Circulation Issues

Written By Elizabeth Gaffney

HBOT for Circulation Issues

Introduction

Hyperbaric Oxygenation (HBO) is a form of therapy directed to significantly increase the partial pressure of oxygen in the blood and in the tissues of the patients to the levels significantly exceeding those achieved in normobaric
conditions. HBO has wide-ranging benefits for conditions related to impaired circulation, including peripheral artery disease (PAD), atherosclerosis, chronic limb ischemia and non-healing wounds. Circulation issues are characterised by inadequate blood flow that leads to hypoxemia and hypoxia and by enhancing oxygen delivery angiogenesis and anti-inflammatory effects, HBOT may provide significant clinical benefits for patients with compromised circulation

Mechanisms of Action of HBOT

HBOT may benefit circulation issues through several mechanisms, primarily by enhancing oxygen delivery to tissues to relieve chronic hypoxia. Hyperbaric Oxygen Therapy (HBOT) consists of breathing oxygen at a pressure higher than local atmospheric pressure for multiple sessions for the treatment or prevention of specific diseases. There is a general consensus that the term HBOT can only be applied when the partial pressure of oxygen in breathing mixture exceeds 1.5 absolute atmosphere (ATA) for a minimum period of 60 minutes (excluding compression and decompression).

  1. Enhanced oxygenation: The primary mechanism by which HBOT works is by increasing the amount of oxygen dissolved in plasma and enhancing its diffusion into tissues, which induces vasoconstriction in small arteries and capillaries in healthy tissues, leading to the redistribution of blood flow to under-perfused areas (Cannellotto et al., 2024).

  2. Angiogenesis: HBOT also stimulates angiogenesis by enhancing the production of growth factors such as VEGF (Huang et al., 2020; De Wolde et al., 2021).

  3. Improved blood flow: The endothelium plays a crucial role in vascular health and HBOT may reduce blood pressure via the regulation of vasodilatory factors including nitric oxide and endothelin-1 (Dragic et al., 2020).

  4. Anti-inflammatory effects: Chronic inflammation is a key component of many vascular diseases and HBOT reduces inflammation by decreasing the levels of pro-inflammatory cytokines and inhibiting the adhesion of white blood cells to the endothelium (Cannellotto et al., 2024).

  5. Stem cells: HBOT can modulate angiogenesis and the endothelium by mobilising endothelial progenitor cells (Li et al., 2019; Thom et al., 2006).

Benefits of HBOT for Patients with Compromised Circulation

HBOT is generally well tolerated and serious side effects are rare (Camporesi, 2014). Patients with circulatory issues may experience a range of benefits from adjunctive HBOT that can significantly improve their quality of life and prognosis.

  1. Improved vascular function: HBOT may improve the markers of vascular function in patients with compromised circulation (Karadurmus et al., 2010; Li et al., 2018a).

  2. Improved wound healing: Patients with PAD or venous insufficiency often experience chronic non-healing wounds, such as diabetic foot ulcers. HBOT is beneficial in the treatment of hypoxic non-healing wounds and can improve limb salvage rates and reduce the need for amputations in patients with severe PAD (Sharma et al., 2021).

  3. Decreased chronic pain: Non-healing wounds are often associated with chronic pain and HBOT may reduce chronic pain in many conditions (Sutherland et al., 2016) by promoting tissue repair and reducing inflammation.

  4. Increased mobility: For patients with PAD, improving oxygen delivery to ischemic tissues and chronic wounds can enhance their mobility and ability to engage in physical activity.

  5. Recovery from stroke: HBOT may also benefit patients with vascular-related cognitive impairment or following a stroke by increasing the recovery of neuronal function and reducing the extent of ischemic brain damage.

Clinical Evidence Supporting HBOT for the Treatment of Circulatory Disorders

There is a large body of evidence from primary research supporting the use of HBOT for the treatment of circulation-related disorders, including atherosclerosis, vasculopathy, slow coronary flow, vasculitis and retinal artery occlusion, and these studies are corroborated by a number of clinical trials. HBOT is recognised by the US FDA for the treatment of retinal artery occlusion and certain non-healing wounds.

