Jornal Vascular Brasileiro
https://app.periodikos.com.br/journal/jvb/article/doi/10.1590/1677-5449.002115
Jornal Vascular Brasileiro
Original Article

Avaliação da saturação tecidual de oxigênio durante o sintoma claudicante em pacientes com doença arterial periférica

Tissue oxygen saturation assessment during claudication symptoms in patients with peripheral arterial disease

João Antônio da Silva Junior; Débora Úrsula Fernandes Souza; Daniela Rodrigues Ferreira; Mariane Cassia Paixão Valeriano; Raquel Ferreira Santos; Raquel Rodrigues Britto; Danielle Aparecida Gomes Pereira

http://dx.doi.org/10.1590/1677-5449.002115 J Vasc Bras, vol.14, n4, p.311-318, 2015
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Resumo

Resumo Contexto O relato de sintoma claudicante em pacientes com doença arterial periférica é utilizado como modulador da intensidade de exercício físico para o tratamento clínico, entretanto os valores de oxigenação tecidual nesse momento são desconhecidos. Objetivo Descrever o suprimento tecidual de oxigênio por meio da espectroscopia de luz próxima ao infravermelho ou Near-Infrared Spectroscopy (NIRS) nos momentos em que o paciente relata sintoma claudicante inicial e máximo em testes de exercício. Métodos Nove pacientes, oito homens com 65,63 ± 6,02 anos de idade, previamente diagnosticados com doença arterial periférica, realizaram teste de exercício de carga constante e de carga incremental com monitorização do nível de oxigenação tecidual através da NIRS. As saturações de oxigênio obtidas no momento em que o paciente relata sintoma claudicante inicial e no momento em que relata sintoma claudicante máximo foram comparadas com os valores de saturação da manobra de oclusão arterial por meio do intervalo de confiança de 95% da diferença. Resultados Verificou-se que os valores de saturação nos momentos de sintoma claudicante inicial e máximo são estatisticamente distintos quando comparados àqueles obtidos na manobra de oclusão arterial, entretanto, através da análise percentual do quão distante esses valores encontram-se é possível observar que, do ponto de vista clínico, eles estão próximos. Conclusões A saturação no momento em que o paciente relata sintomas claudicantes inicial e máximo é bastante próxima do valor de saturação no momento de oclusão e do ponto de vista clínico o relato subjetivo de sintoma do paciente é adequado como parâmetro para a prescrição do exercício físico.

Palavras-chave

doença arterial periférica, espectroscopia de luz próxima ao infravermelho, teste de esforço, claudicação intermitente

Abstract

Abstract Background The time at which claudication symptoms are reported is used to modulate exercise intensity in clinical treatment of patients with peripheral arterial disease, but tissue oxygenation values at that point are unknown. Objective To describe tissue oxygen supply measured using Near-Infrared Spectroscopy (NIRS) when patients report initial and maximum claudication symptoms during exercise tests. Methods Nine patients (eight men) aged 65.63 ± 6.02 years and previously diagnosed with peripheral arterial disease performed constant load exercise testing and incremental load exercise testing while tissue oxygenation levels were monitored by NIRS. Oxygen saturation values at the times at which each patient reported initial onset of claudication symptoms and maximum claudication symptoms were compared with values obtained during the arterial occlusion maneuver, using the 95% confidence interval of the difference. Results It was found that saturation values at the time of both initial and maximum claudication symptoms were statistically different from saturation during the arterial occlusion maneuver, but on the basis of percentage analysis they were similar from a clinical point of view. Conclusions Oxygen saturations at the time patients report initial and maximum claudication symptoms are very close to saturations during arterial occlusion. From a clinical perspective, subjective patient report of symptoms is an appropriate parameter on which to base exercise prescription.

Keywords

peripheral arterial disease, near-infrared spectroscopy, exercise test, intermittent claudication

References

Garcia LA. Epidemiology and pathophysiology of lower extremity peripheral arterial disease. J Endovasc Ther. 2006;13(1^sSupl 2):II3-9.

Silva R, Consolim-Colombo F. Aspectos relevantes para identificação da claudicação intermitente. Acta Paul Enferm. 2011;24(3):426-9.

Bradberry JC. Peripheral arterial disease: pathophysiology, risk factors, and role of antithrombotic therapy. J Am Pharm Assoc. 2003;2004(44):S37-45, quiz S44-5.

Vaz C, Duarte V, Santos AR. Doença arterial periférica e qualidade de vida. Angiol Cir Vasc. 2013;9(1):1-7.

McDermott MM, Guralnik JM, Albay M, Bandinelli S, Miniati B, Ferrucci L. Impairments of muscles and nerves associated with peripheral arterial disease and their relationship with lower extremity functioning: the InCHIANTI Study. J Am Geriatr Soc. 2004;52(3):405-10.

Atkins L, Gardner AW. The relationship between lower extremity functional strength and severity of peripheral arterial disease. Angiology. 2004;55(4):347-55.

Breek J, Hamming J, Vries J, Aquarius AEA, Henegouwen D. Quality of life in patients with intermittent claudication using The World Health Organisation (WHO) questionnaire. Eur J Vasc Endovasc Surg. 2001;21(2):118-22.

