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Pulse oximetry in the evaluation of peripheral vascular disease
D Jawahar1, H R Rachamalla, A Rafalowski
1Department of Medicine, New York Methodist Hospital, Brooklyn, USA.
Insights
Pulse oximetry is not a sensitive tool for detecting early peripheral vascular disease (PVD). Limb elevation did not significantly improve detection rates for PVD using pulse oximetry.
Area of Science:
- Vascular Medicine
- Diagnostic Technologies
Background:
- Peripheral vascular disease (PVD) affects limb circulation.
- Accurate diagnostic tools are crucial for early PVD detection and management.
Purpose of the Study:
- To investigate the efficacy of pulse oximetry in evaluating PVD.
- To determine if limb elevation enhances pulse oximetry's sensitivity for PVD detection.
Main Methods:
- Pulse oximetry readings were taken from the toes of healthy volunteers and PVD patients.
- Ankle-brachial pressure index (ABPI) was used to classify PVD severity.
- Limb elevation was tested to assess its impact on pulse oximetry readings.
Main Results:
- Pulse oximetry showed no gradation in readings with PVD severity.
- Abnormal readings increased with lower ABPI, but sensitivity remained low.
- Limb elevation showed a minor increase in abnormal readings for moderate and severe PVD.
Conclusions:
- Pulse oximetry is not a sensitive method for early PVD detection.
- The technique's utility is limited, even with limb elevation.
- Further research into sensitive PVD diagnostic methods is warranted.
Abstract:
The role of pulse oximetry in the evaluation of peripheral vascular disease (PVD) was investigated. In addition, the value of elevating the limb to improve the sensitivity of detection of PVD by the pulse oximeter was also determined. Pulse oximetry reading in the toes were obtained in 40 young, healthy volunteers and in 40 randomly selected patients referred to the vascular investigation laboratory over a period of two months. All 40 healthy volunteers had normal pulse oximetry readings. Normal pulse oximetry reading in the toes was defined as > 95% O2 Sat and +/-2 of finger pulse oximetry reading. In all 40 patients, pulse oximetry readings were either normal or not detected at all. Since there was no gradation in decrease in the pulse oximetry reading with severity of disease or with elevation of the patient's lower extremity, an absent or no reading was considered as an abnormal result from the test. The frequency of abnormal pulse oximetry readings increased significantly in groups with abnormal ankle-brachial pressure index (ABPI) and also varied significantly with elevation of the patients' lower limbs. In patients with no PVD detected by Doppler (ABPI > 0.9), pulse oximetry readings were normal in all. However, in patients with moderate PVD (ABPI, 0.5-0.9), 84% of the patients' lower limbs had normal pulse oximetry readings and 16% had an abnormal reading at baseline level (flat). An additional 12% of the lower limbs in this group had an abnormal reading on elevation of the limb to 12 inches. In patients with severe PVD (ABPI < 0.5), 54% of the patients' lower limbs had an abnormal reading at baseline and an additional 23% had an abnormal reading at elevation of the limb to 12 inches. In conclusion, pulse oximetry was not a sensitive test for detecting early PVD.