LUNAM, INSERM 1083 CNRS6214, Faculté de Médecine, Université d'Angers, Angers, France.
J Vasc Surg. 2013 Mar;57(3):714-9. doi: 10.1016/j.jvs.2012.08.117. Epub 2013 Jan 9.
Increase in arterial inflow to the lower limbs is important to obtain functional improvement in peripheral artery disease (PAD) patients with claudication. The aim of this study was to assess the effect of electrical stimulation of calf muscles on arterial inflow and tissue oxygen content in PAD in the area of stimulation.
Fifteen adult patients [mean (standard deviation) age, 62 (12 ) years; height, 165 (8)cm; weight, 76 (13) kg; lowest ankle-brachial index 0.66 (0.19)] with stable arterial claudication were recruited. All patients performed a treadmill test (3.2 km/h, 10% slope) associated with a transcutaneous oximetry test expressed as decrease from rest of oxygen pressure (DROP) index values (calf changes minus chest changes from rest) with a maximum walking distance (median [25th/75th percentiles]) of 295 [133-881] m. The DROP index on the symptomatic side was -25 [-18/-34] mm Hg. On another day the patients underwent electrical stimulation in the seated position on the leg that was the most symptomatic on the treadmill. After resting values were recorded, the gastrocnemius was stimulated for 20minutes at increasing contraction rates at 5-minute steps of 60, 75, 86, and 100bpm on the most symptomatic side. Arterial blood inflow with duplex Doppler ultrasound scanning of the femoral artery, DROP transcutaneous oxygen pressure value, and oxygen concentration (O2Hb) from the near-infrared spectroscopic signal of the calf were recorded on both sides. Patients were instructed to report eventual contraction-induced pain in the stimulated calf. Results are given as mean (standard deviation) or median [25th/75th percentiles] according to distribution, and the level of statistical significance was set at P < .05 on two-tailed tests.
Lower limb inflow (mL/min) was 64 [48/86] vs 63 [57/81] (P> .05) before stimulation, 123 [75/156] vs 57 [44/92] (P < .01) at 60bpm, 127 [91/207] vs 49 [43/68] (P < .01) at 75bpm, 140 [84/200] vs 57 [45/71] (P < .01) at 86bpm, and 154 [86/185] vs 55 [46/94] (P < .01) at 100bpm on the stimulated vs nonstimulated limb, respectively. No apparent decrease or significant leg difference was observed in DROP index or O2Hb values. None of the patients reported contraction-induced pain in the leg.
Electrical stimulation of calf muscle with the Veinoplus device results in a significant increase of arterial inflow without measurable muscle ischemia or pain. Potential use of this device as an adjuvant treatment to improve walking capacity in PAD patients remains to be evaluated.
增加下肢动脉血流量对于伴有跛行的外周动脉疾病（PAD）患者获得功能改善很重要。本研究旨在评估小腿肌肉电刺激对刺激区域内 PAD 患者动脉血流量和组织氧含量的影响。
招募了 15 名患有稳定动脉性跛行的成年患者[平均（标准差）年龄 62（12）岁；身高 165（8）cm；体重 76（13）kg；最低踝肱指数 0.66（0.19）]。所有患者均进行了跑步机测试（3.2km/h，10%坡度），并进行了经皮血氧测试，表现为从休息时的氧压下降（DROP）指数值（小腿变化减去休息时的胸部变化），最大步行距离（中位数[25 百分位/75 百分位]）为 295[133-881]m。症状侧的 DROP 指数为-25[-18/-34]mmHg。在另一天，患者在症状最严重的腿上以坐姿接受电刺激。记录休息时的值后，在症状最严重的一侧，以 5 分钟为一个间隔，逐渐增加收缩率，将腓肠肌刺激 20 分钟，收缩率分别为 60、75、86 和 100bpm。用双功超声扫描股动脉记录动脉血流，用经皮氧压值和近红外光谱信号的氧血红蛋白（O2Hb）记录小腿。患者被要求报告刺激小腿时出现的任何收缩引起的疼痛。结果以平均值（标准差）或中位数[25 百分位/75 百分位]表示，具体取决于分布情况，双侧检验的统计学意义水平设为 P<0.05。
刺激前，患侧下肢血流量（mL/min）为 64[48/86]vs 63[57/81]（P>0.05），60bpm 时为 123[75/156]vs 57[44/92]（P<0.01），75bpm 时为 127[91/207]vs 49[43/68]（P<0.01），86bpm 时为 140[84/200]vs 57[45/71]（P<0.01），100bpm 时为 154[86/185]vs 55[46/94]（P<0.01），刺激侧与非刺激侧分别为患侧与健侧。DROP 指数或 O2Hb 值未见明显下降或显著腿间差异。没有患者报告刺激腿出现收缩引起的疼痛。
Veinoplus 装置对小腿肌肉进行电刺激可显著增加动脉血流量，而无可测量的肌肉缺血或疼痛。该设备作为改善 PAD 患者步行能力的辅助治疗手段的潜力仍有待评估。
