Use of a transcutaneous PO2 regional perfusion index to quantify tissue perfusion in peripheral vascular disease

In order to develop transcutaneous oxygen tension (PtcO2) measurements into a practical method for assessing peripheral vascular disease, the relationships between extremity and chest wall PtcO2 were examined in subjects with and without systemic atherosclerotic disease. The ratio of extremity to chest PtcO2, or transcutaneous regional perfusion index (RPI) assessed limb oxygenation more reliably than did direct PtcO2 measurement by obviating the effects of changes in systemic oxygen delivery upon local PtcO2. The authors find that transcutaneous oximetry can be used during treadmill exercise testing and that the RPI is unchanged by exercise in all normal subjects. PtcO2 and RPI were then measured during rest, position change, and exercise testing in patients with intermittent claudication. Whereas normal subjects maintain a constant thigh and calf RPI during exercise, patients with intermittent claudication consistently manifested large decreases in RPI in these areas when they were exercised until symptomatic. The authors find no overlap between the responses of normal subjects and patients with claudication; positive findings are, therefore, highly specific for exercise-induced limb ischemia. Since transcutaneous RPI exercise testing is easily performed and highly reproducible, it is well suited to clinical use in the diagnosis and documentation of intermittent claudication. Furthermore, since limb ischemia can be quantified, this method lends itself both to grading the severity of disease and to evaluating clinical progression of disease. It is suggested that such a quantitative approach to evaluation of intermittent claudication may allow refinement and extension of the indications for operative intervention in patients with intermittent claudication.