A comparative analysis of transcutaneous oximetry (tcPO2) during oxygen inhalation and leg dependency in severe peripheral arterial occlusive disease

Abstract

Transcutaneous oximetry (tcPO2) performed during either oxygen inhalation or leg dependency was intra-individually compared in 64 patients suffering from a peripheral arterial occlusive disease, with and without critical limb ischemia. Among the 81 extremities investigated, 29 had a moderate peripheral arterial occlusive disease (6 in stage I, 23 in stage II) and 52 were initially affected by rest pain or ulceration (stage III/IV). Thirty-seven legs out of the latter improved under conservative treatment. In the remaining 15 limbs, vascular surgery or an amputation became necessary. The tcPO2 was measured at the forefoot with the patient in supine and sitting positions while breathing room air and in the supine position while inhaling 100% oxygen. In limbs with a tcPO2 below 15 mm Hg of patients in the supine position breathing room air, leg dependency generally provoked larger tcPO2 increases than oxygen inhalation. This difference between oxygen inhalation while supine and room air breathing leg dependency tcPO2 values exhibited an approximately linear correlation with the resting tcPO2. Responses of tcPO2 to leg dependency and oxygen inhalation seemed to reflect different mechanisms, that is, microvascular flow redistribution and supine perfusion reserve, respectively. The best discrimination of critical limb ischemia was observed for the tcPO2 of patients breathing room air while in the supine position, which was not surpassed by either the oxygen inhalation or the leg dependency test. Satisfactory results were achieved by combining limits for, first, supine (10 mm Hg) and sitting (45 mm Hg) tcPO2, as well as, second, ankle arterial pressure (60 mm Hg) and supine tcPO2 (10 mm Hg).