Pulse Oximetry in the Evaluation of Peripheral Vascular Disease

Abstract

The role of pulse oximetry in the evaluation of peripheral vascular disease (PVD) was investigated. In addition, the value of elevating the limb to improve the sensitivity of detection of PVD by the pulse oximeter was also determined. Pulse oximetry reading in the toes were obtained in 40 young, healthy volunteers and in 40 randomly selected patients referred to the vascular investigation laboratory over a period of two months. All 40 healthy volunteers had normal pulse oximetry readings. Normal pulse oximetry reading in the toes was defined as > 95% O2 Sat and +/-2 of finger pulse oximetry reading. In all 40 patients, pulse oximetry readings were either normal or not detected at all. Since there was no gradation in decrease in the pulse oximetry reading with severity of disease or with elevation of the patient's lower extremity, an absent or no reading was considered as an abnormal result from the test. The frequency of abnormal pulse oximetry readings increased significantly in groups with abnormal ankle-brachial pressure index (ABPI) and also varied significantly with elevation of the patients' lower limbs. In patients with no PVD detected by Doppler (ABPI > 0.9), pulse oximetry readings were normal in all. However, in patients with moderate PVD (ABPI, 0.5-0.9), 84% of the patients' lower limbs had normal pulse oximetry readings and 16% had an abnormal reading at baseline level (flat). An additional 12% of the lower limbs in this group had an abnormal reading on elevation of the limb to 12 inches. In patients with severe PVD (ABPI < 0.5), 54% of the patients' lower limbs had an abnormal reading at baseline and an additional 23% had an abnormal reading at elevation of the limb to 12 inches. In conclusion, pulse oximetry was not a sensitive test for detecting early PVD.

Utility of digital pulse oximetry in the screening of lower extremity arterial disease

“…They found that pulse oximetry correlated best with the arteriographic appearance. Jawahar et al [6] studied patients between suspected PAD group and non-suspected PAD group. Pulse oximetry results were defined as abnormal if there was a decrease of more than 2% in saturation at the toe from the finger or a decrease of more than 2% on elevation of the foot by 12-in.…”

“…The SaO 2 ] improved after revascularization. Jawahar et al [6] found that pulse oximetry had low sensitivity to detect PAD when compared with the ABI used as the reference test. The patients in these studies were suspected of having arterial disease on clinical grounds, so pulse oximetry was not used as a screening test.…”

Review: The laboratory evaluation of lower limb perfusion in diabetes mellitus. A clinical review

“…However, pulse oximetry alone may be unreliable in assessing the presence of lower limb vascular disease. 30 Again, caution is advised in its interpretation as poor placement and altered skin perfusion can influence readings.…”

Pulse Oximetry as a Potential Screening Tool for Lower Extremity Arterial Disease in Asymptomatic Patients With Diabetes Mellitus

“…Mixed results have been reported with its use in detecting arterial disease in a general group of patients. 12,13 Joyce et al 12 reported that patients with LEAD had significantly lower SaO 2 in the ischemic limbs. The SaO 2 improved after revascularization.…”

“…The SaO 2 improved after revascularization. Jawahar et al 13 found that pulse oximetry had low sensitivity to detect LEAD when compared with the ABI used as the reference test. The patients in these studies were suspected of having arterial disease on clinical grounds, so pulse oximetry was not used as a screening test.…”