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

Signolet, Isabelle; Henni, Samir; Colas-Ribas, Christophe; Feuilloy, Mathieu; Picquet, Jean; Ábrahám, Pierre

doi:10.1016/j.ejvs.2015.12.040

Cited by 10 publications

(7 citation statements)

References 16 publications

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“…Indeed we previously showed that up to 20% of patients with claudication and an abnormal ABI can have normal oximetry results as a consequence of nonvascular limitation. 21 Thus, the highly selected remaining population had apparent unilateral PAD (based on ABI value), strictly unilateral symptoms ( via history and treadmill evaluation and on the similar side), and confirmed exercise-induced ischemia on the symptomatic side (based on exercise oximetry). In these patients, we estimated the intensity of ischemia on the asymptomatic limb using the lowest DROPmin value of each limb (buttock or calf) and calculated the proportion of tests still revealing a significant exercise-induced ischemia (DROPmin < −15 mmHg) on the asymptomatic (both by history and on treadmill) and unaffected (normal ABI) limb.…”

Section: Methodsmentioning

confidence: 99%

High prevalence of exercise-induced ischemia in the asymptomatic limb of patients with apparently strictly unilateral symptoms and unilateral peripheral artery disease

Henni

Bauer

Meliner

et al. 2019

Therapeutic Advances in Cardiovascular Disease

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Background:The prevalence of exercise-induced ischemia in the asymptomatic limb of patients with unilateral claudication based on history and treadmill evaluation, and with unilateral ipsilateral peripheral artery disease (i.e ankle-to-brachial systolic pressure index <0.90) is unknown.Methods:We detected exercise-induced ischemia in the asymptomatic limb of patients with apparently unilateral claudication. Among 6059 exercise-oximetry tests performed in 3407 nondiabetic and 961 diabetic patients. We estimated the intensity of ischemia in the both limb (buttocks and calves) using the lowest minimum value of the decrease from rest of oxygen pressure (DROP; limb changes minus chest changes from rest), with significant ischemia defined as DROP lower than −15 mmHg.Results:We found 152 tests performed in 142 nondiabetic patients and 40 tests performed in 38 diabetic patients. The asymptomatic limb showed significant ischemia in 46.7% and 37.5% of the tests. Strictly unilateral exercise-induced claudication with apparently unilateral peripheral artery disease was rare (<4% of all tests). However, among these highly selected tests, significant ischemia was found in the asymptomatic limb in more than one-third of cases.Conclusion:The asymptomatic limb of patients with peripheral artery disease should not be considered a normal limb.

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Section: Methodsmentioning

confidence: 99%

High prevalence of exercise-induced ischemia in the asymptomatic limb of patients with apparently strictly unilateral symptoms and unilateral peripheral artery disease

Henni

Bauer

Meliner

et al. 2019

Therapeutic Advances in Cardiovascular Disease

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“…In addition, ABI at rest is frequently normal if lesions are not located on the measured axis (such as lesions of the internal iliac artery) [ 16 ]. Furthermore, we recently showed that 14.8 to 20.0% of patients with an abnormal ABI at rest have no exercise induced ischemia while exercise-induced ischemia can be found in 35.4% of patients with a normal ABI at rest [ 16 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…Exercise-oximetry can be used to detect exercise-induced ischemia for patients referred for claudication of unknown, debatable, or arterial-suspected origin [ 15 , 19 ]. Its specific interest is to detect isolated proximal ischemia (as can result from internal iliac artery lesions), or exercise-induced hypoxemia as a cause or worsening factor of walking impairment [ 15 , 18 , 19 ]. Exercise-oximetry has been used as a routine in the last 20 years in our service for patients complaining walking limitation.…”

Section: Introductionmentioning

confidence: 99%

Lower Extremity Arterial Disease and Lumbar Spinal Stenosis: A Study of Exercise-Induced Arterial Ischemia in 5197 Patients Complaining of Claudication

