Comparative Diagnostic Value of Ankle-to-Brachial Index and Transcutaneous Oxygen Tension at Rest and After Exercise in Patients with Intermittent Claudication

Abstract

Background: Few studies have compared sensitivities of ankle-to-brachial index (ABI) and transcutaneous oxygen tension (TcPO₂) in a large group of patients with Leriche stage II intermittent claudication.

Method and Results: 111 patients (138 limbs) with a stable chronic (> three months) intermittent claudication and significant peripheral vascular disease (PVD) proved by angiography were studied. They performed a treadmill test (10%, 3 km/hr) limited by limb pain. ABI and TcPO₂ were measured before, just after exercise, and after three and ten minutes of recovery in supine position.

Sensitivities per patient for ABI and TcPO₂ were respectively at rest: 82.9% and 28.8%, and after exercise: 88.3% and 62.2%. Sensitivities per leg (n=138) for ABI and TcPO₂ were respectively at rest: 73.9% and 26.8%, and after exercise: 82.6% and 34%. The sensitivity of TcPO₂ increased to 56.5% after three minutes of recovery but was always less than that of ABI, which was maximal just after exercise (82.6%). The sensi tivity of the regional perfusion index was similar to that of TcPO₂. The sensitivity of TcPO₂ increased with respect to the Leriche stage and the number of lesions but was always lower than that of ABI. There was a weak correlation between TcPO₂ and ABI after exercise, but no correlation was noted between maximal walking distance, ABI, and TcPO₂.

Conclusion: TcPO₂ is not required in patients with Leriche stage II intermittent clau dication but might be useful either in severely affected patients (Leriche stage III or IV) or in selected patients.

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References

Smith GD , Shipley MJ , Rose G. : Intermittent claudication, heart disease risk factors, and mortality. The Whitehall study. Circulation 182:1925-1931, 1990.

Criqui MH , Langer RD , Fronek A. , et al: Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 326:381-386, 1992.

Dowd Gse , Linge K. , Bentley G. : Measurement of transcutaneous oxygen pressure in normal and ischaemic skin . J Bone Joint Surg 65-B:79-83, 1983.

Wyss CR , Matsen FA , Simmons CW , et al: Transcutaneous oxygen tension measurements on limbs of diabetic and nondiabetic patients with peripheral vascular disease. Surgery 95:339-345, 1984.

Kram HB , Appel PL , Shoemaker WC : Comparison of transcutaneous oximetry, vascular hemodynamic measurements, angiography, and clinical findings to predict the success of peripheral vascular reconstruction. Am J Surg 155:551-558, 1988.

Byrne P. , Provan JL , Ameli FM , et al: The use of transcutaneous oxygen tension measurements in the diagnosis of peripheral vascular insufficiency. Ann Surg 200:159-165, 1984.

Lusiani L. , Visona A. , Nicolin P. , et al: Transcutaneous oxygen tension (TcPO2) measurement as a diagnostic tool in patients with peripheral vascular disease. Angiology 39:873-880, 1988.

Hertzer NR , Beven NW , Young JR , et al: Coronary artery disease in peripheral vascular patients: A classification of 1000 coronary angiograms and results of surgical management. Ann Surg 199:223-233, 1984.

DeBakey ME , Crawford ES , Morris GC Jr , et al: Late results of vascular surgery in the treatment of arteriosclerosis . J Cardiovasc Surg 5:473-480, 1964.

10.

Turnipseed WD , Berkoff HA , Belzer FO : Postoperative stroke in cardiac and peripheral vascular disease. Ann Surg 192:365-368, 1980.

11.

Cronenwett JL , Warner KG , Zelenock GB , et al: Intermittent claudication. Current results of nonoperative management. Arch Surg 119:430-436, 1984.

12.

Mannarino E. , Maragoni G. , Pasqualini L. , et al: Transcutaneous oxygen tension behavior in the different stages of peripheral vascular disease and its correlation with ankle/arm pressure ratio and calf blood flow. Angiology 38:463-468, 1987.

13.

Caillard P. , Mouren X. , Pujade B. , et al: Objectifying exercise ischemia in peripheral vascular disease: A study in 120 patients. Angiology 41:469-478, 1990.

14.

Hauser CJ , Klein SR , Mehringer M. , et al: Superiority of transcutaneous oximetry in noninvasive vascular diagnosis in patients with diabetes. Arch Surg 119:690-694, 1984.

15.

McCollum PT , Spencer Vaa , Walker WF : Oxygen inhalation induced changes in the skin as measured by transcutaneous oxymetry. Br J Surg 73:882-885, 1986.

16.

McKenna M. , Wolfson S. , Kuller L. : The ratio of ankle and arm arterial pressure as an independent predictor of mortality. Atherosclerosis 87:119-128, 1991.

17.

Ouriel K. , McDonnell AE , Metz CE , et al: A critical evaluation of stress testing in the diagnosis of peripheral vascular disease. Surgery 91:686-693, 1982.

18.

Newman AB , Siscovick DS , Manolio TA , et al: Anklearm index as a marker of atherosclerosis in the cardiovascular health study. Circulation 88:837-845, 1993.

19.

Kram HB , White RA , Tabrisky J. , et al: Transcutaneous oxygen recovery and toe pulse reappearance time in the assessment of peripheral vascular disease. Circulation 72:1022-1027, 1985.

20.

Franzeck UK , Talke P. , Bernstein EF , et al: Transcutaneous PO2 measurements in health and peripheral arterial occlusive disease. Surgery 91:156-163, 1982.

21.

Wyss CR , Robertson C. , Love SJ , et al: Relationship between transcutaneous oxygen tension, ankle blood pressure, and clinical outcome of vascular surgery in diabetic and nondiabetic patients. Surgery 101:56-62, 1987.