# Exercise transcutaneous oxygen pressure measurement: From a small research field to a worldwide community clinical practice

Marjolaine Talbot, Adelaïde Guézais, Guillaume Mahé

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Marjolaine Talbot, Adelaïde Guézais, Guillaume Mahé. Exercise transcutaneous oxygen pressure measurement: From a small research field to a worldwide community clinical practice. Experimental Physiology, 2025, 10.1113/ep092877. hal-05095210

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Submitted on 3 Jun 2025

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Distributed under a Creative Commons Attribution 4.0 International License
# Exercise transcutaneous oxygen pressure measurement: From a small research field to a worldwide community clinical practice

Marjolaine Talbot<fnref n="1" />,<fnref n="2" />

Adelaïde Guézais<fnref n="1" />,<fnref n="2" />

Guillaume Mahé<fnref n="1" />,<fnref n="2" />,<fnref n="3" />

<figure><img src="image_2.png" /></figure>

**Correspondence**

Guillaume MAHE, CHU Rennes, Vascular Medicine Unit, 2 Rue Henri Le Guilloux, 35033 Rennes Cedex, France.

Email: maheguillaume@yahoo.fr

Handling Editor: David Poole

**KEYWORDS**

Oximetry, peripheral artrey disease

Lower extremity peripheral artery disease (PAD) has a global prevalence of more than 200 million patients, of whom approximately half exhibit symptoms of limb discomfort during walking activity. The diagnosis of PAD is based on several means such as ankle-brachial index, Doppler waveforms analysis or toe-brachial index, which are measured at rest (Mahé et al., 2021). In the event of inconclusive results from measurements taken at rest, other means measured during exercise or after exercise may be utilized. Transcutaneous oxygen pressure (TcPO₂) measurement, which was previously used to diagnose critical limb ischaemia, a condition in which patients have insufficient blood supply at rest, is also one of the means that can be used during exercise. Abraham et al. (2003) were the first to propose a novel parameter to detect arterial stenosis of the lower limbs using Exercise-TcPO₂ (Abraham et al., 2003). This parameter is called either the delta from rest oxygen pressure or decrease of rest oxygen pressure (DROP) and has a good sensitivity ranging from 79% to 86% and specificity ranging from 76% to 86% as reported by several teams to detect arterial stenosis >70–75% (Abraham et al., 2003; Mahé et al., 2021; Stivalet et al., 2019). In the present issue of *Experimental Physiology*, the team led by Prof Abraham (France) summarized the development of Exercise-TcPO₂ and the enhancement of the technique since 2003 by analysing their patient database containing more than 9000 patients (Lecoq et al., 2025). Even if the technique

appears promising and quite easy to perform there are still several challenges.

The first one is the absence of commercially available software to calculate the DROPs at each site in real-time. As mentioned in their paper, Lecoq and colleagues use in-house software that analyses the data recorded by Radiometer and Perimed systems, which are approved by the Food and Drug Administration (FDA) and marked by the European Commission (CE). On our side, we are using Oxymonitor software that is also in-house software that we validated and which can be downloaded for free (https://imagemed.univ-rennes1.fr/en/oxymonitor/download) (Mahé et al., 2021; Poulin et al., 2018). Unfortunately, to date, none of this software is FDA approved or CE marked. Thus, we call on manufacturers to develop approved software. Readily available and approved software will help to answer the second challenge.

The second challenge is the inadequate level of attention paid to the technique in the international guidelines (Mahé et al., 2021), despite improvements having been mentioned by Lecoq et al. (2025). The French guidelines only suggest the use of the technique as follows: 'In the event of difficulty in diagnosing or excluding LEAD, we suggest proposing the measurement of Exercise-TcPO₂ in patients with complicated pathological conditions (e.g. diabetes, lumbar spinal canal stenosis) (grade 2+)' (Mahé et al., 2021). There are several explanations

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

© 2025 The Author(s). *Experimental Physiology* published by John Wiley & Sons Ltd on behalf of The Physiological Society.

