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Article

Dellon Decompression Using WALANT: A Safe and Effective Approach for Patients with Peripheral Artery Disease

by
Sofija Tusheva
1,*,
Gordana Georgieva
1,
Blagoja Srbov
1,
Savetka Paljoskovska Jordanova
2,
Katerina Jovanovska
1,
Stefania Azmanova Mladenovska
1,
Muamet Memeti
1,
Darko Aleksovski
1,
Biljana Mileska Krzhaloska
1 and
Sofija Pejkova
1
1
University Clinic for Plastic and Reconstructive Surgery, Faculty of Medicine, University Ss. Cyril and Methodius, 1000 Skopje, North Macedonia
2
University Clinic for Cardiology, Faculty of Medicine, University Ss. Cyril and Methodius, 1000 Skopje, North Macedonia
*
Author to whom correspondence should be addressed.
J. Vasc. Dis. 2025, 4(1), 7; https://doi.org/10.3390/jvd4010007
Submission received: 18 December 2024 / Revised: 28 January 2025 / Accepted: 8 February 2025 / Published: 12 February 2025
(This article belongs to the Section Peripheral Vascular Diseases)
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Versions Notes

Abstract

:
Background: Wide-Awake Local Anesthesia No Tourniquet (WALANT) is revolutionizing surgery by providing a bloodless field without tourniquet use, reducing risks, costs, and enhancing patient comfort. While extensively used in hand surgery, its application in foot and ankle procedures, particularly for high-risk patients with diabetic neuropathy and peripheral artery disease (PAD), remains underexplored. This study evaluates the safety, efficacy, and outcomes of WALANT for tarsal tunnel decompression in such patients. Methods: Between March 2022 and April 2024, 32 patients with diabetic neuropathy and PAD underwent Dellon decompression of the tarsal tunnel. Five received spinal anesthesia with a tourniquet, while 27 underwent WALANT. Outcomes assessed included operative time, Visual Analogue Scale (VAS) pain scores, posterior tibial artery blood flow (via Doppler ultrasonography), and complications. Data were collected preoperatively, immediately postoperatively, and at six and nine months. Results: WALANT reduced operative time (40 ± 8 min vs. 65 ± 10 min) and required fewer personnel (four vs. six). VAS scores improved significantly in the WALANT group (from 8.65 ± 0.84 preoperatively to 1.21 ± 0.24 at nine months). Posterior tibial artery blood flow also showed superior improvements with WALANT (5.30 ± 0.65 cm3/s vs. 2.50 ± 0.45 cm3/s). Minor wound healing delays were noted in two WALANT cases; no major complications occurred. Conclusion: WALANT offers a safe, efficient alternative to spinal anesthesia for tarsal tunnel decompression in high-risk patients, minimizing ischemic risks, enhancing vascular outcomes, and reducing postoperative pain.

1. Introduction

WALANT (Wide-Awake Local Anesthesia No Tourniquet) has transformed current practices in surgery, especially in hand surgery: by simplifying practices this technique provided appropriate alternatives to traditional anesthesia methods [1,2,3]. Generally, WALANT provides a bloodless field by combination of local anesthesia with epinephrine, buffered with sodium bicarbonate in a surgical site without application of tourniquet. This minimizes perioperative risks, provides economic advantages, and improves patients’ comfort [4,5,6,7,8,9,10,11].
According to the current literature, WALANT in foot and ankle surgery is not routinely used, despite its obvious benefits in hand surgery, with scarce research on the topic [10,11,12,13,14,15,16]. Tarsal tunnel decompression is a procedure used in challenging patients with diabetic neuropathy with concomitant peripheral artery disease (PAD) [17,18,19,20,21,22,23,24]. These comorbidities increase the risks of ischemic complications, delayed wound healing, and postoperative pain.
Traditional methods of anesthesia regarding this type of surgery involve spinal neuraxial block (spinal anesthesia) combined with the application of a tourniquet, which is a factor in compromising blood flow in patients where blood circulation is already compromised [25,26,27,28]. Tarsal tunnels decompression surgery was initially performed using spinal anesthesia, as was the institutional practice at that time. Spinal anesthesia, while generally safe, can lead to several complications. The most common include hypotension, nausea, vomiting, and urinary retention. Post-dural puncture headache (PDPH) is a frequent issue, with its occurrence influenced by needle type and size. Rare but more serious complications include nerve injury, epidural hematoma, infection (such as meningitis), and, in extreme cases, cardiac arrest [29].
However, in an attempt to minimize tourniquet-related concerns such as ischemic stress and venous congestion and to take advantage of the known economic benefits of WALANT—shorter operative tome, duration of hospitalization, and personnel requirements—there was an institutional shift towards the use of WALANT anesthesia as the method of choice for this type of surgery. This study investigates the safety and efficacy of WALANT as an anesthesia technique in patients with peripheral artery disease who underwent tarsal tunnel decompression surgery and compares its outcome with that of spinal anesthesia.

