Comparative analysis of lower extremities tissue perfusion by the use of perfusion scintigraphy method after hyperbaric oxygenation and lumbar sympathectomy

Abstract

Background/Aim. Lumbar syphatectomy (LS) increases pheripheral blood flow primarily by the arteriolar vasodilatation within the skin vascular net. Increase in tissue nutrition takes place only in the distal blood vessels of the skin. Nevertheless, in some patients sympathectomy brings about improvement in ischemic ulcerations healing. Hyperbaric oxigenation (HBO) is a medical treatment in which a patient breathes 100% oxygen under pressure higher than atmospheric implemented in special units allowing the whole body be in a chamber. The aim of the study was to determine efficacy of the applied therapies for the treatment of inoperable occlusive lower extremities (LE) arteries diseases according to the obtained results. Methods. The study included 30 patients divided into two groups (15 patients each) in which stenosis level of the lower extremities arteries had been determined using aortography due to further treatment with HBO and LS. All the patients were clinically examined, their objective condition evaluation based on claudication distance, pain in rest, skin and skin adnexa atrophy, and temperature and LE functionality, as well as exposed to perfusion scintigraphy prior to the treatment and within 30 days after the treatment finishing. Results. Analyzing patients' status prior to and after the treatments applied the number of patients with obvious improvement was higher in those treated by HBO than those treated by LS. Measuring claudication distance revealed significantly greater changes in patients treated by HBO (from 178.57 m to 754.76 m) than in those treated by LS (from 229 m to 253 m). Other clinical symptoms, such as parasthesia, status of the skin adnexes (hair, nails), skin colour and temperature were also improved after the treatment by HBO. Conclusion. The results obatined in this study confirm the advantages of HBO over LS in therapy of inoperable occlusive LE disease, so LS could be definitely abandoned as a choice for treating such disease.Uvod/Cilj. Lumbalna simpatektomija (LS) povecava periferni protok krvi vazodilatacijom arteriola primarno u vaskularnoj mrezi koze. Povecanje u nutritivnom smislu odvija se samo u distalnoj mrezi sudova koze. Uprkos tome, kod nekih bolesnika simpatektomija donosi poboljsanje u zalecenju ishemicnih ulceracija. Hiperbaricna oksigenacija (HBO) je medicinski tretman u toku koga bolesnik udise 100% kiseonik pod pritiskom visem od atmosferskog, a obavlja se u specijalno dizajniranim uredjajima pri cemu je celo telo bolesnika u komori. Cilj studije bio je da se prema dobijenim rezultatima utvrdi efikasnost primenjenih terapijskih procedura u tretmanu inoperabilne, okluzivne bolesti arterija donjih ekstremiteta. Metode. Grupu ispitanika cinilo je 30 bolesnika podeljenih u dve grupe po 15 bolesnika, kod kojih je stepen stenoze arterija donjih ekstremiteta (DE) utvrdjen aortografijom i koji su izabrani za dalji tretman primenom HBO i LS. Kod svih ispitanika izvrsen je klinicki pregled, ocenjeno je objektivno stanje na osnovu klaudikacione distance, postojanja bola u stanju mirovanja, atrofije koze i koznih adneksa, temperature koze, kao i funkcionalnosti DE i perfuzione scintigrafije pre pocetka lecenja i u toku 30 dana nakon zavrsenog lecenja. Rezultati. Analizirajuci stanje i pre i posle sprovedene terapije HBO i LS broj bolesnika sa vidljivim poboljsanjem bio je veci u grupi koja je tretirana HBO. Merenjem klaudikacione distance ustanovljena je znatno veca promena kod bolesnika tretiranih HBO (sa 178,57 m na 754,76 m), u odnosu na one tretirane LS (sa 229 m na 253 m). Takodje, u toku izvodjenja studije zapazili smo i ostale simptome koji su ukazivali na klinicko poboljsanje bolesnika nakon primenjene HBO, a to su smanjenje intenziteta parestezija, oporavak koznih adneksa (dlakavost, nokti), boje i temperature koze. Zakljucak. Rezultati dobijeni ovim istrazivanjem potvrdjuju nesumljivu prednost HBO u odnosu na LS u terapiji inoperabilne okluzivne bolesti cime se LS moze definitivno napustiti kao terapijski izbor za ovo oboljenje.