Clinical improvement after arterial revascularization is associated with exercise oximetry results.

Abstract

Introduction: Exercise transcutaneous oximetry (Ex-TcpO2) is used to support the vascular origin of lower-limb pain, or to assess walking impairment. The aim of this study was to describe the association between Ex-TcpO2 measurement and the perioperative clinical and morphological outcomes after revascularization in patients with intermittent claudication (IC). Methods: From January to December 2022, a single-center prospective observational study was conducted among patients with IC. Patients were referred by vascular surgeons for Ex-TcpO2 for doubtful arterial origin. Perioperative clinical and morphological outcomes were assessed by the Rutherford-Becker classification and duplex ultrasound examination. The primary patency rate and primary sustained clinical improvement were evaluated at 1 month after revascularization. Results: Eighty-two patients (64% men) underwent Ex-TcpO2 and were enrolled in the study, of whom 65% were category III of the Rutherford classification. Indications for Ex-TcpO2 were to assess the origin of the IC symptoms in 65%. Sixty-seven (81%) patients had positive Ex-TcpO2, and 15 (18%) had negative Ex-TcpO2. Patients with positive Ex-TcpO2 were older (65 ± 13 vs 58 ± 20, p = 0.43), and had a significantly lower ankle-brachial index (ABI) compared to the negative group (0.65 ± 0.22 vs 0.92 ± 0.22, p < 0.001) as well as a lower maximum walking distance (MWD) (200 m [150, 300] vs 525 m [500, 872], p < 0.001). Forty-two patients underwent revascularization (Ex-TcpO2 positive [n = 35/67]; Ex-TcpO2 negative [n = 7/15]). Revascularization technical success and primary patency rate were 100% in both groups. Clinical improvement was significantly greater in the Ex-TcpO2 positive group (97% [n = 34/35] vs 0% [n = 0/7], p < 0.001). Multivariate analysis shows a positive association between pain at the buttock and the decrease from rest of oxygen pressure (DROP) ≤ -15 mmHg at the level of the buttock with the presence of iliac lesions. Conclusion: On a routine basis, Ex-TcpO2 is a tool of interest to assess patients with claudication for doubtful arterial origin or walking distance, especially in proximal IC, and to predict favorable clinical outcomes after revascularization.