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

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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.