Creager MA, Belkin M, Bluth EI. 2012 ACCF/AHA/ACR/SCAI/SIR/STS/SVM/SVN/SVS key data elements and definitions for peripheral atherosclerotic vascular disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Peripheral Atherosclerotic Vascular Disease). Circulation. 2012;125(2):395-467.

Flu HC, Tamsma J, Lindeman J, Hamming J, Lardenoye J. A systematic review of implementation of established recommended secondary prevention measures in patients with PAOD. Eur J Vasc Endovasc Surg. 2010;39(1):70-86.

Manfredini F, Malagoni AM, Mandini S. Near-infrared spectroscopy assessment following exercise training in patients with intermittent claudication and in untrained healthy participants. Vasc Endovascular Surg. 2012;46(4):315-24.

Malagoni AM, Felisatti M, Mandini S. Resting muscle oxygen consumption by near-infrared spectroscopy in peripheral arterial disease: A parameter to be considered in a clinical setting?. Angiology. 2010;61(6):530-6.

Manfredini F, Conconi F, Malagoni AM. Training guided by pain threshold speed: effects of a home-based program on claudication. Int J Angiol. 2004;23(4):379-87.

Manfredini F, Malagoni AM, Mascoli F. Training rather than walking: the test in-train out program for home-based rehabilitation in peripheral arteriopathy. Circ J. 2008;72(6):946-52.

Colier W, Meeuwsen I, Degens H, Oeseburg B. Determination of oxygen consumption in muscle during exercise using near infrared spectroscopy. Acta Anaesthesiol Scand Suppl. 1995;107:151-5.

Comerota AJ, Throm R, Kelly P, Jaff M. Tissue (muscle) oxygen saturation (StO2): a new measure of symptomatic lower-extremity arterial disease. J Vasc Surg. 2003;38(4):724-9.

Ritti-Dias RM, Gobbo LA, Cucato GG. Translation and validation of the walking impairment questionnaire in Brazilian subjects with intermittent claudication. Arq Bras Cardiol. 2009;92(2):136-49.

Souza AC, Magalhães CL, Teixeira-Salmela LF. Adaptação transcultural e análise das propriedades psicométricas da versão brasileira do Perfil de Atividade Humana. Cad Saude Publica. 2006;22(12):2623-36.

Buchalla CM. A classificação internacional de funcionalidade, incapacidade e saúde. Acta Fisiátr.. 2003;10(1):29-31.

Fix AJ, Daughton DM. Human activity profile: professional manual. 1988:25.

Daughton DM, Fix AJ, Kass I, Bell CW, Patil KD. Maximum oxygen consumption and the ADAPT quality-of-life scale. Arch Phys Med Rehabil. 1982;63(12):620-2.

Ferrari M, Muthalib M, Quaresima V. The use of near-infrared spectroscopy in understanding skeletal muscle physiology: recent developments Philos Trans A Math Phys. Eng Sci. 1955;2011(369):4577-90.

Cunha-Filho IT, Pereira DAG, Carvalho AM, Campedeli L, Soares M, Sousa Freitas J. The reliability of walking tests in people with claudication. Am J Phys Med Rehabil. 2007;86(7):574-82.

Monteiro DP, Britto RR, Carvalho MLV, Montemezzo D, Parreira VF, Pereira DAG. Shuttle walking test como instrumento de avaliação da capacidade funcional: uma revisão da literatura. Ciência & Saúde. 2014;7(2):92-7.

Cunha-Filho IT, Pereira DAG, Carvalho AMB, Campedeli L, Soares M, Freitas JS. Confiabilidade de testes de caminhada em pacientes claudicantes: estudo piloto. J Vasc Bras. 2008;7(2):106-11.

Singh SJ, Morgan MD, Scott S, Walters D, Hardman AE. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax. 1992;47(12):1019-24.

Hiatt WR, Rogers RK, Brass EP. The treadmill is a better functional test than the 6-minute walk test in therapeutic trials of patients with peripheral artery disease. Circulation. 2014;130(1):69-78.

McCully KK, Halber C, Posner JD. Exercise-induced changes in oxygen saturation in the calf muscles of elderly subjects with peripheral vascular disease. J Gerontol. 1994;49(3):B128-34.

Ubbink DT, Koopman B. Near-infrared spectroscopy in the routine diagnostic work-up of patients with leg ischaemia. Eur J Vasc Endovasc Surg. 2006;31(4):394-400.

Seifalian AM, Atwal A, White S, Mikhailidis DP, Baker D, Hamilton G. A role for near infrared spectroscopy in the assessment of intermittent claudication. Int Angiol. 2001;20(4):301-6.

McCully KK, Hamaoka T. Near-infrared spectroscopy: what can it tell us about oxygen saturation in skeletal muscle?. Exerc Sport Sci Rev. 2000;28(3):123-7.

Cheatle TR, Potter LA, Cope M, Delpy DT, Smith PD, Scurr JH. Near infrared spectroscopy in peripheral vascular disease. Br J Surg. 1991;78(4):405-8.

Wolf U, Wolf M, Choi JH. Localized irregularities in hemoglobin flow and oxygenation in calf muscle in patients with peripheral vascular disease detected with near-infrared spectrophotometry. J Vasc Surg. 2003;37(5):1017-26.

Kooijman HM, Hopman MT, Colier WN, van der Vliet JA, Oeseburg B. Near infrared spectroscopy for noninvasive assessment of claudication. J Surg Res. 1997;72(1):1-7.

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