2. Materials and Methods

2.1. Design

The study was conducted in compliance with the Declaration of Helsinki and approved by the Institutional Review Board of University Clinic for Plastic and Reconstructive Surgery, Faculty of Medicine, University Ss. Cyril and Methodius, Skopje, North Macedonia. Written informed consent was obtained from all participants.
In a prospective study at a tertiary care center between March 2022 and April 2024, a total of 32 patients with diabetic neuropathy who underwent Dellon decompression of the tarsal tunnels were enrolled. Demographically, 85% of the patients were male (n = 27), whereas 15% were female (n = 5), aged 37–71 (mean age—57). All of them also had PAD, thus reflecting the complex comorbidities of this condition. The primary aim of the study is to establish the safety and efficacy of WALANT versus the traditional method of spinal anesthesia with tourniquet application in tarsal tunnel decompression surgery.
The initial protocol was to perform tarsal tunnel decompression under spinal anesthesia with a pneumatic tourniquet applied to the upper thigh. This was performed to ensure a bloodless operative field and complete sensory and motor blockage. The first 5 patients who underwent surgery received spinal anesthesia. However, in the early phase of the study, several limitations with this method were noted. The procedure had a long duration, with preoperative preparation and recovery time requiring additional operating room personnel with the added concern of the ischemic stress from tourniquet use, especially in patients with poor peripheral circulation.
In contrast, our previous experience with WALANT in hand surgery would oppose the drawbacks of spinal anesthesia. Due to this, the WALANT technique was introduced as a method of choice for this particular procedure. Since then, the remaining 27 patients included in the study underwent tarsal tunnel decompression surgery under WALANT. This involved the infiltration of the local surgical site with 1% lidocaine with an addition of 1:100,000 epinephrine solution, buffered with 8.4% sodium bicarbonate, using the standard technique of application as described by Lalonde (Figure 1). The anesthetic used ranged from 20–40 mL in volume in a tumescent manner depending on the size of the operative area. This was given about 30 to 40 min before the incision, on the basis that adequate anesthesia and vasoconstriction would have been achieved by the time of the incision. Importantly, in WALANT there was no need for using a tourniquet, which as a result reduced the risk of ischemic complications.

2.2. Selection/Exclusion Criteria

All the patients enrolled in the study had to satisfy all the following criteria: a diagnosis of tarsal tunnel syndrome confirmed by clinical examination, positive Tinel sign above the tarsal tunnel and neuropathic symptoms assessed by a Michigan neuropathy screening instrument (MNSI). On the other hand, unregulated glycemia, infected foot, and proximal arterial occlusion were exclusion criteria for patient selection for the surgery. In addition, contraindicated use of epinephrine and history of amide anesthetic allergy were exclusion criteria for receiving WALANT.

2.3. Data Collection

Extensive data collection was performed to observe the results of the surgical intervention in both groups. The time required for all surgeries and the number of operating room personnel needed to conduct the surgery were recorded. Patient comfort in relation to pain was checked on a Visual Analogue Scale (VAS), intra- and postoperatively. Vascular status was assessed by Doppler ultrasonography of the flow in the posterior tibial artery preoperatively and at the follow-up, therefore giving a view of the long-term effect of the surgical interventions on blood flow. The obtained results of both groups were then compared.

