Transcutaneous Oxygen and Carbon Dioxide Measurement in Peripheral Vascular Disease

Combined transcutaneous oxygen tension (tcPO2) and transcutaneous carbon dioxide tension (tcPCo2) measurements were carried out at both the subclavicular and metatarsal level in 29 controls and 100 patients with peripheral arterial obstructive disease (PAOD) (intermittent claudication: n = 40, critical limb ischemia: n = 60). Interindividual variation coefficients of arterial and subclavicular tcPCO2 (n = 94 subjects) were superimposable, while tcPo2 variability was twice the arterial value. Furthermore, arterial tensions were better predicted by tcPCO2 than by tcPO2 measurement. In the 75 limbs with an ABI < 0.9 of patients with intermittent claudication, tcPCO2 did not differ significantly from controls (n = 58 limbs), but it was elevated in those with critical limb ischemia (n = 74 limbs), although control and pathological values overlapped widely even in this latter group. At variance with tcPCO2, tcPQ2 was lower in intermittent claudication than in controls, and undetectable in most of the symptomatic limbs with critical ischemia, irrespective of concomitant diabetes. In the overall sample (n = 255 limbs), tcPCO2 did not show significant changes for tcPo2 values ranging from 80 to 10 mmHg, and it increased markedly in several—but not all—patients whose tcPo2 values were below that limit. To evaluate further the biological significance of an increase in tissue tcPCO2, another sample of 24 subjects underwent acute forearm ischemia for a period of thirteen minutes, a maneuver that increased tcPCO2 markedly, indicating that this parameter is indeed a correlate of drastic reductions in limb perfusion. Thus, tcPCO2 is methodologically less variable than tcPo2 and more predictive of arterial values. However, the wide overlap with control values restrains its use as an isolated diagnostic tool to substantiate PAOD, even in the most advanced stages of disease. Marked elevations in tCPCO2 can be found in patients with critical limb ischemia, although normal values may coexist with low or negligible tcPO2 levels for reasons to be clarified. Further work is needed to establish the extent to which tcPcO2 determination may complement tcPO2 to differentiate extreme from less severe degrees of critical limb ischemia.

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