Hyperbaric Oxygen Therapy for Arterial Insufficiencies

Arterial Insufficiencies: Problem Wounds, Central Retinal Artery Occlusion

Arterial insufficiencies is a broad category of conditions that are approved by the Undersea and Hyperbaric Medical Society (UHMS) for treatment with Hyperbaric Oxygen Therapy (HBOT.) The category covers:

Central Retinal Artery Occlusion (stroke of the eye)
Problem Wounds

Of all the approved conditions for HBOT, diabetic foot ulcers comprise the vast majority of treatments in hyperbaric facilities throughout North America. In Canada, the scarcity of hyperbaric facilities and the lack of training about the effectiveness of HBOT has resulted in many diabetics unnecessarily losing their legs to amputation. For example, British Columbia has only one hospital based chamber, located at Vancouver General Hospital (VGH.)

The physiological rationale for the use of HBOT in the treatment of problem wounds is explained in the UHMS Enhancement of Healing in Problem Wounds page. These scientifically established effects of HBOT include:

providing adequate oxygen tension within the wound for neutrophils, leukocytes and macrophages to perform immune functions
providing adequate oxygen tension within the wound for osteoclasts and osteoblasts to remodel bone
providing adequate oxygen tension within the wound for fibroblasts to lay down collagen
enhancement of the effectiveness of antibiotics
suppression of the synthesis of many bacterial toxins
potent anti-inflammatory effects
amelioration of ischemic reperfusion injury
new blood vessel growth (angiogenesis) stimulated by VEGF and PDGF pathways
an 8 fold increase in the mobilization of CD34 stem cells from bone marrow to circulation
increased nitric oxide (NO) within the wound, correlated to wound healing and closure

"The net result of serial hyperbaric oxygen exposures is improved local host immune response, clearance of infection, enhanced tissue growth and angiogenesis leading to progressive improvement in local tissue oxygenation and healing of hypoxic wounds." - UHMS Problem Wounds Page

In the USA, HBOT treatment for problem wounds with reimbursement from insurance companies can occur in a hospital or a private hyperbaric facility. In Canada, in order to qualify for HBOT covered by the Medical Services Plan (MSP) for problem wounds, you must have a referral to a hospital based chamber from your wound care clinic. Treatments at our facility are not covered by MSP.

Biofilms in Problem Wounds

It has been reported by Wolcott et al. that problem wounds have a biofilm component. This is the main reason for the regular debridement of wounds in standard wound care. Physical removal of the infected surface of problem wounds is one of the only effective ways to remove the biofilm infection. Biofilm is a multi-kingdom form that bacteria can take in the body, that are strongly antibiotic and immune resistant. It is believed that the chronicity of many infections can be attributed to this bacterial form. HBOT has been shown to be a effective potentiator of antibiotics in many biofilm infections, it remains to be seen if HBOT has a direct anti-biofilm effect. For more information visit our biofilm page.

How can Oceanside Hyperbaric Help with Problem Wounds?

Early Intervention
HBOT is indicated by the medical system to enhance healing of problem wounds. This means, that in order to qualify for treatment that is covered by insurance providers a wound must not respond to 8-weeks of standard wound care. At this point, HBOT is the treatment of last resort before amputation. But why wait until the wound progresses to this point? Would it not be sensible and cost effective to enhance the healing of a problem wound before the end stage? This approach to the treatment of problem wounds requires an educated and empowered patient.

Peripheral Neuropathy and Peripheral Artery Disease (PAD) are early signs of the loss of adequate blood supply to the extremities. Sometimes these conditions can be halted or reversed with lifestyle interventions, like improved diet, exercise and weight loss. Early intervention at this point with HBOT can prevent to development of problem wounds altogether.

Cost Effectiveness
The cost effectiveness of a preserved limb through administration of HBOT versus the cost of amputation through failed standard wound care treatment is well established. This does not take into account any value for the quality of life that is sacrificed with the loss of a limb, which is priceless to the client. Nor does it consider that often amputations fail to heal and require further amputations.

The cost to the medical system and insurance providers for a hospital based hyperbaric treatment is between $1000-2000 per session. We provide the service for less than 10% of the cost.

Other Problem Wounds
The UHMS only approves 2-types of problem wounds for reimbursement. There is a growing body of evidence that shows that the same treatment protocol used for UHMS approved problem wounds is effective in the treatment of non-UHMS approved problem wounds such as:

Travel and Accommodation Costs
For local clients, the prospect of travelling to Vancouver for hospital based treatment can be cost prohibitive. The Medical Services Plan does have a Travel Assistance Program (TAP) however meals, accommodation, mileage, fuel, parking and local transportation expenses are the responsibility of the client. There is also great value in staying close to home.

For clients who are out of town or out of country, it may be cost effective to pay for travel, accommodation and treatment at our facility rather than other options. See our Accommodations section for more info.

How can Oceanside Hyperbaric Help with Central Retinal Artery Occlusion ?

Central Retinal Artery Occlusion (CRAO) is a stroke of the eye. The physiological rationale for the administration of HBOT in CRAO is covered in the UHMS Arterial Inefficiencies: Central Retinal Artery Occlusion Page.
One of the key factors in the success of HBOT in the treatment of CRAO is the timeliness of administration. Unfortunately, for local clients and referring physicians prompt treatment in a hospital setting is not possible, as the Vancouver Island Health Authority (VIHA) has no hyperbaric chambers. The only option for prompt hyperbaric care for Vancouver Islanders is referral to a private facility like Oceanside Hyperbaric.
The effectiveness of HBOT on chronic CRAO is unknown, so late treatment of CRAO would be experimental._