[Methodology in angiologic-therapeutic-clinical research. Inter- and intra-individual comparison in arterial...

The objective metabolic evaluation of the insufficiency of the peripheral circulation in patients with arterial occlusive disease has proved to be very intricate. Previously blood specimen were taken more proximally from the femoral vein and not from the draining blood vessel of the exercised muscles. Consequently the analysed blood samples contained a higher degree of blood from non-ischemic muscle. This methodological problem could be overcome by introducing a catheter into the popliteal vein. This new technique permits to study the spontaneous and reactive metabolic changes in the legs during and after treadmill exercise in patients with intermittent claudication. Exercise- and post-exercise metabolism was studied in the legs of 18 individuals without arterial occlusive disease and in 76 patients with intermittent claudication. Change of lactate, pyruvate blood gases and acid-base balance was studied inter- and intraindividually in arterial and popliteal venous blood during and after an exhaustive constant load exercise on a treadmill. The metabolic effect during bicycle- and treadmill exercise was compared intraindividually. During exercise, the difference between the arterio-popliteal venous blood samples in lactate concentrations was significantly higher in patients than in controls. In general, patients had a significantly higher lactate-pyruvate ratio in the popliteal venous blood than in the arterial blood. During treadmill exercise the popliteal venous PO2 did not fall below 16.5 +/- 1.1 mmHg in the controls. Individual values during exercise varied from 6.4 mmHg to 18.1 mmHg in patients. The transition from supine at rest to upright position on the treadmill reduced the popliteal venous oxygen saturation from 49.4% to 26.3% in the patients.(ABSTRACT TRUNCATED AT 250 WORDS)