  1. Atherosclerosis and coronary artery disease: In patients undergoing HBOT for diabetic foot ulcerations (100% O2, 2.4 ATA, 105 mins, 30 sessions) and for peripheral arterial occlusive disease (100% O2, 2.5 ATA, 90 mins, 10–15 sessions), HBOT improved markers of atherosclerosis (Karadurmus et al., 2010; Lin et al., 2018). HBOT at 2 ATA for 90 mins (24 sessions) improved the endothelial function of patients with slow coronary flow (Li et al., 2018a) and, following implantation of drug-eluting stents, patients had enhanced myocardial perfusion and microcirculation and reduced inflammation and vascular endothelial dysfunction (Li et al., 2018b).

  2. Peripheral artery disease: Several systematic reviews and meta-analyses of randomised clinical trials show evidence of the effectiveness of HBOT (typically 100% O2, 2.2–2.8 ATA, 90 mins, 20–60 sessions) in improving the healing of chronic limb ischaemia and diabetic leg ulcers and/or reducing the requirement for amputation (Stoekenbroek et al., 2014; Kranke et al., 2015; Golledge & Singh, 2019; Brouwer et al., 2020; Takagi et al., 2024).

  3. Retinal artery occlusion: Hyperbaric oxygen can maintain retinal oxygenation during ischemic events, and 2–8 sessions of HBOT at 2–2.8 ATA (³90 mins,) is used as a treatment for retinal artery occlusion and is recognised by the FDA (Wu et al., 2018; Celebi, 2021).

  4. Radionecrosis: Radiation therapy damages capillary beds and arterioles and HBOT may be beneficial in the treatment of radionecrosis (100% O2, 2–2.5 ATA, 60–120 mins, 30–60 sessions) by promoting angiogenesis and wound healing (Borab et al., 2017).

  5. Stroke rehabilitation: HBOT at 2 ATA for 90 mins (40–60 sessions) may improve cognitive function and play a role in rehabilitation following stroke, even in the chronic phase (Hadanny et al., 2020).

Conclusion

Hyperbaric oxygen therapy offers a promising adjunctive treatment for circulatory conditions and by enhancing oxygen delivery, promoting angiogenesis, reducing inflammation, and improving endothelial function, HBOT may provide significant clinical benefits to patients with compromised circulation.

References

  • Borab, Z., Mirmanesh, M. D., Gantz, M., Cusano, A., & Pu, L. L. (2017). Systematic review of hyperbaric oxygen therapy for the treatment of radiation-induced skin necrosis. Journal of Plastic, Reconstructive and Aesthetic Surgery, 70(4), 529-538.

  • Brouwer, R. J., Lalieu, R. C., Hoencamp, R., van Hulst, R. A., & Ubbink, D. T. (2020). A systematic review and meta-analysis of hyperbaric oxygen therapy for diabetic foot ulcers with arterial insufficiency. Journal of Vascular Surgery, 71(2), 682-692.

  • Camporesi, E. M. (2014). Side effects of hyperbaric oxygen therapy. Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc, 41(3), 253-257.

  • Cannellotto, M., Yasells García, A., & Landa, M. S. (2024). Hyperoxia: Effective mechanism of hyperbaric treatment at mild-pressure. International Journal of Molecular Sciences, 25(2), 777.

  • Celebi, A. R. C. (2021). Hyperbaric oxygen therapy for central retinal artery occlusion: Patient selection and perspectives. Clinical Ophthalmology, 3443-3457.

  • De Wolde, S. D., Hulskes, R. H., Weenink, R. P., Hollmann, M. W., & Van Hulst, R. A. (2021). The effects of hyperbaric oxygenation on oxidative stress, inflammation and angiogenesis. Biomolecules, 11(8), 1210.

  • Dragic, S., Momcicevic, D., Zlojutro, B., Jandric, M., Kovacevic, T., Djajić, V., … & Kovacevic, P. (2020). Serum levels of nitric oxide and endothelin-1 in vasculopathy managed with hyperbaric oxygen therapy. Clinical Hemorheology and Microcirculation, 75(2), 233-241.

  • Golledge, J., & Singh, T. P. (2019). Systematic review and meta‐analysis of clinical trials examining the effect of hyperbaric oxygen therapy in people with diabetes‐related lower limb ulcers. Diabetic Medicine, 36(7), 813-826.

