P-097 - EVALUATION OF DIRECT VERSUS INDIRECT ANGIOSOMAL REVASCULARIZATION IMPACT ON TISSUE OXYGENATION CHANGES USING NIRS

TOPIC:
Peripheral Occlusive Arterial Disease
AUTHORS:
Racyte A. (Vilnius University, Faculty of Medicine ~ Vilnius ~ Lithuania) , Pikturnaite G. (Vilnius University, Faculty of Medicine ~ Vilnius ~ Lithuania) , Baltrunas T. (Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania ~ Vilnius ~ Lithuania)
Introduction:
Endovascular approach is the most commonly used technique to treat critical limb ischemia. This method allows to restore blood flow precisely to the artery supplying the ischemic zone, based on the angiosome concept. However, there is a lack of evidence to make direct angiosomal revascularization a method of choice. The aim of this study was to identify whether oxygen saturation increase in an ischemic zone after performing direct angiosomal revascularization is greater than after indirect revascularization.
Methods:
A prospective observational study was performed. Patients had to meet strict inclusion and exclusion criteria (Table 1). Either direct or indirect endovascular revascularization was carried out in all cases. Patient assignment to direct or indirect revascularization group was not randomized and the decision was made by the operating surgeon during the procedure. Tissue oxygen saturation near the ischemic wound was recorded intraoperatively using near-infrared spectroscopy (NIRS). Data was downloaded, post-processed and compared between the two groups.
Results:
This clinical trial included 30 patients with critical limb ischemia (Rutherford V-VI) and chronic total occlusion in below the knee arteries. The mean age of the patients was 74,7. Male patients accounted for 57%. In the indirect revascularization group 6 (40%) patients had diabetes mellitus and 4 (26,7%) had end stage renal disease while in the direct revascularization group there were 10 (66,7%) patients with diabetes mellitus and 6 (40%) with end stage renal disease. Greater oxygen saturation increase was observed in the direct angiosomal revascularization group, however, the change between groups was not statistically significant (Mann Whitney test, p=0,619) (Table 2; Figure 1). A post-hoc Power analysis revealed that the sample size for independent groups T-test with alpha error probability of 0.05 and Power (1 - error probability) of 0.95 is 884 subjects.
Conclusion:
In this clinical trial no statistically significant difference in tissue oxygen saturation increase was observed between direct and indirect angiosomal revascularization groups. Thus, this study suggests that only a minor benefit at most could exist in direct angiosomal revascularization.
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