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Comparison of exercise oximetry and ankle pressure measurements for patients with intermittent claudication: an observational study of 433 patients

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Abstract

To study the concordance of exercise-oximetry and of ankle-brachial pressure index (ABI) and ankle pressure (AP) at rest, and after exercise, in patients complaining of vascular-type claudication to diagnose lower extremity artery disease (LEAD). Treadmill test in 433 patients with exercise-oximetry included constant load (3.2 km/h, 10% slope) phase for up to 15 min followed by an increment phase, if necessary. The presence (TcpO2e+) or absence (TcpO2e−) of ischemia was a decrease of limb minus chest oxygen pressure change greater than or less than − 15 mmHg. The post-exercise ABI and AP were measured after another test of a maximum of 5 min except if resting-ABI < 0.90. LEAD was diagnosed (+) based on resting-ABI < 0.90, post-exercise ABI < 0.8∙resting-ABI, or a difference of 30 mmHg between post-exercise and resting AP, or diagnosis was considered negative for all other cases (−). The discrepancies between the exercise-oximetry and pressure results were analyzed. We found 351 patients with resting-ABI+, of whom 52 were classified as TcpO2e−. Of the 82 patients with resting-ABI−, 25 had post-exercise ABI+ or AP+, of whom, 10 had TcpO2e−, while 57 had post-exercise ABI− and AP−, of whom, 28 had TcpO2e+. Discrepancies arose mainly from nonvascular limitations, isolated proximal ischemia, and detection of LEAD in the incremental phase of the exercise-oximetry. Post-exercise pressure measurements were easy and useful, but exercise-oximetry provided additional information for both resting-ABI− and resting-ABI+ patients and can help to prove the vascular origin of walking limitation of LEAD patients.

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Abbreviations

ABI:

Ankle brachial index

AP:

Ankle pressure

DROP:

Decrease from rest of oxygen pressure

LEAD:

Lower extremity artery disease.

TcpO2e:

Exercise transcutaneous oximetry

US:

Ultrasound imaging

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Acknowledgements

The authors are grateful to Stephanie Marechal, Marine Mauboussin, and Patrick Vandeputte for their technical support. We thank Laurent Landais for the image preparations. The work is presented on behalf of the SOCOS-SAM group.

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Authors and Affiliations

  1. Vascular Medicine, University Hospital of Angers, 4, rue Larrey, 49933, Angers Cedex 9, France

    Pierre Abraham, Jeanne Hersant, Pierre Ramondou & Samir Henni

  2. MitoVasc institute UMR CNRS 6015 / INSERM 1083, Faculté de Médecine, Univ. Angers, Angers, France

    Pierre Abraham & Samir Henni

  3. Thoracic and vascular surgery, University Hospital of Angers, Angers, France

    Jean Picquet

  4. Ecole Superieure d’Electronique de l’Ouest (ESEO), Angers, France

    Mathieu Feuilloy

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PA and SH conceived and designed and analyzed the study and wrote the graft, JH, PR, JP, MF participated to data acquisition, reviewed & approved the final version of manuscript.

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Correspondence to Pierre Abraham.

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This article is part of the special issue on Exercise Physiology: future opportunities and challenges in Pflügers Archiv—European Journal of Physiology

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Abraham, P., Hersant, J., Ramondou, P. et al. Comparison of exercise oximetry and ankle pressure measurements for patients with intermittent claudication: an observational study of 433 patients. Pflugers Arch - Eur J Physiol 472, 293–301 (2020). https://doi.org/10.1007/s00424-019-02340-w

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