Sinusoidal changes in transcutaneous oxygen pressure, suggesting Cheyne-Stokes respiration, are frequent and of poor prognosis among patients with suspected critical limb ischemia

Data on simultaneous hemodynamic changes and pain rating estimation in arterial claudication while walking are lacking. This study was conducted to determine if a difference in transcutaneous oxygen pressure (tc pO2) exists between proximal and distal localization at pain appearance (PAINapp), maximal pain (PAINmax) and pain relief (PAINrel) in proximal or distal claudication and if a relationship exists between tc pO2 changes and pain intensity. We analyzed the pain rating (Visual Analog Scale (VAS)) to lower limb ischemia, measured with the decrease from rest of oxygen pressure (DROP) tc pO2 index during constant-load treadmill tests in patients with calf ( n = 41) or buttock ( n = 19) claudication. Calves versus buttocks results were analyzed with ANOVA tests. The R2 correlation coefficient between individual VAS versus DROP was calculated. Ischemia intensity versus pain rating changes were correlated. Significant ischemia was required for pain appearance, but pain disappeared despite the persistence of ischemia. We observed no statistical difference for DROP at PAINapp, PAINmax or PAINrel between proximal or distal claudication. A significant correlation between pain rating versus DROP was found: from PAINapp to PAINmax, R2 = 0.750 (calves) and 0.829 (buttocks), and from PAINmax to PAINrel, R2 = 0.608 (calves) and 0.560 (buttocks); p<0.05. Pain appeared after a significant decrease of hemodynamic parameters but disappeared while parameters were not normalized. No difference in pain rating was found in proximal versus distal claudication.

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Toe Pressure Measurements in Patients Suspected of Critical Limb Ischemia

Angiology ◽

10.1177/00033197211063657 ◽

2021 ◽

pp. 000331972110636

Author(s):

Loubna Dari ◽

Damien Barcat ◽

Benjamin Ally ◽

David Lagarde ◽

Carine Boulon ◽

...

Keyword(s):

Critical Limb Ischemia ◽

Pressure Measurement ◽

Limb Ischemia ◽

Scatter Plot ◽

Reference Test ◽

Transcutaneous Oxygen ◽

Hemodynamic Assessment ◽

Coefficient Corrélation ◽

Transcutaneous Oxygen Pressure ◽

Toe Pressure

An objective hemodynamic assessment is mandatory to confirm Critical Limb Ischemia (CLI). Toe pressure measurement is recommended. We compared toe measurements obtained using the Laser Doppler method (LD) (PERIMED PeriFlux, Sweden) considered as the reference test, with those obtained with a portable device using photoplethysmography (PPG) (Sys Toe Atys Medical, France). A total of 93 (123 legs) patients from 3 French hospitals with a clinical suspicion of CLI were included and had measurements with each device carried out by skilled operators. PPG was unable to provide a measurement in 10 patients. Lin’s Coefficient correlation concordance (CCC) and Bland and Altman’s scatter plot were analyzed for the 83 remaining patients, CCC was .84 95%CI (.77–.89). For detection of CLI, Cohen’s kappa was .67 95%CI (.53–.81). The PPG device is fairly reliable for toe pressure measurement in patients suspected of CLI and could be useful when LD is not available. However, it fails to deliver a measurement in approximately 10% of cases. No conclusion should be made about CLI for these patients when no measurement is obtainable and other methods should be used (LD, transcutaneous oxygen pressure) to assess perfusion of the limbs.

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Comparison of Ankle Pressure, Systolic Toe Pressure, and Transcutaneous Oxygen Pressure to Predict Major Amputation After 1 Year in the COPART Cohort

Angiology ◽

10.1177/0003319718793566 ◽

2018 ◽

Vol 70 (3) ◽

pp. 229-236 ◽

Cited By ~ 3

Author(s):

Pierre Salaun ◽

Ileana Desormais ◽

François-Xavier Lapébie ◽

Alessandra Bura Rivière ◽

Victor Aboyans ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Oxygen Pressure ◽

Limb Ischemia ◽

Arterial Disease ◽

Major Amputation ◽

Transcutaneous Oxygen ◽

Ankle Pressure ◽

Transcutaneous Oxygen Pressure ◽

Peripheral Arterial ◽

Toe Pressure

The hemodynamic definition of critical limb ischemia (CLI) has evolved over time but remains controversial. We compared the prediction of major amputation by 3 hemodynamic methods. Patients were selected from the Cohorte des Patients ARTériopathes cohort of patients hospitalized for peripheral arterial disease. Patients with CLI were enrolled according to the Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease II definition and followed up for at least 1 year. We compared the major amputation rate according to initial ankle pressure (AP), systolic toe pressure (STP), and forefoot transcutaneous oxygen pressure (TcPO2); 556 patients were included and divided into surgical (264) and medical (292) groups. The AP failed to identify 42% of patients with CLI. After 1 year, 27% of medical and 17% of surgical patients had undergone major amputation. The TP <30 mm Hg predicted major amputation in the whole sample and in the medical group (odds ratio [OR] 3.5 [1.7-7.1] and OR 5 [2-12.4], respectively), but AP did not. The TcPO2 <10 mm Hg also predicted major amputation (OR 2.3 [1.5-3.5] and OR 3.8 [2.1-6.8]). The best predictive thresholds to predict major amputation were STP <30 mm Hg and TcPO2 <10 mm Hg. None of these methods performed before surgery was able to predict outcome in the revascularized patients.

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Comparison of two devices for measuring exercise transcutaneous oxygen pressures in patients with claudication

VASA ◽

10.1024/0301-1526/a000454 ◽

2015 ◽

Vol 44 (5) ◽

pp. 355-362 ◽

Cited By ~ 8

Author(s):

Marie Urban ◽

Alban Fouasson-Chailloux ◽

Isabelle Signolet ◽

Christophe Colas Ribas ◽

Mathieu Feuilloy ◽

...

Keyword(s):

Oxygen Pressure ◽

Optical Sensors ◽

Chemical Sensors ◽

Transcutaneous Oxygen ◽

Starting Values ◽

Two Systems ◽

Transcutaneous Oxygen Pressure ◽

New Sensors ◽

Changes Over Time ◽

Over Time

Abstract. Summary: Background: We aimed at estimating the agreement between the Medicap® (photo-optical) and Radiometer® (electro-chemical) sensors during exercise transcutaneous oxygen pressure (tcpO2) tests. Our hypothesis was that although absolute starting values (tcpO2rest: mean over 2 minutes) might be different, tcpO2-changes over time and the minimal value of the decrease from rest of oxygen pressure (DROPmin) results at exercise shall be concordant between the two systems. Patients and methods: Forty seven patients with arterial claudication (65 + / - 7 years) performed a treadmill test with 5 probes each of the electro-chemical and photo-optical devices simultaneously, one of each system on the chest, on each buttock and on each calf. Results: Seventeen Medicap® probes disconnected during the tests. tcpO2rest and DROPmin values were higher with Medicap® than with Radiometer®, by 13.7 + / - 17.1 mm Hg and 3.4 + / - 11.7 mm Hg, respectively. Despite the differences in absolute starting values, changes over time were similar between the two systems. The concordance between the two systems was approximately 70 % for classification of test results from DROPmin. Conclusions: Photo-optical sensors are promising alternatives to electro-chemical sensors for exercise oximetry, provided that miniaturisation and weight reduction of the new sensors are possible.

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