Immersing Feet in Carbon Dioxide-enriched Water Prevents Expansion and Formation of Ischemic Ulcers after Surgical Revascularization in Diabetic Patients with Critical Limb Ischemia

Abstract

Objective: We investigated the effect of immersion of feet in CO2-enriched water for preventing expansion and formation of ischemic ulcer in critical limb ischemia of diabetic patients after surgical revascularization.

Materials and methods: Eligible patients were allocated CO2 group (CO2 immersion plus standard care) or control group (standard care alone) and were followed up for 3 months after surgical revascularization. The end point is defined as an expansion of a target ulcer (more than 101% of original size) or the formation of new ulcers during the follow-up period.

Results: Fifty-nine patients out of originally enrolled 66 patients with type II diabetes were included in intention-to-treat population. The cumulative prevention rate for ischemic ulcer after 3 months was 97.1% in the CO2 group, while, in the control group, it was 77.8%, i.e., significantly lower than the CO2 group (P = 0.012, log-rank test). The transcutaneous oxygen pressure increased significantly only in the CO2 group, from 56 ± 14 to 63 ± 15 mmHg (P < 0.01, Wilcoxon signed rank test), in 3 months.

Conclusion: These results suggest that addition of CO2 immersion to standard care of critical limb ischemia in diabetic patients improves early postoperative outcome after vascular surgery.

Keywords: adjunctive treatments; carbon dioxide; critical limb ischemia; revascularization; transcutaneous oxygen pressure.

Fig. 1

Prevention rate for formation and expansion of ischemic ulcer in CO₂ group and control group. A Kaplan-Meier plot was created with respect to the prevention rate (Y axis), i.e., the number of limbs free from ulcer aggravation / number of enrolled limbs in each group. “Free from ulcer aggravation” is defined as ulcer expansion of less than 101% of the original size and/or absence of newly formed ulcers. A significant difference was observed between CO₂ group and control group (P = 0.012 by log-rank test).