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High prevalence of exercise-induced ischemia in the asymptomatic limb of patients with apparently strictly unilateral symptoms and unilateral peripheral artery disease.

Authors
  • Henni, Samir1, 2
  • Bauer, Pascal3
  • Le Meliner, Tanguy1
  • Hersant, Jeanne1
  • Papon, Xavier4
  • Daligault, Mickael4
  • Chretien, Jean-Marie5
  • Ammi, Myriam4
  • Picquet, Jean4, 2
  • Abraham, Pierre6
  • 1 Department of Vascular Investigation, University of Angers Hospital, France. , (France)
  • 2 UMR Mitovasc CNRS6015-INSERM 1083, University of Angers, France. , (France)
  • 3 Cardiology and Angiology, University Hospital Giessen, Germany. , (Germany)
  • 4 Department of Vascular and thoracic Surgery, University of Angers Hospital, France. , (France)
  • 5 Department of Biostatistics and Data Management, University of Angers Hospital, France. , (France)
  • 6 Laboratoire d'Explorations Vasculaires; Centre Hospitalier Universitaire, 49033 Angers Cedex 01, France. , (France)
Type
Published Article
Journal
Therapeutic advances in cardiovascular disease
Publication Date
Jan 01, 2019
Volume
13
Identifiers
DOI: 10.1177/1753944718819063
PMID: 30803404
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The prevalence of exercise-induced ischemia in the asymptomatic limb of patients with unilateral claudication based on history and treadmill evaluation, and with unilateral ipsilateral peripheral artery disease (i.e ankle-to-brachial systolic pressure index <0.90) is unknown. We detected exercise-induced ischemia in the asymptomatic limb of patients with apparently unilateral claudication. Among 6059 exercise-oximetry tests performed in 3407 nondiabetic and 961 diabetic patients. We estimated the intensity of ischemia in the both limb (buttocks and calves) using the lowest minimum value of the decrease from rest of oxygen pressure (DROP; limb changes minus chest changes from rest), with significant ischemia defined as DROP lower than -15 mmHg. We found 152 tests performed in 142 nondiabetic patients and 40 tests performed in 38 diabetic patients. The asymptomatic limb showed significant ischemia in 46.7% and 37.5% of the tests. Strictly unilateral exercise-induced claudication with apparently unilateral peripheral artery disease was rare (<4% of all tests). However, among these highly selected tests, significant ischemia was found in the asymptomatic limb in more than one-third of cases. The asymptomatic limb of patients with peripheral artery disease should not be considered a normal limb.

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