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Estimation of the functional role of arterial pathways to the buttock circulation during treadmill walking in patients with claudication

¹Physiologie, Explorations Fonctionnelles Vasculaires et d'Effort; ²Laboratoire de Physiologie, UMR-Centre National de la Recherche Scientifique 6214-Institut National de la Santé et de la Recherche Médicale 771; ³Service de Chirurgie Vasculaire et Thoracique, and ⁴Radiologie C, Centre Hospitalier Universitaire, Angers Cedex 9, France

Submitted 18 August 2006 ; accepted in final form 7 November 2006

The aim of the study was to estimate the functional contribution of the arterial inflow pathways to the pelvic circulation during walking in patients with stage 2 lower extremity arterial disease. Transcutaneous oxygen pressure (Ptc_O2) changes during exercise can be used to estimate the severity of regional blood flow impairment while walking. Seventy patients with stable lower limb claudication were studied using a multivariate linear regression model. The relationship between exercise-induced buttock Ptc_O2 changes, the ipsilateral calf Ptc_O2 changes, and the arterial diameters of the pelvic arteriographic pathways were analyzed. The ipsilateral hypogastric and lumbar pathway, as well as the ipsilateral calf Ptc_O2 changes, were the only variables significantly related to buttock Ptc_O2 changes (r = 0.47; P < 0.001). Their normalized respective contribution to the regressive model was 39%, 19%, and 18%. None of the contralateral hypogastric, mesenteric, and sacral pathways or pathways stemming from the external iliac artery showed significant correlation to buttock Ptc_O2 changes. The ipsilateral hypogastric and ipsilateral lumbar pathways are the major pathways responsible for the functional buttock blood flow supply during walking. The role of contralateral hypogastric, inferior mesenteric, and median sacral pathways and arteries distal to the internal iliac trunk is negligible in the normal or compensatory blood flow supply. Distal Ptc_O2 decrease at exercise aggravates proximal Ptc_O2 decrease, possibly through the occurrence of a "steal phenomenon" of distal over proximal circulation during walking.

peripheral arterial disease; hemodynamic; regional blood flow; exercise; pelvis