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Transcutaneous Oxygen and Carbon Dioxide Measurement in Peripheral Vascular Disease

Medicina Interna, USL 12, Pisa, Italy

Giosue' Catapano, M.D.

Giulia Dell'Omo, M.D.

Medicina Interna, I Clinica Medica, Azienda Ospedaliera e Universita' di Pisa, Pisa, Italy

Letizia Iabichella, M.D.

PISA, ITALY

Raffaella Berchiolli, M.D.

Mauro Ferrari, M.D.

Medicina Interna, Istituto di Chirurgia Generale e Sperimentale, Azienda Ospedaliera e Universita' di Pisa, Pisa, Italy

Roberto Pedrinelli, M.D.

Medicina Interna, I Clinica Medica, Azienda Ospedaliera e Universita' di Pisa, Pisa, Italy

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.

Vascular and Endovascular Surgery, Vol. 29, No. 4, 273-280 (1995)
DOI: 10.1177/153857449502900403


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