Where Ankle Pressures Fail: NIRS-Derived Tissue Oxygen Saturation as a Calcification-Independent Marker of Peripheral Arterial Disease

© 2026 HMP Global. All Rights Reserved.

Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of Wounds or HMP Global, their employees, and affiliates.

Hi, I’m Alisha Oropallo. I am the medical director of the Northwell Health Wound Healing Center and Hyperbarics. I’m also a professor of surgery in the Department of Vascular Surgery at Zucker School of Medicine and a professor of the Feinstein Institutes for Medical Research.

So, near-infrared can be utilized for many different factors. However, we looked at some of the more serious concerns. Clinician on how we could use near-infrared at a point of care, and one of those was in patients that have artificially elevated ankle-brachial indices (ABIs), and those are patients with diabetes, which in our cohort showed about 50% of the patients with peripheral arterial disease. And in these types of patients, they may have supranormal ABIs, but that does not mean that they have a normal ankle-brachial index. In fact, near-infrared can help us discern that differentiation between normal and abnormal.

Physicians should understand that there are many different modalities to assess peripheral arterial disease. Some modalities could be other noninvasive technologies, but they may take time. But near-infrared is point of care in seconds.

So, you can discern right away, using the ratios of the plantar aspect or the dorsal aspect of the foot to a reference marker on the forearm, to be able to discern whether the patient has problems with the macrocirculation as well as pinpoint areas of the microcirculation.

The next steps for this research would involve exploring other types of vascular etiologies. In other words, what about patients with venous leg ulcers? What about patients with mixed etiology? And what about patients that have arterial ulcers but are complicated with other comorbidities, such as not just diabetes, but commonly renal insufficiency?

It’s important for us to understand that when we assess a patient, many patients may have a perfect macrocirculation. But the angiosomal distribution is also contributory.

And what microcirculation does is it helps assess that angiosomal distribution and gives the provider an understanding of what’s intact and what’s not intact. And that can also help because, in certain situations, you may not be able to help salvage the limb. But you may understand why, and so will the patient.