<footnote n="1">¹CHU Rennes, Vascular Medicine Unit, Rennes, France</footnote>

<footnote n="2">²CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), Rennes, France</footnote>

<footnote n="3">³Univ Rennes, Rennes, France</footnote>
<figure><img src="image_3.png" /><figcaption>**FIGURE 1** Sites which have downloaded the Oxymonitor software.</figcaption></figure>

for this lack of attention. (i) It was thought to be a technique used by
only a few physicians. However, it is clear that the technique has been
spreading for 4–5 years and that the technique is no longer confined to
a small community in the research field (Figure 1). (ii) It was considered
no more informative than post-exercise ankle brachial index which
was cheaper and less time-consuming. Yet, a number of observational
studies have demonstrated the value of post-exercise and Exercise-
TcPO₂ in clinical practice with a possible interest of the combination of
the tests. And (iii) no randomized controlled trial has been performed
to demonstrate the interest of the Exercise-TcPO₂ for PAD patient
management resulting in the absence or low reimbursement of this
technique by the authorities. Indeed, in the section ‘Directions for the
future’, Lecoq et al. raised the questions of which population should
undergo this procedure and whether there is an interest in using
Exercise-TcPO₂ to adapt rehabilitation programmes or estimate the
results of medical or surgical treatments.

Thus, we invite you to read the paper in the present issue of *Experimental Physiology* and contribute to the development of the use of Exercise-TcPO₂ in research on the physiology and vascular medicine fields and finally in clinical practice.

AUTHOR CONTRIBUTIONS

All authors have approved the final version of the manuscript and
agree to be accountable for all aspects of the work in ensuring that
questions related to the accuracy or integrity of any part of the work
are appropriately investigated and resolved. All persons designated as
authors qualify for authorship, and all those who qualify for authorship
are listed.

CONFLICT OF INTEREST

None declared.

FUNDING INFORMATION

No funding was received for this work.

ORCID

Guillaume Mahe https://orcid.org/0000-0003-1318-4745

REFERENCES

Abraham, P., Picquet, J., Vielle, B., Sigaudo-Roussel, D., Paisant-Thouveny, F., Enon, B., & Saumet, J.-L. (2003). Transcutaneous oxygen pressure measurements on the buttocks during exercise to detect proximal arterial ischemia: Comparison with arteriography. *Circulation*, *107*(14), 1896-1900.

Lecoq, S., Hersant, J., Feuilloy, M., Ouedraogo, N., Houle, M., & Abraham, P. (2025). Exercise oximetry in clinical practice: A single-center perspective on procedure and techniques. *Experimental Physiology*, doi: 10.1113/EP092711.

Mahé, G., Boge, G., Bura-Rivière, A., Chakfé, N., Constans, J., Goueffic, Y., Lacroix, P., Le Hello, C., Pernod, G., Perez-Martin, A., Picquet, J., Sprynger, M., & SFMV/SCVE group. & SFMV/SCVE group. (2021). Disparities between international guidelines (AHA/ESC/ESVS/ESVM/SVS) concerning lower extremity arterial disease: Consensus of the French society of vascular medicine (SFMV) and the French Society for Vascular and Endovascular Surgery (SCVE). *Annals of Vascular Surgery*, *72*, 1–56.

Poulin, A., Guilcher, A., Omarjee, L., Jaquinandi, V., Gandon, Y., Mahe, G., & Stivalet, O. (2018). Validation of a software to perform exercise oximetry to diagnose arterial stenosis of the lower limbs. *Atherosclerosis*, *278*, 325–327.
Stivalet, O., Paisant, A., Belabbas, D., Omarjee, L., Le Faucheur, A., Landreau, P., Garlantezec, R., Jaquinandi, V., Liedl, D. A., Wennberg, P. W., & Mahé, G. (2019). Exercise testing criteria to diagnose lower extremity peripheral artery disease assessed by computed-tomography angiography. *PLoS ONE*, 14(6), e0219082.

**How to cite this article:** Talbot, M., Guézais, A., & Mahé, G. (2025). Exercise transcutaneous oxygen pressure measurement: From a small research field to a worldwide community clinical practice. *Experimental Physiology*, 1–3.
https://doi.org/10.1113/EP092877