2.4. Impact Level

To quantify the contribution of each advantage of the WALANT technique to its overall effectiveness and potential for adoption, an impact level scoring system was applied. The impact level for each outcome was calculated collaboratively by the research team, including surgeons, clinical staff, and data analysts, to assess the relative importance of each advantage of WALANT. Quantitative factors, such as pain relief (as measured by VAS scores), vascular flow improvement (via Doppler ultrasonography), complication rates, operative time, staff required, rehabilitation duration, and cost, were measured directly from study data, while qualitative factors, including patient comfort and intraoperative communication, were evaluated using surveys and expert feedback.
Each outcome was rated on a scale from 1 to 10, where 10 indicated a high-impact, critical advantage; 7–9 denoted significant impact, essential for widespread adoption; 4–6 represented moderate impact, complementary to primary advantages; and 1–3 reflected minimal impact, serving a supportive role. The scoring process was further validated by statistical analysis, using ANOVA, to ensure consistency and reliability in differentiating the impact levels of individual factors.

3. Results

In WALANT, several improvements in the outcome were clearly evident over the conventional practice of using spinal anesthesia. This study has emphasized the safety, efficacy, as well as practicality related to the WALANT technique in tarsal tunnel decompression in patients identified with diabetic neuropathy plus peripheral artery disease. The results extend to include operative efficiency or long-term pain relief, vascular conditions, and overall safety following the patient.

3.1. Operative Efficiency

One important difference was seen in operative time. For procedures performed under WALANT, the time spent on average was 40 ± 8 min, as compared with the time spent performing procedures under spinal anesthesia, which required tourniquet application, averaging at 65 ± 10 min (Figure 2). This is a big reduction in operative time, possibly due to the smooth workflow that WALANT provided. No administration of spinal block was necessary, and time-consuming application and management of tourniquets were not needed either. Local anesthesia per se allowed for both anesthesia and a bloodless field, thus enabling surgeons to move ahead with the surgery more quickly.
WALANT considerably streamlined the flow in the surgery. The mean operative time was 40 ± 8 min, thereby indicating efficiency in the approach. Local infiltration of lidocaine with epinephrine achieved satisfactory anesthesia and hemostasis without additional time required for the application of a tourniquet or to perform a spinal block. Additionally, buffering the anesthetic solution makes the solution less acidic. As a result, the application was significantly less painful and the patients were more compliant during surgery. Unnecessary delays in the system were thereby obviated, with the possibility of transition directly into the operative field by surgeons.
The WALANT method also minimized the number of operating room personnel down to an average of four employees per procedure. This streamlined resource utilization reduced procedural intensity and costs, especially in a resource-poor setting (Figure 3).

3.2. Pain Relief and Comfort of the Patient

WALANT provided excellent long-term pain relief: In the current study, an extended cohort of 27 patients who received WALANT during the surgery was evaluated for post-surgical pain. Thus, the average preoperative VAS score was 8.65 ± 0.84, which reflects very significant baseline pain levels.
The mean intraoperative VAS score decreased significantly to 2.13 ± 0.54 during surgery, which indeed shows the immediate pain management benefits of WALANT.
The mean VAS score decreased further to 1.47 ± 0.28 at six months postoperatively, with sustained relief. The average score for the VAS by nine months was 1.21 ± 0.24 (p < 0.0001), confirming the long-term efficacy of the technique (Figure 4).
Patients consistently rated their comfort during and after the operation as excellent. The absence of ischemic discomfort from a tourniquet and the preservation of continuous blood flow during the procedure were major contributors to this perception. These findings confirm further the efficacy of WALANT in immediate and sustained pain relief and in improving comfort for the patients, especially those with poor vascular health.

3.3. Vascular Outcomes

The current paper reviews the vascular recovery process in 27 patients with diabetic neuropathy and concomitant peripheral artery disease who underwent Dellon decompresion of the tarsal tunnels. In all patients, blood flow was assessed preoperatively and at 6 and 9 months following surgery.
The mean preoperative blood flow was 1.70 ± 0.25 cm3/s, reflecting severe vascular compromise as a result of PAD. These findings underline the baseline ischemic condition where there is poor arterial perfusion of concern tissues.
The blood flow showed a marked increase to 2.45 ± 0.45 cm3/s at 6 months postoperatively. These results show an early postoperative vascular recovery as a result of local sympatectomy of the posterior tibial artery during neurolysis of the posterior tibial nerve within the tarsal tunnel, showing a decrease in vascular resistance as arterial circulation enhances.
At 9 months, the mean blood flow had further increased to 5.30 ± 0.65 cm3/s, which was significantly and continuously higher than preoperative and 6-month postoperative values (p < 0.0001) (Figure 5).
These findings suggest that the continued perfusion through WALANT during surgery supports endothelial function in the long run and may promote vascular recovery. This factor is especially important in the case of patients with PAD, as greater blood flow does relate to better symptom management, enhances the healing process, and reduces further complications.

