Value of Transcutaneous Oximetry during Exercise Test in Assessing the Severity of Chronic Lower Limb Ischemia

Introduction. The severity of lower extremity ischemia can be determined based on the ankle-brachial index (ABI), a noninvasive and widely available diagnostic method. Transcutaneous oximetry (tcpO₂) is one of the methods for assessing lower extremity blood flow not only at rest but also during exercise. This has prompted interest in studying the feasibility of assessing the severity of chronic lower extremity ischemia using this method.

Objective. To determine the correlation between transcutaneous oxygen tension (tcpO₂) values on the feet during exercise testing and the ABI value at rest in patients with occlusive-stenotic lesions of the lower extremity arteries.

Materials and Methods. This retrospective study included 34 patients (23 men and 11 women, mean age 69±4.9 years) with occlusive-stenotic lesions of the aortoiliac segment and lower extremity arteries. All patients were diagnosed with chronic ischemia stage IIb according to Fontaine-Pokrovsky. The patients underwent the following examinations: multislice computed tomography angiography and/or catheter angiography of the abdominal aorta and lower extremity arteries, tcpO₂ of the feet during exercise testing, and ABI calculation. Exclusion criteria were occlusivestenotic lesions of the lower extremity arteries preventing ankle pressure measurement, acute or chronic limb-threatening ischemia, and comorbidities limiting treadmill testing. We assessed the correlation between the ABI level and minimum foot tcpO₂ values at rest, measured sitting, standing, during and after treadmill walking, as well as their ratios at different measurement periods. The predictive ability of tcpO2 indicators in relation to the ABI level was also analyzed.

Results. No statistically significant correlation was found between absolute foot tcpO₂ values and ABI. The highest statistically significant (p=0.001) Spearman correlation coefficient (rho=0.48) was found between ABI and the ratio of foot tcpO₂ during the recovery period after exercise to the baseline value measured in a standing position before exercise. At a ratio below 0.84, the sensitivity and specificity for a decrease in ABI below 0.7 were 70% and 88%, respectively (p<0.001).

Conclusion. The ratio of foot tcpO₂ values during the recovery period after exercise to the same value measured in a standing position before exercise significantly correlates with the ABI value, and a value of this ratio below 0.84 may indicate subcompensated lower extremity ischemia.

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