CONFERENCE DAY 1　Tuesday, January 26th

Moderated poster round : Original research : PVD and acute thrombectomy

Usefulness of Tissue Perfusion Monitoring for Peripheral Artery during endovascular therapy

Katsutsohi Takayama*, Kaoru Myouchin*, Kimihiko Kichikawa **
*Department of Radiology and Interventional Neuroradiology, Ishinkai Yao General Hospital, Yao, Japan **Department of Radiology, Nara Medical University, Kashihara, Japan

Background: Although skin perfusion pressure (SPP) is widely used clinically to predict probability of wound healing, it has not been reported that Skin Perfusion (SP) is useful for assessing endpoint for endovascular therapy (EVT) for peripheral artery disease (PAD) during procedure.

Purpose: The aims of this study was to determine whether SP monitor during procedure is useful for assessing the endpoint for EVT for PAD.

Material and methods: 112 limbs in 77 patients (54 men; age 48-97 years [mean 73.0 years] who SPP improved postoperatively among 90 patients were underwent successful EVT for PAD and intraoperative SP and SPP between January 2014 and November 2014. This study included 37 lesions in the iliac arteries, 60 lesions in the superficial femoral arteries and 18 lesions in the below the knee arteries. SPP and SP was measured using MV monitor PLUS System (Nexis Corp, Fukuoka, Japan)  Change of Skin Perfusion in dorsal and planter region and correlation between SPP and SP in dorsal and planter region were retrospectively assessed.

Result: SP in dorsal and planter region after EVT were significantly improved in all cases. And there was statistically positive correlation between SPP and SP in dorsal and planter region. Asymptomatic distal embolization occurred in 2 patients (1.8%) during EVT.

Both of cases were easily detected by SP monitor, and thrombolysis was performed immediately. No ischemic complication occurred in both cases due to thrombolysis

Conclusion: SP is useful for monitoring and assessing the endpoint for EVT for PAD.

Katsutoshi Takayama, MD, PhD

Department of Radiology and Interventional Neuroradiology, Ishinkai Yao General Hospital

1-41 Numa Yao, Osaka, Japan , 581-0036,

How compression therapy could be alleviating chemotherapy-induced peripheral neuropathy: A study of skin microcirculation homeostasis across all CIPN grades.
Citation: J Clin Oncol 33, 2015 (suppl; abstr e20670)

Tsuyoshi Ohno, Charles de Kerckhove, Takashi Mine, Hiroki Yoshioka, Mikiko Kosaka, Kazuyuki Matsuda, Maiko de Kerckhove, Yoshihiro Mori, Shigetoshi Matsuo, Takashi Azuma, Takehiro Mishima, Satoshi Inoue, Takashi Hamada, Susumu Eguchi; Nagasaki Prefecture Shimabara Hospital, Shimabara, Japan; Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan; Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

Background: We previously reported that compression and medication therapies applied to breast cancer patients 1) control chemotherapy-induced peripheral neuropathy (CIPN) grades, and 2) increase skin perfusion; however, it is not fully clear at the microcirculation level how our 3S Approach ofstockings, sleeves, and selected prophylactic medications appears to alleviate CIPN symptoms. In light of vasomotion research relating tissue-fluid exchange to skin microcirculation homeostasis, quantified by Stability Index [SI] for Total Blood Flow [TBF], we investigated compression therapy’s effect on skin microcirculation homeostasis across all CIPN grades.
Methods: Compression stockings were applied for 24 hours on 22 3S-adopting, nab-PTX–treated breast cancer patients (44 lower limb samples) just before IV, and on 25 female healthy volunteers (n = 50). Measurements before and after application were by laser Doppler blood flow meter. The nab-PTX group was subdivided by CIPN grade for subsequent analysis (n = 12 for Grade 0, n = 20 for Grade 1, and n = 12 for Grades 2 and 3 combined). SI is derived by [TBF Standard Deviation] / [Mean TBF], where low SI values indicate normal, stable blood flow and high values indicate impairment.
Results: Before applying stockings, SI [mean, %] was 11.6 ± 6.3 in the 44 patient samples and 8.3 ± 4.9 in the 50 volunteer samples. Applying the stockings significantly lowered patient SI to 8.7 ± 3.4 (p < 0.01) and volunteer SI to 6.5 ± 2.5 (p < 0.05). By patient subgroup, Grade 0 SI lowered from 14.1 ± 5.4 to 11.3 ± 3.9, p = 0.085; Grade 1, 11.9 ± 8.0 to 8.4 ± 3.2, p = 0.043 [significant]; Grades 2+3, 9.2 ± 3.3 to 6.6 ± 1.2, p = 0.012 [significant].
Conclusions: Our study suggests that the skin microcirculation homeostasis of nab-PTX patients appears to be 1) poor compared to the healthy population and 2)improved by compression therapy across every CIPN grade, including high grades. Such apparent effectiveness may relate to previous 3S findings of improved CIPN grade control, increased skin perfusion, and potentially improved drug clearance at the skin level and may support continuing compression therapy even for high grade patients.