3.4. Safety and Complications

The WALANT technique had an excellent safety profile with no major complication rates recorded. Operative wounds healed properly. Minor wound healing delays occurred in two patients probably because of persistent diabetes mellitus and advanced vascular disease. Conservative management was performed; thereby, the outcomes of surgery were unaffected.
Epinephrine solutions could be safely used in WALANT, thus effectively creating a relatively bloodless surgical field while maintaining vascular integrity. No evidence of ischemic or venous congestion complications were noted that demonstrated the suitability of WALANT in patients with significant comorbidities of the circulation. Although WALANT is generally safe, the potential for allergic reactions to lidocaine should be considered. Proper patient screening and a thorough medical history are essential to minimize this risk [29].

3.5. Functional Outcomes and Patient Satisfaction

At six and nine months after surgery, the patients demonstrated significant reductions in neuropathic pain and gains in functional mobility. Symptomatic relief was sustained throughout this patient series by combining nerve decompression with increased vascular flow.
The high patient satisfaction scores reflected shorter operative times, reduced postoperative restrictions, and improved comfort throughout the perioperative period. The reduction in VAS scores, especially at nine months, underlines the long-term benefits of the WALANT approach.
The WALANT technique significantly enhances operative efficiency, improves postoperative pain, improves vascular health, and increases overall patient satisfaction during tarsal tunnel decompression. Long-term benefits underpinned by the sustained reduction of VAS scores and a further increase in blood flow from the posterior tibial artery give very strong supporting reasons for including WALANT into regular use within the field of foot and ankle surgery, particularly in the setting of diabetic neuropathy and PAD.

