Hyperbaric Oxygen Therapy (HBOT) in the Treatment of Acute Peripheral Arterial Insufficiency (APAI)

Acute peripheral arterial insufficiency (APAI) entails an unforeseen decline in blood flow to the farthest parts of the body, mainly the arms and legs. The legs, which represent the lower extremities, are the most affected, and in severe cases, limb loss via amputation is carried out. The blockage in the blood supply by the arteries implies that tissues are in a deficit, resulting in their damage and, ultimately, death. One of the most common acute peripheral arterial insufficiency symptoms is sudden pain in the affected limb. The pain hinders movement and regular functioning. The sharp pain resembles that of cramped muscles. Also, the affected limb appears pale and is noticeably cooler than average body temperature. The changes result from compromised blood flow, which results in lower temperatures. Some causes of arterial embolism include blood clots and debris, which block arteries, thus leading to blocked bloodways. The arteries could also be impaired by the impact of crush or trauma injuries as well as clogging by such substances as cholesterol. Hyperbaric oxygen therapy is explored as adjunctive therapy in treating acute peripheral arterial insufficiency.

Mechanism of Action

HBO is beneficial since it stops further arterial tissue damage, thus reducing the chances of morbidity and mortality. Also, the increased oxygen concentration creates an optimal environment for all wound closure and healing phases. In cases where amputation results, the wounds heal fast, and a lesser scar is formed; slow scar healing results in a substantial scar. HBOT increases the efficacy of other forms of treatment for the (APAI). The healing process is boosted when used alongside revascularization, which is either performed via surgical bypass or endovascular revascularization. It also reduces the frequency of amputation, which is explored when other forms of treatment are ineffective. The viability of damaged arterial tissue is improved through elevated tissue oxygen tensions. The tissues of the affected limbs can heal and generate faster since epithelization is boosted well. Introducing hyperbaric oxygen (HBO) lessens local edema resulting from fluid accumulation without the cell.  

High oxygen concentration aids in the reduction of carbon dioxide and other residual products retained in the arterial tissues. Oxygenation lessens claudication, which is characterized by pain in the arms and legs due to reduced blood flow. HBOT comes in handy during the preoperative and postoperative periods. During the former, it aids in curbing further degeneration of affected tissues. During the latter, it boosts the recovery and healing process of the affected tissues/wounds and those operated on. The quality of life is improved in the process as one can quickly get back to various activities and an active lifestyle.  

References

Harris, K. A. (2023). Acute arterial ischemia. Peripheral Arterial Disease Handbook, 14(12), 147–167. https://doi.org/10.1201/9780429191497-10  

Lin, P.-Y., Sung, P.-H., Chung, S.-Y., Hsu, S.-L., Chung, W.-J., Sheu, J.-J., Hsueh, S.-K., Chen, K.-H., Wu, R.-W., & Yip, H.-K. (2018). Hyperbaric oxygen therapy enhanced circulating levels of endothelial progenitor cells and angiogenesis biomarkers, blood flow, in ischemic areas in patients with peripheral arterial occlusive disease. Journal of Clinical Medicine, 7(12), 548–552. https://doi.org/10.3390/jcm7120548  

Sato, Y., Urasawa, K., Morishita, T., Tan, M., Hayakawa, N., Tokuda, T., Nakano, A., Miyazawa, T., Shimooka, Y., Minegishi, Y., Dannoura, Y., Ikeda, H., Hayashi, T., Miwa, T., & Hieda, S. (2021). Combined treatment with hyperbaric oxygen therapy and endovascular therapy for patients with chronic limb-threatening ischemia　― study protocol for the Hotfoot Multicenter randomized controlled trial ―. Circulation Reports, 3(12), 737–741. https://doi.org/10.1253/circrep.cr-21-0097