Prevalence and Causes of Normal Exercise Oximetry in the Calf in Patients with Peripheral Artery Disease and Limiting Calf Claudication.

OBJECTIVE: In patients with claudication, an ankle brachial index (ABI) under 0.90 is considered to be abnormal and a sufficient argument for the arterial origin of exercise induced pain. Exercise transcutaneous oxygen pressure (Ex-tcpO2) can provide evidence of exercise induced regional blood flow impairment (RBFI) and confirm the arterial origin of walking induced pain. The frequency with which calf Ex-tcpO2 remains apparently normal in patients with claudication and abnormal ABI is unknown. Causes of these discrepant results have yet to be analysed. METHODS: A retrospective analysis of 4575 Ex-tcpO2 tests performed on 3,281 patients was conducted. The focus was on patients with a history of calf claudication and ABI under 0.90. Duplicate or non-standard tests were excluded, as were patients with no pain or those able to walk more than 15 minutes (on a treadmill). Searches were conducted for possible explanations of normal calf Ex-tcpO2 in the selected patients. RESULTS: Cardiorespiratory limitation was identified in 50 patients and isolated non-calf ischemia in 36 of the 106 patients selected. There was no obvious explanation during Ex-tcpO2, but clinical improvement after non-vascular treatment or total absence of improvement after a technically successful revascularisation was noted in 12 patients. Four patients were lost on follow up. Four patients improved after revascularisation, which suggests that the Ex-tcpO2 result was false negative. CONCLUSIONS: Ex-tcpO2 is negative in more than 20% of tests performed in patients with an ABI under 0.90 and a history of calf claudication. In most cases, when excluding re-tests and non-limiting or non-calf claudication on the treadmill, non-calf ischemia or a non-vascular limitation occurring during the test were observed. This observation supports both the value of treadmill testing in patients with calf claudication assumed to be of arterial origin (ABI<0.90) and the use of Ex-tcpO2 to detect non-calf ischemia.

Test-retest Reliability of GPS derived Measurements in Patients with Claudication.

OBJECTIVE: In patients with peripheral artery disease (PAD), the different distances between stops and the stop durations recorded with Global Positioning System (GPS) during a 1 hour stroll in the community are highly variable. Nevertheless, the reliability of the greatest community walk distance (greatest distance), the average of walking speeds (average speed) and the durations of stops (average stop durations) have not been studied. DESIGN: Seventeen PAD patients performed two series of evaluations (T1 and T2) within a 1 month period. METHODS: Each series included: a 1 hour stroll in the community with the calculation of the walking impairment questionnaire (WIQ) scores, the measurement of maximal walking distance on a treadmill (MWD on treadmill) and a 1 hour stroll in the community with GPS. The Garmin GPS-60 (Garmin Ltd, Olathe, Kan) receiver was used for all patients. Test-retest reliability of MWD on treadmill, WIQ, and GPS parameters were assessed with intraclass coefficient of correlation (ICC). RESULTS: ICCs are almost perfect between T1 and T2 for greatest distance (ICC = 0.911), average speed (ICC = 0.905), and MWD on treadmill (ICC = 0.992), and substantial for the average WIQ (ICC = 0.794). Correlation of average stop durations was considered substantial (ICC = 0.691). CONCLUSIONS: Despite the previously reported "within stroll" variability of walking bouts for distances, speeds, and stop durations, GPS derived greatest distance and average speed are reliable in PAD patients in test-retest experiments. The GPS appears to be a new tool to assess walking limitation and allows objective clinical investigation.