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Loreaux F, Jéhannin P, Le Pabic E, Paillard F, Le Faucheur A, Mahe G. An unfavorable dietary pattern is associated with symptomatic peripheral artery disease. Nutr Metab Cardiovasc Dis 2024; 34:2173-2181. [PMID: 39003132 DOI: 10.1016/j.numecd.2024.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 04/11/2024] [Accepted: 05/29/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND AND AIMS Diet has an essential role in primary and secondary cardiovascular prevention by modulating various cardiovascular risk factors. The need to have easily useable tools seems essential to facilitate the daily practice of clinicians in order to propose the most optimal management of their patients' diet. The aim of this study was to compare the diet assessed with a simple food frequency questionnaire (FFQ) between patients with symptomatic peripheral artery disease (PAD) and healthy subjects. MATERIALS AND RESULTS In this ancillary study (ELECTRO-PAD study), we included symptomatic PAD patients and healthy participants. All participants filled a FFQ previously validated called Cardiovascular-Dietary-Questionnaire 2 (CDQ-2). CDQ-2 allows the calculation of different scores: global food score, saturated fatty acids score (SFA), unsaturated fatty acids score (UFA), fruit and vegetable score. The higher the score, the better the diet. We compared the different scores between PAD patients and healthy participants. We included 37 PAD patients and 40 healthy subjects. Mean global score was significantly lower in PAD patients compared to the healthy participants (5.35 ± 7.65 vs 10.60 ± 5.81; p = 0.0011). Similarly, the sub-scores concerning unsaturated fatty acids and fruits-vegetables were significantly lower in PAD patients (p < 0.010). Only the sub-score concerning saturated fatty acids was not significantly different (p = 0.8803) between PAD patients and healthy participants. CONCLUSION CDQ-2 highlights that PAD patients have an unfavorable diet compared with healthy participants. CDQ-2 is a tool of interest to help the clinicians for dietary advice of PAD patients.
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Affiliation(s)
| | | | - Estelle Le Pabic
- CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), F-35000 Rennes, France
| | | | | | - Guillaume Mahe
- Vascular Medicine Unit, CHU Rennes, France; CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), F-35000 Rennes, France; Centre de Cardio-prévention, CHU Rennes, France; Univ Rennes 1, Rennes, France.
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2
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Mahé G, Aboyans V, Cosson E, Mohammedi K, Sarlon-Bartoli G, Lanéelle D, Mirault T, Darmon P. Challenges and opportunities in the management of type 2 diabetes in patients with lower extremity peripheral artery disease: a tailored diagnosis and treatment review. Cardiovasc Diabetol 2024; 23:220. [PMID: 38926722 PMCID: PMC11210102 DOI: 10.1186/s12933-024-02325-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
Lower extremity peripheral artery disease (PAD) often results from atherosclerosis, and is highly prevalent in patients with type 2 diabetes mellitus (T2DM). Individuals with T2DM exhibit a more severe manifestation and a more distal distribution of PAD compared to those without diabetes, adding complexity to the therapeutic management of PAD in this particular patient population. Indeed, the management of PAD in patients with T2DM requires a multidisciplinary and individualized approach that addresses both the systemic effects of diabetes and the specific vascular complications of PAD. Hence, cardiovascular prevention is of the utmost importance in patients with T2DM and PAD, and encompasses smoking cessation, a healthy diet, structured exercise, careful foot monitoring, and adherence to routine preventive treatments such as statins, antiplatelet agents, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. It is also recommended to incorporate glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) in the medical management of patients with T2DM and PAD, due to their demonstrated cardiovascular benefits. However, the specific impact of these novel glucose-lowering agents for individuals with PAD remains obscured within the background of cardiovascular outcome trials (CVOTs). In this review article, we distil evidence, through a comprehensive literature search of CVOTs and clinical guidelines, to offer key directions for the optimal medical management of individuals with T2DM and lower extremity PAD in the era of GLP-1RA and SGLT2i.
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Affiliation(s)
- Guillaume Mahé
- Vascular Medicine Unit, University Hospital of Rennes, Rennes, France.
- Clinical Investigation Center, CIC 1414, INSERM, Rennes, France.
- M2S- EA 7470, University of Rennes, Rennes, France.
