Mahe Guillaume, Kalra Manju, Abraham Pierre, Liedl David A, Wennberg Paul W
Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA INSERM Clinical Investigation Center CIC 1414, Rennes, France
Division of Vascular and Endovascular Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
Vasc Med. 2015 Jun;20(3):251-5. doi: 10.1177/1358863X14567030. Epub 2015 Mar 6.
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.
近端间歇性跛行继发于外周动脉疾病（PAD）引起的缺血，而近端假性间歇性跛行继发于其他疾病过程，如髋关节炎、脊柱狭窄、神经病变等。两者之间的鉴别可能具有挑战性。运动经皮氧分压测量（exercise-TcPO2）可对下肢动脉树近端动脉和分支中导致血流减少的病变进行无创检测。我们展示了美国首例使用exercise-TcPO2算法的病例报告。一名71岁的糖尿病患者，左侧近端和右小腿出现间歇性跛行，踝臂指数不确定，在血管内介入治疗前后进行了exercise-TcPO2研究。放置了四个TcPO2探头：一个位于胸部水平（参考探头），两个分别置于双侧臀部，一个置于有症状的小腿。使用先前验证的方案在每个探头部位计算静息氧压差值（DROP）指数。初始exercise-TcPO2证实了左侧近端和右小腿缺血，在对左髂动脉病变进行血管内治疗后，近端exercise-TcPO2值有所改善。这些数据表明，exercise-TcPO2在评估动脉不可压缩和/或近端间歇性跛行的患者的PAD方面可能有用。