Lecoq

Hersant²,

Feuilloy³

et al. 2022

JCM

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Only few studies have analyzed the associations of lower extremity artery disease (LEAD) with lumbar spinal stenosis (LSS), although it is expected to be a frequent association. With exercise-oximetry, we determined the presence of exercise-induced regional blood flow impairment (ischemia) in 5197 different patients complaining of claudication and referred for treadmill testing. We recorded height, weight, age, sex, ongoing treatments, cardiovascular risk factor (diabetes, high blood pressure, current smoking habit), and history of suspected or treated LSS and/or lower limb revascularization. An ankle-brachial index at rest < 0.90 or >1.40 on at least one side was considered indicative of the presence of LEAD (ABI+). Ischemia was defined as a minimal DROP (Limb-changes minus chest-changes from rest) value < –15 mmHg during exercise oximetry. We analyzed the clinical factors associated to the presence of exercise-induced ischemia in patients without a history of LSS, using step-by-step linear regression, and defined a score from these factors. This score was then tested in patients with a history of LSS. In 4690 patients without a history of (suspected, diagnosed, or treated) LSS, we observed that ABI+, male sex, antiplatelet treatment, BMI< 26.5 kg//m2, age ≤ 64 years old, and a history of lower limb arterial revascularization, were associated to the presence of ischemia. The value of the score derived from these factors was associated with the probability of exercise-induced ischemia in the 507 patients with a history of LSS. This score may help to suspect the presence of ischemia as a factor of walking impairment in patients with a history of lumbar spinal stenosis.

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“…Aetiological diagnosis of claudication of the lower limb is important. We have used transcutaneous oxygen pressure (TcpO2) at exercise in the last 20 years, to argue for the vascular origin of exercise‐related pain during treadmill tests (Abraham et al, 2018; Gernigon et al, 2013; Henni et al, 2018; Jaquinandi et al, 2007; Signolet et al, 2016). As a routine, we use a constant load (3.2 km/hr, 10% slope) standard procedure.…”

Section: Introductionmentioning

confidence: 99%

Specific slow tests are not mandatory in patients with extremely short standard (3.2 km/hr 10% slope) test durations during exercise oximetry

Sempore

Ramondou

Hersant

et al. 2020

Clin Physio Funct Imaging

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Aim To compare the transcutaneous oxygen pressure results observed in patients with severe walking limitation during standard procedures (3.2 km/hr, 10% slope) versus during a test performed at a low speed (2 km/hr, 10% slope). Methods In 31 patients, the decrease from rest of oxygen pressure (DROP) index was measured on both buttocks, both thighs and both calves during two consecutive tests on treadmill. The maximal walking time (MWT) and the minimal DROP values (DROPmin) observed during the 2 tests were compared with t test. Correlation of DROPmin values during the slow and standard procedure was performed with linear regression. The −15 mmHg cut‐off value defined for standard test interpretation was used arbitrarily for the interpretation of slow test results. Results MWT was 80 ± 52 s versus 376 ± 269 s at standard and slow speed, respectively (p < .001). No difference on all recorded DROPmin values at a standard (−9.5 ± 6.9 mmHg) and slow (−10.5 ± 7.9 mmHg) speed was found; n = 186, p = .168. Coefficient of correlation between DROPmins found at the two tests was r = 0.820 (p < .01), with regression line close to the line of identity. With the identical −15 mmHg cut‐off, 166 (89.2%) of 186 the results were classified similarly after standard and slow procedures. Conclusion Specific slow treadmill procedures are not mandatory in patients with extremely short test durations when performing standard (3.2 km/hr 10% slope) exercise oximetry. In patients expected to be unable to walk at standard speed, the −15 mmHg normal limit seems to be valid for the interpretation of tests with a slow procedure (2.0 km/hr).

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

Cited by 10 publications

References 16 publications

High prevalence of exercise-induced ischemia in the asymptomatic limb of patients with apparently strictly unilateral symptoms and unilateral peripheral artery disease

High prevalence of exercise-induced ischemia in the asymptomatic limb of patients with apparently strictly unilateral symptoms and unilateral peripheral artery disease

Lower Extremity Arterial Disease and Lumbar Spinal Stenosis: A Study of Exercise-Induced Arterial Ischemia in 5197 Patients Complaining of Claudication

Specific slow tests are not mandatory in patients with extremely short standard (3.2 km/hr 10% slope) test durations during exercise oximetry

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