Percutaneous isolated limb perfusion delivery of antibiotic to the lower limb

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Authors: Byrne,M.;Wraight,P.;Christov,S.;McCann,J.;Dowling,R.;Mitchell,P.;Kaye,D.

Publication: Heart Lung and Circulation

Year: 2015

Volume: 24

Start Page: S129


Aim: To determine the effectiveness of the percutaneous isolated limb procedure (PILP) for the delivery of the antibiotic Timentin to the lower limb of individuals with diabetes, peripheral vascular disease and significant infection.

Method: Over two separate clinical studies, 11 individuals with a significant diabetes-related foot infection were recruited to receive ticarcillin / clavulanic acid (Timentin) using PILP. Patients had an antegrade femoral artery catheter, retrograde Venous Recovery Catheter and Venous Support Device inserted under local anaesthetic. The catheters were connected with an oxygenator, heater and paediatric cardiac perfusionpumpto create a lower limb circuit, with a proximal external tourniquet to isolate the limb circulation. Systemic and circuit antibiotic levels were determined during the procedure.

Results: No alteration in vital signs or biochemical parameters from the limb or systemic circulation were recorded during the procedure or during the 28-day follow-up. Ticarcillin concentrations in the limb circulation were more than 20-fold higher than that determined in the systemic circulation at the 15 min time point (circuit 140.8±9.9 μg/mL vs systemic 6.7±1.7 μg/mL, p<0.0001). The higher concentration was maintained within the circuit (8-fold) throughout the 30 min procedure (at 30 min, circuit 87.6±12.3 μg/mL vs systemic 10.3±2.5 μg/mL, p<0.0001).

Conclusions: The significantly higher concentrations of Timentin maintained within the PILP circuit compared to the systemic circulation indicate it is a safe and effective method of isolated antibiotic delivery in individuals with diabetes, peripheral vascular disease and significant lower limb infection.

  • Listing ID: 4636
  • Author/s: Byrne,M.;Wraight,P.;Christov,S.;McCann,J.;Dowling,R.;Mitchell,P.;Kaye,D.
  • Publication: Heart Lung and Circulation
  • Year: 2015
  • Volume: 24
  • Start Page: S129
  • Article Keywords: antibiotic agent;timentin;ticarcillin;local anesthetic agent;clavulanic acid;society;leg;Australia and New Zealand;heart;limb perfusion;procedures;limb;systemic circulation;diabetes mellitus;concentration (parameters);infection;human;peripheral vascular disease;catheter;oxygenator;devices;clinical study;artery catheter;follow up;tourniquet;femoral artery;patient;parameters;vital sign