Acute Effects of Hyperbaric Oxygen Therapy on Lower Extremity Arterial Hemodynamics in Patients with Diabetic Foot Ulcers: A Duplex Ultrasound Study

Objective: Evaluate the effects of hyperbaric oxygen therapy (HBOT) on lower extremity arterial hemodynamics using duplex ultrasound in patients with ulcers and assess the correlation between hemodynamic changes and clinical outcomes.Methods: Single-center, pre-post intervention study including 28 patients with ulcers undergoing standardized HBOT protocol. Hemodynamic assessments were performed by duplex ultrasound before and after treatment, measuring peak systolic velocity (PSV), end-diastolic velocity (EDV), and flow volume in the common femoral and popliteal arteries.Results: The mean age of participants was 65.2 ± 12.4 years, with 64.3% being male. No statistically significant differences were observed in hemodynamic parameters after hyperbaric oxygen therapy (HBOT). For the common femoral artery: PSV (cm/s): 115.0 (95% CI 103.5–126.6) to117.4 (95% CI 104.4–130.4); p = 0.764. EDV (cm/s): 12.8 (95% CI 9.2–16.4) to 15.1 (95% CI 9.6–20.6); p = 0.423. Flow volume (cm³/s): 1,847 (95% CI 1,610–2,084) to 1,923 (95% CI 1,657–2,189); p = 0.291. For the popliteal artery: PSV (cm/s): 76.4 (95% CI 64.3–88.5) to 74.8 (95% CI 65.7–83.9); p = 0.635. EDV (cm/s): 8.3 (95% CI 6.6–10.0) to 8.8 (95% CI 6.7–10.9); p = 0.555. Flow volume (cm³/s): 718 (95% CI 615.2–820.8) to 658 (95% CI 585.3–730.7); p = 0.111. Conclusion: HBOT did not demonstrate statistically significant changes in macrovascular hemodynamic parameters of the lower extremities in patients with ulcers. These findings suggest that the clinical benefits of HBOT may be mediated primarily by microvascular and cellular mechanisms, rather than changes in macrovascular flow.Keywords: Hyperbaric oxygen therapy; Ulcer; Hemodynamics; Duplex ultrasound; Peripheral arterial disease