2015年5月28日（木）18：15～19：15）

宮崎シーガイヤ コンベンションセンター 4F 第一会場（天瑞）メインホール

イブニングセッション　IS-05

Usefulness of Tissue Perfusion Monitoring and SPP(Skin Perfusion Pressure) for Peripheral Artery during EVT

佐藤 友保 先生（土谷総合病院）高山勝年（医真会八尾総合病院）海老原大志（(株)MID　企業説明）

2015年5月23日（日）

第2会場（福岡国際会議場 福岡サンパレス2F パレスルームA）

[091-4] オーラルセッション：循環器①

下肢EVT施術中におけるSRPPシステムを用いた皮膚灌流圧と皮膚組織血流の評価

矢谷 慎吾 先生（佐世保市立総合病院 医療技術　臨床工学室）

2014年6月14日（土）

ポスター会場1（神戸国際展示場 1号館2階）

[P-2-444] ポスター ：モニタリング2

ベッドサイドでのSRPP法を利用した透析患者下肢血流評価

近藤 武史 （住吉クリニック病院 臨床工学部）

2014年6月15日（日）

第2会場 (神戸ポートピアホテル 南館1F 大輪田A)

[WS-12] ワークショップ 12：透析領域のモニタリング技術を再考する

末梢循環モニタリングによるStability indexの臨床的意義

庭山 淳 （住吉クリニック病院 血液浄化療法部）

Jun 3, 2014

Decreased skin perfusion due to chemotherapy-induced peripheral neuropathy in breast cancer patients, and improvement by wearing stockings.

Author(s): Tsuyoshi Ohno, Hiroki Yoshioka, Mikiko Kosaka, Sadayuki Matsuda, Takashi Mine, Maiko de Kerckhove, Charles de Kerckhove, Junji Irie, Keiji Inoue, Masashi Haraguchi, Masachika Kitajima, Shinichiro Ito, Hirotaka Tokai, Takayuki Tanaka; Nagasaki Municipal Hospital, Nagasaki, Japan

Background: Nanoparticle albumin-bound paclitaxel (nab-PTX) has become a key drug used in chemotherapy for breast cancer, but it often causes adverse effects such as peripheral neuropathy. No effective management has so far been established. We have applied a 3S approach to peripheral neuropathy based on two concepts: compression therapy using stockings and sleeves, and pharmacological therapy using selectedprophylactic medications, including goshajinkigan, a herbal medicine. We previously reported better CTCAE grades and notably superior nab-PTX dosage maintenance in a 3S group compared to a control group with no prophylactic treatment. Regarding the mechanism responsible for the effects of 3S, no relationship had yet been clarified between the grades of chemotherapy-induced peripheral neuropathy (CIPN) and skin perfusion. Therefore, the aim of the present study was to elucidate whether compression therapy using stockings is related to the skin blood perfusion of the lower limbs.
Methods: We used a laser Doppler blood flow meter (NL-101 Nahri Nexis Japan) to measure the perfusion of the skin. The blood perfusion of the lower limbs was measured before and after stocking use in a 3S prophylactic treatment group (n=50) and in a control group of healthy volunteers using the same procedure (n=50).
Results: In the control group, the median skin perfusion level of the lower limbs before wearing stockings was 10.9 ± 3.8 mL/min/100g, which tended to increase after stocking use to 11.8 ± 4.3 mL/min/100g (p=0.063). In the 3S group of nab-PTX chemotherapy patients, the median skin perfusion level before stocking use was 8.7 ± 3.3 mL/min/100g, which was notably lower than the control group level before stockings were worn (p < 0.01). Of note, the median skin perfusion level significantly increased to 11.3 ± 3.8 mL/min/100g (p < 0.001) in the 3S after stocking use. Conclusions: This study demonstrated that the skin perfusion of the lower limbs is decreased following nab-PTX chemotherapy, and also that the skin perfusion is improved by compression therapy. Compression therapy may therefore lead to alleviation of CIPN, thus supporting our use of the 3S treatment.

2014年3月23日（日）

東京国際フォーラム，JPタワー ホール＆カンファレンス，東京商工会議所（東京都）

VascularDisease(Therapy)4

PE-621 Multiple-line Revascularization Strategy is Superiorto Single Line Strategy in PPI for the Patient swith CLI

Naofumi Oyamada （ Rakuwakai Marutamachi Hospital, Kyoto ）

2013年10月26日（土）～27日（日）

ベルサール秋葉原1・2階

シンポジューム　SY-０4　各種モニタリング技術を用いた臨床評価

- 頭頚部組織血流量モニタリングを中心に -

偕行会　名港共立クリニック　佐藤隆