Transcutaneous Oxygen Tension (TcPO2) Measurement as a Diagnostic Tool in Patients with Peripheral Vascular Disease

Abstract

Transcutaneous oxygen tension (TcPO₂) was measured through Clark's elec trode at the dorsum of the foot in 52 healthy controls whose ages ranged from twenty to sixty-five years (mean 45.05 ±14.09) and 36 nondiabetic patients with peripheral vascular disease (PVD) (5 stage I, 16 stage II, 4 stage III, 11 stage IV), under standardized conditions at rest and during recovery from limb ische mia obtained with pneumatic cuff compression for 3 minutes.

At rest the TcPO₂ averaged 71.20±14.26 mm Hg (range 46-92) in the con trols and 51.56±26.38 in the PVD patients (p < .01). A wide overlap was ob served between the two groups and among the different stages of the disease, and consequently, the diagnostic value of TcPO₂ at rest was limited (sensitivity equal to 32%). During the recovery from ischemia the time constant (recovery half-time, T½) averaged 38.01±7.23 sec in the controls and 55.84 ± 19.82 in the PVD patients (p < .01). The T½ added to the diagnostic value of the method, making it more sensitive (55%), especially for stage II patients. The TcPO₂ at rest was lower with increasing severity of the disease; both the TcPO₂ at rest and the T½ correlated with the ankle-arm pressure index in the diseased limbs (r = .48 and - .41 respectively, p < .001).

The method showed a limited degree of reproducibility in the controls when the right and the left lower extremity were compared in each subject; in fact, the intrasubject variance of TcPO₂ and T½ was of the same magnitude as the intersubject variance (F=1.73 and 1.26 respectively), and the standard devia tions of the difference between lower extremities was elevated (13.32 mm Hg for TcPO₂ and 7.80 sec for T½). Moreover, the T½ decreased with increasing age in the controls (r = - .47, p < .001).

The authors conclude that, although it is a good indicator of the severity of PVD, the TcPO₂ has a limited diagnostic value in this kind of patients, owing to the wide range of normalcy, to the low degree of reproducibility in a single individual, and to the influence of the age factor.

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References

Peabody J. , Willis M. , Gregory G. , et al: Clinical limitations and advantages of transcutaneous oxygen electrodes. Acta Anesthesiol Scand 68:76-82, 1978.

Franzeck UK , Talka P. , Bernstein EF , et al: Transcutaneous PO2 measurements in health and peripheral occlusive disease. Surgery 91:156-163, 1982.

Hauser C. , Shoemaker WC : Use of a transcutaneous PO2 regional perfusion index to quantify tissue perfusion in peripheral vascular disease. Ann Surg 197:336-343, 1983.

Mustapa N. , Rehead RG , Jain SK , et al: Transcutaneous partial oxygen pressure assessment of the ischemic lower limb. Surg Gynecol Obstet 156:582-585, 1983.

Wyss CR , Matsenf A. III , Simmons CW , et al: Transcutaneous oxygen tension measurements on limbs of diabetic and non-diabetic patients with peripheral vascular disease. Surgery 95:330, 1984.

Tonnesen KH : Transcutaneous oxygen tension in imminent foot gangrene. Acta Anesthesiol Scand 68(s):107-110, 1978.

Casillas JM , Becker F. , Roux J. , et al: TcPO2 et viabilité d'un moignon d'amputation. Etude préliminaire. J Mal Vascul 10:71-72, 1985.

White RA , Nolan L. , Harley D. , et al: Noninvasive evaluation of peripheral disease using transcutaneous oxygen tension. Amer J Surg 144:68-75, 1982.

Holdich Tah , Reddy PJ , Walker RT , Dormandy JA : Transcutaneous oxygen tension during exercise in patients with claudication . Br Med J 292:1625-1628, 1986 .

10.

Christensen KJ , Larsen JF , Klerige M. : Transcutaneous oxygen tension response to exercise in health and in occlusive arterial disease. Acta Chir Scand 152:657-660, 1986.

11.

Antignani PL , Conte M. , Perna AM , Paolucci A. , Bartolo M. : Modificazioni statiche e dinamiche della pressione transcutanea di ossigeno in soggetti arteriopatici. Min Angiol 10:285-300. 1985.

12.

Becker F. , Casillas JM : Methodes d'explorations fonctionelle vasculaires permettant d'apprecier une ten-dance evolutive en phase critique de l'arteriopathie des membres inferieurs . Signal pulse pulpaire, pression digitale, PO2 transcutanee à l'avant-pied. Notes preliminaires. J Mal Vascul 10:43-46, 1985.

13.

Signorelli S. , Buttò G. , Finocchiaro F. , et al: La tensione transcutanea di ossigeno nella valutazione funzionale del vasculopatico degli arti inferiori. In: Angiologia 86, ed. by Bertini D , Nuzzaci G , Pratesi C , Righi D. Bologna: Monduzzi, 1986, pp 595-602.

14.

Mannarino E. , Pasqualini L. , Marangoni G. , et al: Comportamento e significato della determinazione della tensione transcutanea di ossigeno nelle arteriopatie obliteranti degli arti inferiori ai diversi stadi. In: Angiologia 86, ed. by Bertini D , Nuzzaci G , Pratesi C , Righi D. Bologna: Monduzzi, 1986, pp 415-421.

15.

Ohgi S. , Ito K. , Hara H. , Mori T. : Continuous measurement of transcutaneous oxygen tension on stress test in claudicants and normals. Angiology 37:27-35, 1986.

16.

Antignani PL , Perna AM , Paolucci A. , et al: Modificazione della TcPO2 durante test posturali in soggetti sani ed arteriopatici. In: Patologia Vascol'87 , ed. by Del Guercio R , Leonardo G , Zannini G. Bologna: Monduzzi, 1987, pp 1059-1063.

17.

McCollum PT , Spencer Vaa , Walker WF : Oxygen inhalation induced changes in the skin as measured by transcutaneous oxymetry. Br J Surg 73:882-885, 1986.

18.

Sheffield PJ , Workman WT : Non invasive tissue oxygen measurement in patient administered normobaric and hyperbaric oxygen by mask. Hyperbaric Oxygen Review 6:47-62, 1985.

19.

Roberts DH , Breckenridge AM : Transcutaneous oxygen tension during exercise in patients with claudication . Br Med J 293:392, 1986.

20.

Clyne CA , Ryan J. , Webster JH , Chant Adb : Oxygen tension on the skin of ischemic legs. Amer J Surg 143:315-318, 1982.

21.

Modesti PA , Boddi M. , Poggesi L. , et al: L'ossimetria transcutanea nella valutazione dell'insufficienza arteriosa periferica iniziale per pazienti diabetici. In: Angiologia 86, ed. by Bertini D , Nuzzaci G , Pratesi C , Righi D. Bologna: Monduzzi, 1986, pp 409-413.

22.

Mannarino E. , Pasqualino L. , Marangoni G. , et al: Correlazione tra tensione transcutanea di 02, indici Doppler e pletismografia s.g. nella valutazione del danno nell'arteriopatico. In: Angiologia 86, ed. by Bertini D , Nuzzaci G , Pratesi C , Righi D. Bologna: Monduzzi, 1986, pp 603-608.

23.

Huch R. , Huch A. , Lübber Jdw : Transcutaneous measurement of blood PO2 (TcPO2). Method and application in perinatal medicine. J Perinat Med 1:183-186, 1973.