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Exercise transcutaneous oximetry significantly modifies the diagnostic hypotheses and impacts scheduled investigations or treatments of patients with exertional limb pain

Published:January 04, 2018DOI:https://doi.org/10.1016/j.ejim.2018.01.008

      Highlights

      • Exercise oximetry (Ex-TcpO2) is now available in nine referral centers in France.
      • It modifies 44% of the diagnostic hypotheses of patients with exertional limb pain.
      • Ex-TcpO2 positively influences investigations or treatments of studied patients.
      • Applied to ~600 patients, this test induced a reduction of costs of ~130,000 Euros.

      Abstract

      Introduction

      In lower extremity peripheral artery disease (PAD), transcutaneous oximetry at exercise (Ex-TcpO2) has been largely validated in research practice, but evidence of routine practice in various vascular laboratories is missing. We hypothesized that Ex-TcPO2 would change the diagnosis hypotheses, investigations and treatments for patients referred for exertional limb pain.

      Material & methods

      A multicenter prospective trial was conducted in nine different referral centers. Investigators performed Ex-TcpO2 and recorded investigations and treatments already scheduled for the patient. We encoded referral physician's diagnostic hypothesis. Before Ex-TcpO2, vascular physicians were asked to give their diagnosis hypotheses. A minimal decrease from rest of oxygen pressure (DROP) < minus 15 mm Hg defined the presence of exercise-induced ischemia on the area of interest. After Ex-TcPO2, we recorded post-test diagnostic hypothesis and investigations and treatments to be cancelled or performed. We compared the diagnosis hypotheses, scheduled investigations and treatments, before and after the Ex-TcpO2.

      Results

      We included 603 patients (485 males: 80.4%), aged 64.7 ± 9.8 years. The post-test diagnosis hypothesis differed in 266 patients (44.1%; p < 0.0001) and in 96 patients (15.9%) from the pre-test hypothesis of referring and vascular physician, respectively. This led to the recommendation to cancel 27 scheduled investigations or treatments of a total cost of ~130,000 euros.

      Discussion

      Ex-TcPO2 in patients with exertional limb pain is applicable in various vascular institutions, and significantly modifies the diagnostic hypotheses and impacts scheduled investigations or treatments of patients with exertional limb pain.

      Keywords

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