4. Discussion

Several studies have demonstrated the benefits of WALANT in terms of efficiency and patient comfort, particularly in hand and foot surgeries [15,16]. Conversely, spinal anesthesia remains a reliable option, especially in cases requiring prolonged operative time or when patient comorbidities contraindicate adrenaline use [30]. Including such comparative analyses provides a balanced perspective on both methods.
In tarsal tunnel decompression, there was a significant difference between spinal anesthesia with the tourniquet used and the WALANT technique in offering deep insight into implications in patients with peripheral arterial diseases. Such differences highlighted the advantages of WALANT in particular with regard to eliminating risks linked to tourniquet ischemia-induced changes that would impact surgical outcome and safety.
The mean operative time was significantly shorter in the WALANT group, at 40 min, versus 65 min in the spinal anesthesia group. This is because performing spinal anesthesia was an involved process: it included positioning, sterile preparation of the injection site, and delivering the medication very carefully into the subarachnoid space. Added to this was the time required to prepare and apply the pneumatic tourniquet after the spinal block had been administered, a prerequisite for maintaining a bloodless surgical field. Tourniquet monitoring during the surgery itself added layers of complexity.
By contrast, the WALANT technique was not technically demanding: a single injection of a solution containing a local anesthetic—lidocaine, bicarbonate, and epinephrine—for vasoconstriction could provide both anesthesia and vasoconstriction at the site of surgery (Figure 6).
Maintenance of a bloodless field in absence of tourniquet-related ischemic stress and venous congestion makes this technique more comfortable for the patient, as well as the surgeon, eliminating the time pressure implied by the tourniquet. The specific technique of application and the added bicarbonate makes the application less painful and contributes greatly to patient comfort and compliance [31]. There was no tourniquet applied, and all additional preparation and monitoring steps required for spinal anesthesia were also avoided. As a result, this was much quicker and more efficient, which benefited not only the surgical team but also the patient. This further made WALANT particularly useful in resource-limited settings where time and personnel are usually at a premium.
The use of epinephrine in local anesthesia, while beneficial for prolonging anesthetic effects and reducing intraoperative bleeding, requires careful consideration, particularly in patients with preexisting cardiovascular conditions. Epinephrine can exacerbate conditions such as tachycardia, hypertension, arrhythmias, and, in rare cases, myocardial ischemia or infarction [32]. Patients with ischemic heart disease, coronary artery disease, or rhythm disturbances are at heightened risk, necessitating cautious dosing and vigilant monitoring [33]. In hereditary arrhythmogenic syndromes, the use of epinephrine may exacerbate underlying conduction abnormalities, emphasizing the need for individualized perioperative risk assessment [34]. While studies support the safe use of lidocaine with epinephrine under controlled conditions, clinicians should avoid its use in patients with uncontrolled cardiovascular disease, severe hypertension, or significant arrhythmias to mitigate potential complications.
These differences in operative workflow directly relate to the differences in required personnel in the operating room. Spinal anesthesia generally requires a larger well-coordinated team, increasing logistical challenges and costs. WALANT reduced the overall complexity of the operation, but it also greatly reduced costs. This efficiency in resource utilization underlines the practicality of WALANT, especially in outpatient or rural surgical settings where access to anesthesiologists and support staff may be limited.
While both spinal anesthesia and WALANT were effective in pain management, the patient-reported experience was significantly different. In the group receiving spinal anesthesia, discomfort due to the tourniquet was a frequent complaint. Many of the patients, despite the sensory block from the spinal anesthesia, had uncomfortable pressure and ischemic pain related to the mechanical compression of the tourniquet. This was of greater concern for the patients with PAD, whose compromised vascular systems were less tolerant of ischemic stress. Longer periods of ischemia increased discomfort but also raised potential risks related to tissue viability and healing.
On the other hand, WALANT completely avoided the application of a tourniquet. Patients in the WALANT group showed much higher comfort during the procedure, with an average VAS pain score of 2.2, compared to higher scores for the spinal anesthesia group. The absence of ischemic stress allowed for continued blood flow to the surgical site and surrounding tissues, enhancing patient safety and comfort. This is particularly important in patients with PAD, for whom ischemia avoidance is crucial in order to avoid postoperative complications.
Doppler ultrasonography demonstrated that both groups had improved posterior tibial artery flow after tarsal tunnel decompression, confirming the efficacy of the intervention. However, at six months post-op, the WALANT group better sustained these improvements. In particular, the mean posterior tibial artery flow was 2.60 cm3/s for the WALANT group versus 2.50 cm3/s for the spinal anesthesia group.
The sustained vascular benefits in the WALANT group are likely the effect of the absence of ischemic stress during surgeries. In the spinal anesthesia group, a tourniquet, besides being effective in creating a bloodless field, caused a temporary standstill of blood flow to the limb [35,36,37,38,39,40,41]. To patients with PAD, temporary ischemia may further worsen endothelial dysfunction, delay vascular recovery, and compromise the long-term outcome [42,43]. Because WALANT uses epinephrine-induced vasoconstriction and not mechanical occlusion, it preserved the blood inflow during the procedure [44,45,46,47,48]. This means perfusion could remain unimpeded with this method, which, of course, is very important for maintaining tissue oxygenation and promoting adequate healing.
The controlled application of epinephrine in the WALANT solution was safe and advantageous for the clear surgical field without adversary effects on vascular integrity.

Limitations

This study has notable limitations. The small size of the spinal anesthesia group limits the statistical power and generalizability of intergroup comparisons. Additionally, this was a single-center pilot study, and further multicenter trials with randomized allocation are necessary to confirm the findings. Selection criteria were not randomized, as patients were allocated based on clinical risk and surgeon discretion, potentially introducing selection bias. The manual administration of local anesthesia in WALANT requires specific expertise, which could impact reproducibility in less experienced settings. Lastly, while outcomes were assessed up to nine months postoperatively, longer-term follow-up is needed to evaluate the durability of benefits and safety.

5. Conclusions

The key conclusion of this study is that WALANT is not only a functional and efficient alternative for tarsal tunnel decompression but also a particularly safe and beneficial option for patients with peripheral artery disease (PAD). By eliminating the need for a tourniquet, WALANT mitigates ischemia-induced complications, enhances intraoperative comfort, promotes vascular improvements, and streamlines surgical logistics.
In conditions with severe peripheral artery disease where the limiting of ischemic stress is deemed most important, WALANT has proved to be revolutionary in surgical management. With maintained perfusion and effective anesthesia and hemostasis, this represents a paradigm change in managing high-risk vascular patients. Its findings may lead to revising some existing “best practices” to state an obvious but safer, more efficient, patient-centered approach toward surgical treatment in persons who have complex vascular conditions.

