Transcutaneous Oxygen Tension and Doppler Ankle Pressure During Upper and Lower Body Exercise in Patients with Peripheral Arterial Occlusive Disease

Abstract

The effects of upper and lower body exercise on blood supply to the lower extremi ties were investigated in patients with peripheral arterial occlusive disease (PAOD) by measurements of transcutaneous oxygen tension (tcPO₂) and Doppler ankle pressure (DAP).

Twenty patients with PAOD (PAOD group) and 10 subjects without PAOD (control group) performed treadmill test (TT), recumbent cycle ergometry (CE), and rowing ergometry (RE) with a fixed seat. The tcPO₂ was registered on the calf and DAP was measured at the end of each step of CE and RE.

The walking distance in TT of the control group was not limited (> 1000 m), whereas that of the PAOD group was 161 m in median. In the control group there was no significant difference of performance between CE (125 ±33 W) and RE (111 ±24 W), whereas in the PAOD group, performance was lower in CE (72 ±31 W) than in RE (102 ±28 W) (P <0.01). DAP of controls increased during both CE (136 to 165 mmHg) and RE (170 to 213 mmHg), whereas the DAP of the PAOD group decreased during CE (from 85 to 44 mmHg) and remained relatively constant during RE (113 to 101 mmHg). In controls, tcPO₂ did not distinctly change during TT (70 to 66 mmHg) and increased during CE (58 to 73 mmHg) and RE (69 to 82 mmHg), whereas in the PAOD group, tcPO₂ decreased during TT (66 to 33 mmHg) and CE (50 to 22 mmHg) and remained almost unchanged in RE (64 to 60 mmHg). A hyperbolic relationship was found between tcPO₂ and DAP.

In conclusion, during upper body exercise, blood supply to the lower extremities in patients with PAOD was not affected, whereas lower body exercise led to exhaustion of the functional reserve of blood supply. Because of a hyperbolic relationship between tcPO₂ and DAP, tcPO₂ remained relatively constant if blood supply was sufficient, but in disturbed blood supply a small change of DAP was accompanied by a great change of tcPO₂. Therefore, in critical ischemia the change of tcPO₂ was more sensitive than that of DAP.

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References

Lübbers DW , Grossmann U. : Gas exchange through the human epidermis as a basis of tcPO2 and tcPCO2 measurements. In: Continuous Transcutaneous Blood Gas Monitoring, ed. by Huch R , Huch A. New York: M Dekker, 1983, pp 1-34.

Tremper KK , Waxman K. , Shoemaker WC : Effects of hypoxia and shock on transcutaneous PO2 values in dogs . Crit Care Med 7:526-531, 1979.

Lübbers DW : Theoretical basis of the transcutaneous blood gas measurements. Crit Care Med 9:721-733, 1981.

Eickhoff JH , Jacobsen E. : Is transcutaneous oxygen tension independent of variations in blood flow and in arterial blood pressure? Biotelem Pt Monitg 9:175-184, 1982.

Steinacker JM , Spittelmeister W. : Dependence of transcutaneous O 2 partial pressure on cutaneous blood flow. J Appl Physiol 64:21-25, 1988.

Linge K. , Roberts DH , Dows Gse : Indirect measurement of skin blood flow and transcutaneous oxygen tension in patients with peripheral vascular disease. Clin Physiol Meas 8:293-302, 1987.

Marinelli MR , Beach KW , Glass MJ , et al: Noninvasive testing vs clinical evaluation of arterial disease. JAMA 241:2031-2039, 1979.

Osmundson PJ : Noninvasive tests in the diagnosis of peripheral vascular disease. Cardiovasc Clin 10:271-277, 1980.

Zierler RE : Hemodynamic considerations in evaluation of arterial disease by Doppler ultrasound . Clin Diagn Ultrasound 26:13-24, 1990.

10.

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.

11.

Katsamouris A. , Brewster DC , Megerman J. , et al: Transcutaneous oxygen tension in selection of amputation level. Am J Surg 147:510-517, 1984.

12.

Kohler TR : Doppler evaluation of lower limb vessels. Clin Diagn Ultrasound 26:139-148, 1990.

13.

deWolfe VG: Chronic occlusive arterial disease of the lower extremities. In: Clinical Vascular Disease, ed. by Spittell JA , Philadelphia: F. A. Davis Co., 1983, pp 15-36.

14.

Cross S. , Kneafsy D. , Given F. : The treadmill in peripheral vascular disease. Ir Med J 80:404-406, 1987.

15.

Barnard RJ , Hall JA : Patient with peripheral vascular disease. In: Exercise in Modern Medicine, ed. by Franklin DA , Gordon S , Timmis GC , Baltimore: Williams & Wilkins, 1989, pp 107-117.

16.

Kannel WB , Skinner JJ Jr , Schwartz MJ , et al: Intermittent claudication incidence in the Framingham study . Circulation 41:875-883, 1970.

17.

Liu Y. , Steinacker JM , Stange A. , et al: Exercise testing on a modified rowing ergometry compared to bicycle ergometry in patients with peripheral vascular occlusive disease. Int J Sports Med 12:130, 1991 (Abstract).

18.

Steinacker JM , Stauch M. : Die Ruderergometrie im Vergleich zur Fahrradergometrie in der praeoperativen Diagnostik von nichtinvasiven Eingriffen im Alter. München Med Wochenschr 135:250-254, 1993.

19.

Bergh U. , Kanstrup IL , Ekblom B. : Maximal oxygen uptake during exercise with various combinations of arm and leg work. J Appl Physiol 41:191-196, 1976.

20.

Miles DS , Sawka MN , Hanpeter DE , et al: Central hemodynamics during progressive upper- and lower-body exercise and recovery. J Appl Physiol 57:366-370, 1984.

21.

Sehested J. , Bille S. , Hauge P. : Assessment of a standard exercise test in peripheral arterial disease. J Cardiovasc Surg 28:520-523, 1987.

22.

Berglund B. , Eklund B. : Reproducibility of treadmill exercise in patients with intermittent claudication. Clin Physiol 1:253-256, 1981.

23.

Criqui MH , Fronek A. , Barret-Connor E. , et al: The prevalence of peripheral arterial disease in a defined population . Circulation 71:510-515, 1985.

24.

Balady GJ , Weiner DA , McCabe CH , et al: Value of arm exercise testing in detecting coronary artery disease . Am J Cardiol 55:37-39, 1985.

25.

Lazarus B. , Cullinane E. , Thompson PD : Comparison of the results and reproducibility of arm and leg exercise tests in men with angina pectoris. Am J Cardiol 47:1075-1079, 1981.

26.

Wyss CR , Matsen FA III, King R. , et al: Dependence of transcutaneous oxygen tension on local arteriovenous pressure gradient in normal subjects. Clin Sci 60:499-506, 1981.

27.

Lübbers DW : Cutaneous and transcutaneous PO2 and PCO2 and their measuring conditions. In: Continuous Transcutaneous Blood Gas Monitoring, ed. by Huch A , Huch A , Lucey JF , New York: AR Liss, 1979 , pp 13-31.

28.

Gardner AW , Skinner JS , Cantwell BW , et al: Relationship between foot pressure at rest and following exercise . Angiology 42:481-490, 1991.

29.

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.

30.

Hauser CJ , Appel P. , Shoemaker WC : Pathophysiologic classification of peripheral vascular disease by positional changes in regional transcutaneous oxygen tension. Surgery 95:689-693, 1984.