Application of exercise transcutaneous oxygen pressure measurements for detection of proximal lower extremity arterial disease: a case report.
Proximal claudication is secondary to ischemia caused by peripheral artery disease (PAD), whereas proximal pseudo-claudication is secondary to other disease processes such as hip arthritis, spinal stenosis, neuropathy, and so forth. The differentiation between the two can be challenging. Exercise transcutaneous oxygen pressure measurement (exercise-TcPO2) allows noninvasive detection of flow-reducing lesions in the proximal arteries and tributaries of the lower extremity arterial tree. We present the first case report in the United States using an exercise-TcPO2 algorithm. A 71-year-old diabetic patient with proximal left-sided and right-calf claudication with indeterminate ankle-brachial indices underwent an exercise-TcPO2 study before and after endovascular intervention. Four TcPO2 probes were placed: one at chest level (reference probe), one on each buttock, and one on the symptomatic calf. The Delta from Resting Oxygen Pressure (DROP) index was calculated at each probe site using a previously validated protocol. Proximal left- and right-calf ischemia were confirmed by the initial exercise-TcPO2, and, after endovascular treatment of the left iliac artery lesion, improvements in proximal exercise-TcPO2 values were found. These data suggest that exercise-TcPO2 can be useful in PAD evaluation in patients with non-compressible arteries and/or proximal claudication.
Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA INSERM Clinical Investigation Center CIC 1414, Rennes, France wennberg.paul@mayo.edu maheguillaume@yahoo.fr.
Guillaume
G
Mahe
Division of Vascular and Endovascular Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
Manju
M
Kalra
Laboratory of Vascular Investigations, University Hospital, Angers, France; and Faculty of Medicine, LUNAM University, Angers, France.
Pierre
P
Abraham
Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.
David A
DA
Liedl
Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.
Paul W
PW
Wennberg
D000368:Aged; D001785:Blood Gas Monitoring, Transcutaneous; D005080:Exercise Test; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis*; D007866:Leg / Q000098:blood supply*; D008297:Male; D058729:Peripheral Arterial Disease / Q000175:diagnosis*
claudication; diagnosis; exercise test; methods; oxymetry; peripheral artery disease; transcutaneous oxygen pressure measurements