Author Contributions

Conceptualization, S.T. and S.P.; data curation, S.T. and S.P.J.; formal analysis, K.J.; investigation, S.A.M.; methodology, S.T. and S.P.; project administration, B.M.K.; software, D.A.; supervision, G.G. and S.P.; validation, B.S. and M.M.; visualization, G.G.; writing—original draft, S.T.; writing—review and editing, S.P. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

This study was was approved by the Ethical Committee at the University Clinic for Plastic and Reconstructive Surgery, Faculty of Medicine, Skopje.Approval code: 0302-251/1 Approval date: 10 April 2023.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study. The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of the University Clinic for Plastic and Reconstructive Surgery, Faculty of Medicine, University Ss. Cyril and Methodius, Skopje; protocol code 0302-251/1).

Data Availability Statement

The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author.

Acknowledgments

The authors would like to thank Donald H. Lalonde and A. Lee Dellon for providing their support for introducing their techniques at our center.

Conflicts of Interest

The authors declare no conflicts of interest.

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Figure 1. Technique of application of WALANT at the medial ankle for tarsal tunnel decompression surgery, no less than 30 min preoperatively, in the stationary.
Figure 1. Technique of application of WALANT at the medial ankle for tarsal tunnel decompression surgery, no less than 30 min preoperatively, in the stationary.
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Figure 2. Comparison of operative times (mean ± SD, minutes) between WALANT (n = 27) and spinal anesthesia (n = 5). WALANT demonstrated significantly shorter operative times (40 ± 8 min) compared to spinal anesthesia (65 ± 10 min, p < 0.001). Error bars represent standard deviations. Statistical significance was determined using an independent t-test. The reduced operative time with WALANT highlights its efficiency compared to the traditional method.
Figure 2. Comparison of operative times (mean ± SD, minutes) between WALANT (n = 27) and spinal anesthesia (n = 5). WALANT demonstrated significantly shorter operative times (40 ± 8 min) compared to spinal anesthesia (65 ± 10 min, p < 0.001). Error bars represent standard deviations. Statistical significance was determined using an independent t-test. The reduced operative time with WALANT highlights its efficiency compared to the traditional method.
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Figure 3. Comparison of impact levels between WALANT and spinal anesthesia across key parameters: cost-effectiveness, operative time, patient safety, and vascular outcomes. Impact levels, scored on a scale of 1–10, are based on measurable outcomes and statistical analysis. WALANT demonstrates significantly higher scores in cost-effectiveness (10 vs. 6), operative time (10 vs. 7), patient safety (9 vs. 6), and vascular outcomes (8 vs. 5) compared to spinal anesthesia. Statistical significance (p < 0.05) was determined using independent t-tests for continuous data and chi-square tests for categorical data. Data were derived from the study cohort (WALANT: n = 27; spinal anesthesia: n = 5). Error bars represent standard deviations, and scoring reflects the observed clinical advantages of WALANT over spinal anesthesia.
Figure 3. Comparison of impact levels between WALANT and spinal anesthesia across key parameters: cost-effectiveness, operative time, patient safety, and vascular outcomes. Impact levels, scored on a scale of 1–10, are based on measurable outcomes and statistical analysis. WALANT demonstrates significantly higher scores in cost-effectiveness (10 vs. 6), operative time (10 vs. 7), patient safety (9 vs. 6), and vascular outcomes (8 vs. 5) compared to spinal anesthesia. Statistical significance (p < 0.05) was determined using independent t-tests for continuous data and chi-square tests for categorical data. Data were derived from the study cohort (WALANT: n = 27; spinal anesthesia: n = 5). Error bars represent standard deviations, and scoring reflects the observed clinical advantages of WALANT over spinal anesthesia.
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Figure 4. Changes in posterior tibial artery blood flow (mean ± SD) over time in patients undergoing tarsal tunnel decompression with WALANT (n = 27). Blood flow was assessed preoperatively, at 6 months, and at 9 months postoperatively using Doppler ultrasonography. A significant increase in blood flow was observed at 6 months (2.45 ± 0.45 cm3/s, p < 0.0001) and 9 months (5.30 ± 0.65 cm3/s, p < 0.0001) compared to baseline (1.70 ± 0.25 cm3/s). The error bars represent standard deviations. Statistical significance was determined using repeated measures ANOVA with post hoc testing.
Figure 4. Changes in posterior tibial artery blood flow (mean ± SD) over time in patients undergoing tarsal tunnel decompression with WALANT (n = 27). Blood flow was assessed preoperatively, at 6 months, and at 9 months postoperatively using Doppler ultrasonography. A significant increase in blood flow was observed at 6 months (2.45 ± 0.45 cm3/s, p < 0.0001) and 9 months (5.30 ± 0.65 cm3/s, p < 0.0001) compared to baseline (1.70 ± 0.25 cm3/s). The error bars represent standard deviations. Statistical significance was determined using repeated measures ANOVA with post hoc testing.
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Figure 5. Comparison of posterior tibial artery blood flow (mean ± SD, cm3/s) over time between the WALANT group (n = 27) and the spinal anesthesia group (n = 5). Blood flow was measured preoperatively, at 6 months, and at 9 months postoperatively using Doppler ultrasonography. The WALANT group demonstrated significantly higher blood flow at 6 months (2.45 ± 0.45 cm3/s) and 9 months (5.30 ± 0.65 cm3/s) compared to the spinal anesthesia group (6 months: 2.00 ± 0.35 cm3/s, 9 months: 2.50 ± 0.50 cm3/s, p < 0.05). Preoperative values were comparable between the two groups (WALANT: 1.70 ± 0.25 cm3/s vs. spinal anesthesia: 1.60 ± 0.20 cm3/s, p > 0.05). Error bars represent standard deviations. Statistical significance was assessed using repeated measures ANOVA with post hoc testing.
Figure 5. Comparison of posterior tibial artery blood flow (mean ± SD, cm3/s) over time between the WALANT group (n = 27) and the spinal anesthesia group (n = 5). Blood flow was measured preoperatively, at 6 months, and at 9 months postoperatively using Doppler ultrasonography. The WALANT group demonstrated significantly higher blood flow at 6 months (2.45 ± 0.45 cm3/s) and 9 months (5.30 ± 0.65 cm3/s) compared to the spinal anesthesia group (6 months: 2.00 ± 0.35 cm3/s, 9 months: 2.50 ± 0.50 cm3/s, p < 0.05). Preoperative values were comparable between the two groups (WALANT: 1.70 ± 0.25 cm3/s vs. spinal anesthesia: 1.60 ± 0.20 cm3/s, p > 0.05). Error bars represent standard deviations. Statistical significance was assessed using repeated measures ANOVA with post hoc testing.
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Figure 6. Bloodless surgical field during Dellon decompression under WALANT anesthesia.
Figure 6. Bloodless surgical field during Dellon decompression under WALANT anesthesia.
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MDPI and ACS Style

