No evidence of a change in serum level of vascular endothelial growth factor (VEGF) during a course of hyperbaric oxygen exposures in patients with diabetic foot ulcers.

Clinical Bottom Line: 1. There may not be any significant change in serum VEGF during a course of hyperbaric oxygen therapy for diabetic leg ulcer.

Appraised by: Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital Sydney; Friday, 30 November 2001

Clinical Scenario: A diabetic patient presented for treatment of leg ulcer. Three-part Question: For diabetic patients with leg ulcers, do blood levels of vascular endothelial growth factor (VEGF) alter when patients receive hyperbaric oxygen therapy compared to a sham air treatment? Search Terms: Diabetic ulcers, vascular endothelial growth factor.

The Study: Double-blinded randomised controlled trial, intention-to-treat unknown. Diabetic patients selected as suitable for hyperbaric oxygen therapy to improve healing. Control group (N = 8; 8 analysed): Patients received air at 2.4ATA for 90 minutes daily, five times per week to a total of 30 treatments. Other treatment not stated. Experimental group (N = 8; 8 analysed): Patients received 100% oxygen at 2.4ATA on the same regimen as control group.

    • The Evidence:

Entry values Time Hyperbaric air HBO P-value VEGF serum level (pg/ml) Pre-treatment 424.7 +/-317.8 376.5 +/-184.6 0.08

Comments: 1. Abstract only, very few quantitative results given. 2. Authors state there was a significant drop in VEGF after the first treatment with hyperbaric oxygen (p=0.008), but little change overall with oxygen administration. 3. Analysis using paired t-test may not have been appropriate. 4. Clinical significance unknown 5. These patients may also be reported in other studies from this group (see Abidia).

Expiry date: July 2021 References: 1. Chin K, Xie Y, Abidia A, Laden G, Greenman J, Monson J, Grout P, McCollum P. The relationship of hyperbaric oxygen therapy and vascular endothelial growth factor in diabetic patients with leg ulcers: a double-blind randomised controlled trial. Undersea and Hyperbaric Medicine 2001; 28(Suppl):63.