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

ABSTRACT Background Hyperbaric oxygen therapy (HBOT) is an established treatment for diabetic foot ulcers, yet its acute effects on macrovascular hemodynamics Objective To evaluate the acute effects of HBOT on lower extremity arterial hemodynamics using standardized duplex ultrasound assessment in patients with diabetic foot ulcers. Methods This single-center study enrolled 28 patients with diabetic foot ulcers undergoing HBOT. Duplex ultrasound examinations were performed immediately before and after HBOT sessions, measuring peak systolic velocity (PSV), end-diastolic velocity (EDV), and volumetric flow in the common femoral and popliteal arteries. Results No statistically significant changes were observed in any hemodynamic parameter following HBOT. In the common femoral artery, PSV changed from 115.0 ± 29.8 to 117.4 ± 33.5 cm/s (p = 0.764), EDV from 12.0 ± 7.4 to 14.8 ± 10.6 cm/s (p = 0.349), and volumetric flow from 1761.6 ± 511.9 to 1841.4 ± 500.3 ml/min (p = 0.530). Similar non-significant changes were observed in the popliteal artery. Effect sizes were small for all variables (Cohen’s d: -0.041 to 0.244). Complete wound healing was achieved in all patients (100%). Conclusions HBOT did not produce detectable changes in macrovascular hemodynamics despite universal wound healing success. These findings suggest that HBOT’s therapeutic benefits may primarily occur at the microvascular level, beyond the resolution of conventional duplex ultrasound assessment.