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Prevalence and Causes of Normal Exercise Oximetry in the Calf in Patients with Peripheral Artery Disease and Limiting Calf Claudication

Abstract : Objective In patients with claudication, an ankle brachial index (ABI) under 0.90 is considered to be abnormal and a sufficient argument for the arterial origin of exercise induced pain. Exercise transcutaneous oxygen pressure (Ex-tcpO2) can provide evidence of exercise induced regional blood flow impairment (RBFI) and confirm the arterial origin of walking induced pain. The frequency with which calf Ex-tcpO2 remains apparently normal in patients with claudication and abnormal \{ABI\} is unknown. Causes of these discrepant results have yet to be analysed. Methods A retrospective analysis of 4575 Ex-tcpO2 tests performed on 3,281 patients was conducted. The focus was on patients with a history of calf claudication and \{ABI\} under 0.90. Duplicate or non-standard tests were excluded, as were patients with no pain or those able to walk more than 15 minutes (on a treadmill). Searches were conducted for possible explanations of normal calf Ex-tcpO2 in the selected patients. Results Cardiorespiratory limitation was identified in 50 patients and isolated non-calf ischemia in 36 of the 106 patients selected. There was no obvious explanation during Ex-tcpO2, but clinical improvement after non-vascular treatment or total absence of improvement after a technically successful revascularisation was noted in 12 patients. Four patients were lost on follow up. Four patients improved after revascularisation, which suggests that the Ex-tcpO2 result was false negative. Conclusions Ex-tcpO2 is negative in more than 20% of tests performed in patients with an \{ABI\} under 0.90 and a history of calf claudication. In most cases, when excluding re-tests and non-limiting or non-calf claudication on the treadmill, non-calf ischemia or a non-vascular limitation occurring during the test were observed. This observation supports both the value of treadmill testing in patients with calf claudication assumed to be of arterial origin (ABI<0.90) and the use of Ex-tcpO2 to detect non-calf ischemia.
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https://hal.archives-ouvertes.fr/hal-01277096
Contributeur : Nathalie Renois <>
Soumis le : lundi 22 février 2016 - 09:49:04
Dernière modification le : mercredi 14 octobre 2020 - 04:17:12

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Isabelle Signolet, Henni S., C. Colas-Ribas, Mathieu Feuilloy, J. Picquet, et al.. Prevalence and Causes of Normal Exercise Oximetry in the Calf in Patients with Peripheral Artery Disease and Limiting Calf Claudication . European Journal of Vascular and Endovascular Surgery, Elsevier, 2016, ⟨10.1016/j.ejvs.2015.12.040⟩. ⟨hal-01277096⟩

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