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Peripheral Arterial Disease

Peripheral Arterial Disease (PAD) is a condition caused by obstruction of the peripheral arteries leading to an increased risk for cardiovascular events. The classical PAD symptom is intermittent claudication or walking pain, but notably two-thirds of all patients are asymptomatic. Early diagnosis and treatment using noninvasive vascular objective tests, such as Ankle Brachial Index (ABI), toe pressure, Pulse Volume Recording (PVR) and transcutaneous oxygen, are crucial.

Critical Limb Ischemia

Critical Limb Ischemia (CLI) is a severe form of Peripheral Arterial Disease (PAD) with high incidence of amputation and mortality. The distal blood flow and microcirculatory function are severely compromised resulting in rest pain, ischemic ulcers and gangrene. CLI is a clinical diagnosis, but should be supported by objective vascular testing. The same objective diagnostic test as for PAD can be used, but due to the risk of calcified vessels causing elevated ABI (Ankle Brachial Index) values, toe pressures and tcpO2 are recommended.

Diabetic ulcers

Diabetic ulcers are the most common cause to lower extremity amputation. To prevent amputation, it is important to diagnose and treat the wound as early as possible. One of the most important factors relating to the outcome of a diabetic foot ulcer is Peripheral Arterial Disease (PAD). Ischemia has to be excluded. Falsely elevated ABI (Ankle Brachial Index) values due to calcified vessels, makes the diagnosis of PAD in diabetics difficult. In addition, neuropathy renders conventional parameters such as pain and temperature of the foot, unreliable. Therefore, objective noninvasive vascular tests, such as toe pressure and transcutaneous oxygen (tcpO2), are warranted.

Evaluation of vascular reconstructions

Revascularizations including endovascular and surgical techniques may be used to treat patients with Peripheral Arterial Disease (PAD). The choice of method depends on the individual patient. To assess the severity of disease, peripheral pressures (ABI and toe pressure) and microcirculatory investigations (transcutaneous oxygen), are good diagnostic tools. In addition, these vascular tests can help evaluate the treatment outcome.

Amputation levels

Amputations are costly for healthcare systems and traumatic for the affected patient. An adequate amputation level is important to avoid secondary amputations. Together with clinical criteria, objective measurements, such as tcpO2, heat-controlled laser Doppler and skin perfusion pressure (SPP), can assist in the identification of the optimal amputation level to ensure proper healing.

Hyperbaric oxygen therapy

Hyperbaric oxygen therapy (HBOT) is a medical treatment in which the patient breathes 100% oxygen inside a pressurized treatment chamber. The aim is to increase the oxygen level in the tissue. It is used in cases where partial or total tissue hypoxia occurs such as acute limb ischemia, diabetic foot lesion, arterial ulcers and more.

tcpO2 is widely used to qualify patients for HBO treatment and to monitor the tissue oxygenation during treatment inside the chamber.

Raynaud video – Thursday, January 12, 2016 at 21:00. Courtesy of Telepool. www.mdr.de/hauptsache-gesund/

Raynaud

Patients with Raynaud or vibration syndrome exhibit discoloration of their digits after exposure to cold. The underlying cause is unknown but might in some cases be a consequence of long-term exposure to hand-transmitted vibration at work. To assess the condition, local cooling of the hands and fingers is commonly used.

To follow changes in skin blood flow as a response to cold provocation, both PeriFlux System 5000 and a blood perfusion imager, such as the PeriCam PSI System, can be used. When using PeriFlux System 5000, laser Doppler probes are attached to the fingers, which are then immersed into cold water. Continuous monitoring of changes in blood perfusion is then possible.

The PeriFlux System 5000 is not available within the EU and the EEA.

References

  1. International Consensus on the Diabetic Foot and Practical Guidelines on the Management and Prevention of the Diabetic Foot, International Working Group on the Diabetic Foot, 2012
  2. European Society for Vascular Surgery, CLI Guideline Committee Guidelines for Critical Limb Ischaemia and Diabetic Foot, 2011
  3. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASCII). Eur J Vasc and Endovasc Surgery, Vol 33 suppl 1, 2007
  4. Transcutaneous Oximetry in Clincal Pratice: Consensus statements from an expert panel based on evidence. Fife, Smart, Sheffield, Hopf, Hawkins and Clarke. UHM 2009, Vol. 36, No. 1.
  5. Laser Doppler imaging of skin blood flow for assessing peripheral vascular impairment in hand-arm vibration syndrome. Terada K, Miyai N, Maejima Y, Sakaguchi S, Tomura T, Yoshimasu K, Morioka I, Miyashita K. Ind Health. 2007, 45, (2), 309-17

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Improving quality of life since 1981

Perimed AB, established in 1981, provides instruments, software and expertise to enable assessment of the microcirculation. We utilize laser Doppler, laser speckle (LASCA) and transcutaneous oxygen (tcpO2 or TCOM), to accurately monitor and quantify blood perfusion and tissue oxygenation in real-time. Our modular PeriFlux System 5000 and PeriFlux 6000, the latest generation of our PeriFlux System, are excellent choices for diagnosing Peripheral Arterial Disease (PAD) and Critical Limb Ischemia (CLI) or for assessing wound healing potential in your vascular patients. Our blood perfusion imager PeriCam PSI System allows you to investigate spatial distribution, for example during cortical spreading depression.