

Evaluation Methods for Foot Perfusion in Critical Limb Ischemia

• jin H
• Kim H

• KMID: 2525877
• DOI: http://doi.org/10.46268/jsu.2021.8.2.25

Abstract

Critical limb ischemia is a clinical syndrome of ischemic pain at rest or tissue loss resulting from non-healing ulcers or gangrene related to peripheral artery disease. The primary therapeutic goal is to preserve limb function. The most important factor for determining the healing potential of a wound is the degree of perfusion to the affected segment. Several tests objectively measure the degree of tissue perfusion: for example, ankle-brachial index, toe pressure, ultrasound, transcutaneous oxygen pressure, two-dimensional perfusion angiography, indocyanine green angiography, diagnostic nuclear medicine imaging, and laser doppler skin perfusion pressure. In this study, we investigated tests that can measure tissue perfusion and discussed the advantages and limitations of each test.

Keyword

Critical limb ischemia; Tissue perfusion; Skin perfusion

Figure

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  Fig. 1 Ankle-brachial index (ABI) and pulse volume recording. (A) The ABI is calculated by dividing the higher of the posterior tibial and dorsalis pedis artery systolic blood pressures in a given limb by the higher of the brachial artery systolic blood pressures obtained from either arm. (B) In patients with noncompressible vessels due to calcification, an accurate ABI cannot be obtained.

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  Fig. 2 Toe pressure/Toe-brachial index (TBI). A pressure cuff is wrapped around the toes then the blood pressure is measured/ The TBI is calculated similarly to the ABI.

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  Fig. 3 Skin perfusion pressure measurement. A laser doppler probe is attached to the angiosome of the wound. The cuff is placed over the probe (A) and the blood pressure is measured (B).

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  Fig. 4 Transcutaneous partial pres-sure of oxygen (TcPO2). TcPO2 is noninvasive technique to assess the healing potential of foot ulcer or amputation wound. This test is performed with placing platinum oxygen electrodes on the skin (A) and the absolute value of the oxygen tension or a ratio of the values is shown on the screen.

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  Fig. 5 Two dimensional perfusion angiography images.

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