Henni Samir, Bauer Pascal, Le Meliner Tanguy, Hersant Jeanne, Papon Xavier, Daligault Mickael, Chretien Jean-Marie, Ammi Myriam, Picquet Jean, Abraham Pierre
Department of Vascular Investigation, University of Angers Hospital, France.
UMR Mitovasc CNRS6015-INSERM 1083, University of Angers, France.
Ther Adv Cardiovasc Dis. 2019 Jan-Dec;13:1753944718819063. doi: 10.1177/1753944718819063.
: The prevalence of exercise-induced ischemia in the asymptomatic limb of patients with unilateral claudication based on history and treadmill evaluation, and with unilateral ipsilateral peripheral artery disease (i.e ankle-to-brachial systolic pressure index <0.90) is unknown.
: We detected exercise-induced ischemia in the asymptomatic limb of patients with apparently unilateral claudication. Among 6059 exercise-oximetry tests performed in 3407 nondiabetic and 961 diabetic patients. We estimated the intensity of ischemia in the both limb (buttocks and calves) using the lowest minimum value of the decrease from rest of oxygen pressure (DROP; limb changes minus chest changes from rest), with significant ischemia defined as DROP lower than -15 mmHg.
: We found 152 tests performed in 142 nondiabetic patients and 40 tests performed in 38 diabetic patients. The asymptomatic limb showed significant ischemia in 46.7% and 37.5% of the tests. Strictly unilateral exercise-induced claudication with apparently unilateral peripheral artery disease was rare (<4% of all tests). However, among these highly selected tests, significant ischemia was found in the asymptomatic limb in more than one-third of cases.
: The asymptomatic limb of patients with peripheral artery disease should not be considered a normal limb.
基于病史和跑步机评估，对于患有单侧间歇性跛行且伴有单侧同侧外周动脉疾病（即踝臂收缩压指数<0.90）的患者，其无症状肢体中运动诱发缺血的患病率尚不清楚。
我们检测了明显患有单侧间歇性跛行患者无症状肢体中的运动诱发缺血情况。在对3407名非糖尿病患者和961名糖尿病患者进行的6059次运动血氧测定测试中，我们使用静息时氧分压下降的最低最小值（DROP；肢体变化减去静息时胸部变化）来估计双下肢（臀部和小腿）的缺血强度，显著缺血定义为DROP低于-15 mmHg。
我们发现142名非糖尿病患者进行了152次测试，38名糖尿病患者进行了40次测试。无症状肢体在46.7%的非糖尿病患者测试和37.5%的糖尿病患者测试中显示出显著缺血。具有明显单侧外周动脉疾病的严格单侧运动诱发间歇性跛行很少见（<所有测试的4%）。然而，在这些经过高度筛选的测试中，超过三分之一的病例在无症状肢体中发现了显著缺血。
外周动脉疾病患者的无症状肢体不应被视为正常肢体。