  • Hadanny, A., Rittblat, M., Bitterman, M., May-Raz, I., Suzin, G., Boussi-Gross, R., … & Efrati, S. (2020). Hyperbaric oxygen therapy improves neurocognitive functions of post-stroke patients–a retrospective analysis. Restorative Neurology and Neuroscience, 38(1), 93-107.

  • Huang, X., Liang, P., Jiang, B., Zhang, P., Yu, W., Duan, M., … & Huang, X. (2020). Hyperbaric oxygen potentiates diabetic wound healing by promoting fibroblast cell proliferation and endothelial cell angiogenesis. Life Sciences, 259, 118246.

  • Karadurmus, N., Sahin, M., Tasci, C., Naharci, I., Ozturk, C., Ilbasmis, S., … & Saglam, K. (2010). Potential benefits of hyperbaric oxygen therapy on atherosclerosis and glycaemic control in patients with diabetic foot. Endokrynologia Polska, 61(3), 275-279.

  • Kranke, P., Bennett, M. H., Martyn‐St James, M., Schnabel, A., Debus, S. E., & Weibel, S. (2015). Hyperbaric oxygen therapy for chronic wounds. Cochrane Database of Systematic Reviews, (6).

  • Li, Y., Zhang, H., Liang, Y., Wang, W., Xu, T., Zhang, J., … & Wang, T. (2018). Effects of hyperbaric oxygen on vascular endothelial function in patients with slow coronary flow. Cardiology Journal, 25(1), 106-112.

  • Li, Y., Hao, Y., Wang, T., Wei, L., Wang, W., Liang, Y., & Guo, X. (2018). The effect of hyperbaric oxygen therapy on myocardial perfusion after the implantation of drug-eluting stents. Annals of Clinical and Laboratory Science, 48(2), 158-163.

  • Li, Y. C., Lee, F. Y., Chua, S., & Yip, H. K. (2019). Hyperbaric oxygen therapy enhanced circulating levels of endothelial progenitor cells and angiogenesis biomarkers, blood flow in ischemic area in patients with peripheral arterial occlusive disease. European Heart Journal, 40(Supplement_1), ehz745-1093.

  • Lin, P. Y., Sung, P. H., Chung, S. Y., Hsu, S. L., Chung, W. J., Sheu, J. J., … & Yip, H. K. (2018). Hyperbaric oxygen therapy enhanced circulating levels of endothelial progenitor cells and angiogenesis biomarkers, blood flow, in ischemic areas in patients with peripheral arterial occlusive disease. Journal of Clinical Medicine, 7(12), 548.

  • Sharma, R., Sharma, S. K., Mudgal, S. K., Jelly, P., & Thakur, K. (2021). Efficacy of hyperbaric oxygen therapy for diabetic foot ulcer, a systematic review and meta-analysis of controlled clinical trials. Scientific Reports, 11(1), 2189.

  • Stoekenbroek, R. M., Santema, T. B., Legemate, D. A., Ubbink, D. T., Van Den Brink, A., & Koelemay, M. J. W. (2014). Hyperbaric oxygen for the treatment of diabetic foot ulcers: A systematic review. European Journal of Vascular and Endovascular surgery, 47(6), 647-655.

  • Sutherland, A. M., Clarke, H. A., Katz, J., & Katznelson, R. (2016). Hyperbaric oxygen therapy: A new treatment for chronic pain? Pain Practice, 16(5), 620-628.

  • Takagi, G., Kirinoki-Ichikawa, S., Tara, S., Takagi, I., & Miyamoto, M. (2024). Effectiveness of repetitive hyperbaric oxygen therapy for chronic limb-threatening ischemia. Journal of Nippon Medical School, 91(1), 66-73.

  • Thom, S. R., Bhopale, V. M., Velazquez, O. C., Goldstein, L. J., Thom, L. H., & Buerk, D. G. (2006). Stem cell mobilization by hyperbaric oxygen. American Journal of Physiology-Heart and Circulatory Physiology, 290(4), H1378-1386.

  • Wu, X., Chen, S., Li, S., Zhang, J., Luan, D., Zhao, S., … & Xu, Y. (2018). Oxygen therapy in patients with retinal artery occlusion: A meta-analysis. PLoS One, 13(8), e0202154.

Elizabeth Gaffney https://www.sourceprojects.co
Previous

Bone Fractures
Next

Dermatology