Tusheva, S.; Georgieva, G.; Srbov, B.; Paljoskovska Jordanova, S.; Jovanovska, K.; Azmanova Mladenovska, S.; Memeti, M.; Aleksovski, D.; Mileska Krzhaloska, B.; Pejkova, S. Dellon Decompression Using WALANT: A Safe and Effective Approach for Patients with Peripheral Artery Disease. J. Vasc. Dis. 2025, 4, 7. https://doi.org/10.3390/jvd4010007

AMA Style

Tusheva S, Georgieva G, Srbov B, Paljoskovska Jordanova S, Jovanovska K, Azmanova Mladenovska S, Memeti M, Aleksovski D, Mileska Krzhaloska B, Pejkova S. Dellon Decompression Using WALANT: A Safe and Effective Approach for Patients with Peripheral Artery Disease. Journal of Vascular Diseases. 2025; 4(1):7. https://doi.org/10.3390/jvd4010007

Chicago/Turabian Style

Tusheva, Sofija, Gordana Georgieva, Blagoja Srbov, Savetka Paljoskovska Jordanova, Katerina Jovanovska, Stefania Azmanova Mladenovska, Muamet Memeti, Darko Aleksovski, Biljana Mileska Krzhaloska, and Sofija Pejkova. 2025. "Dellon Decompression Using WALANT: A Safe and Effective Approach for Patients with Peripheral Artery Disease" Journal of Vascular Diseases 4, no. 1: 7. https://doi.org/10.3390/jvd4010007

APA Style

Tusheva, S., Georgieva, G., Srbov, B., Paljoskovska Jordanova, S., Jovanovska, K., Azmanova Mladenovska, S., Memeti, M., Aleksovski, D., Mileska Krzhaloska, B., & Pejkova, S. (2025). Dellon Decompression Using WALANT: A Safe and Effective Approach for Patients with Peripheral Artery Disease. Journal of Vascular Diseases, 4(1), 7. https://doi.org/10.3390/jvd4010007

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