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Limoges, France
- EpiMaCT, Inserm 1094 & IRD 270, Limoges University, Limoges, France
| | - Emmanuel Cosson
- AP-HP, Avicenne Hospital, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Paris 13 University, Sorbonne Paris Cité, Bobigny, France
- Nutritional Epidemiology Research Unit, UMR U557 INSERM/U11125 INRAE/CNAM, Paris 13 University, Sorbonne Paris Cité, Bobigny, France
| | - Kamel Mohammedi
- Department of Endocrinology, Diabetes, and Nutrition, University Hospital of Bordeaux, Pessac, France
- INSERM, BMC, U1034, University of Bordeaux, Pessac, France
| | - Gabrielle Sarlon-Bartoli
- Vascular Medicine and Hypertension Department, La Timone University Hospital of Marseille, Marseille, France
- Centre for Nutrition and Cardiovascular Disease (C2VN), Faculty of Medicine, Aix-Marseille University, Marseille, France
| | - Damien Lanéelle
- Department of Vascular Medicine, Caen Normandy University Hospital, Caen, France
- COMETE, INSERM, GIP Cyceron, University of Caen Normandy, Caen, France
| | - Tristan Mirault
- Vascular Medicine Department, Hôpital Européen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
- Institut des Sciences Cardiovasculaires, Paris Cardiovascular Research Center, INSERM U970, Université Paris Cité, Paris, France
| | - Patrice Darmon
- Centre for Nutrition and Cardiovascular Disease (C2VN), Faculty of Medicine, Aix-Marseille University, Marseille, France
- Department of Endocrinology, Metabolic Diseases, and Nutrition, Assistance Publique-Hôpitaux de Marseille (AP-HM), University Hospital Conception, Marseille, France
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3
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Zarrintan S, Rahgozar S, Ross EG, Farber A, Menard MT, Conte MS, Malas MB. Endovascular therapy versus bypass for chronic limb-threatening ischemia in a real-world practice. J Vasc Surg 2024:S0741-5214(24)01093-0. [PMID: 38718850 DOI: 10.1016/j.jvs.2024.04.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE The recent Best Endovascular vs Best Surgical Therapy in Patients with Critical Limb Ischemia (BEST-CLI) study showed that bypass was superior to endovascular therapy (ET) in patients with chronic limb-threatening ischemia (CLTI) deemed suitable for either approach who had an available single-segment great saphenous vein (GSV). However, the superiority of bypass among those lacking GSV was not established. We aimed to examine comparative treatment outcomes from a real-world CLTI population using the Vascular Quality Initiative-Medicare-linked database. METHODS We queried the Vascular Quality Initiative-Medicare-linked database for patients with CLTI who underwent first-time lower extremity revascularization (2010-2019). We performed two one-to-one propensity score matchings (PSMs): ET vs bypass with GSV (BWGSV) and ET vs bypass with a prosthetic graft (BWPG). The primary outcome was amputation-free survival. Secondary outcomes were freedom from amputation and overall survival (OS). RESULTS Three cohorts were queried: BWGSV (N = 5279, 14.7%), BWPG (N = 2778, 7.7%), and ET (N = 27,977, 77.6%). PSM produced two sets of well-matched cohorts: 4705 pairs of ET vs BWGSV and 2583 pairs of ET vs BWPG. In the matched cohorts of ET vs BWGSV, ET was associated with greater hazards of death (hazard ratio [HR] = 1.34, 95% confidence interval [CI], 1.25-1.43; P < .001), amputation (HR = 1.30, 95% CI, 1.17-1.44; P < .001), and amputation/death (HR = 1.32, 95% CI, 1.24-1.40; P < .001) up to 4 years. In the matched cohorts of ET vs BWPG, ET was associated with greater hazards of death up to 2 years (HR = 1.11, 95% CI, 1.00-1.22; P = .042) but not amputation or amputation/death. CONCLUSIONS In this real-world multi-institutional Medicare-linked PSM analysis, we found that BWGSV is superior to ET in terms of OS, freedom from amputation, and amputation-free survival up to 4 years. Moreover, BWPG was superior to ET in terms of OS up to 2 years. Our study confirms the superiority of BWGSV to ET as observed in the BEST-CLI trial.
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Affiliation(s)
- Sina Zarrintan
- Department of Surgery, Division of Vascular & Endovascular Surgery, University of California San Diego (UCSD), San Diego, CA
| | - Shima Rahgozar
- Department of Surgery, Division of Vascular & Endovascular Surgery, University of California San Diego (UCSD), San Diego, CA
| | - Elsie G Ross
- Department of Surgery, Division of Vascular & Endovascular Surgery, University of California San Diego (UCSD), San Diego, CA
| | - Alik Farber
- Department of Surgery, Division of Vascular & Endovascular Surgery, Boston University School of Medicine, Boston, MA
| | - Matthew T Menard
- Department of Surgery, Division of Vascular & Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michael S Conte
- Department of Surgery, Division of Vascular & Endovascular Surgery, University of California San Francisco (UCSF), San Francisco, CA
| | - Mahmoud B Malas
- Department of Surgery, Division of Vascular & Endovascular Surgery, University of California San Diego (UCSD), San Diego, CA.
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Dumas G, Danjou A, Richaud C, Spear R, Joly M, Blaise S. Feasibility of performing treadmill walking test for patients with peripheral arterial occlusive disease by the advanced practice nurses. JOURNAL DE MEDECINE VASCULAIRE 2024; 49:90-97. [PMID: 38697715 DOI: 10.1016/j.jdmv.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/22/2024] [Indexed: 05/05/2024]
Abstract
AIM The treadmill walking test with post-exercise pressure measurement can be used as a diagnostic test and could classify peripheral arterial disease of the lower limbs. It can also exclude the diagnosis allowing to raise the possibility of differential diagnoses. In this study, we assessed the feasibility of performing treadmill test by advanced practice nurse to assess suspected lower extremity peripheral artery disease patients. DESIGN AND METHOD This is a longitudinal monocentric study to assess the feasibility of a treadmill walking test performed by an advanced practice nurse. The primary endpoint was the number of tests performed during this period. The secondary objectives were to evaluate the reasons for requesting the test, the main results obtained in terms of the test's contribution and diagnoses, and patients' clinical characteristics. RESULTS From February to May 2023, amongst 31 patients who underwent the treadmill walking test, 4 tests were able to rule out peripheral arterial disease and to detect differential diagnoses. For the remaining 27 patients, 4 had stage IIa of the Leriche classification, 23 had stage IIb, 2 of which were associated with a narrow lumbar spine. In contrast to the usual report, the APN's report on the walking test included an identification of cardiovascular risk factors, as well as a possible medical reorientation linked to the correction of a detected cardiovascular risk factor. CONCLUSION The treadmill walking test can be performed by an advanced practice nurse. He/She added a comprehensive/global patient management, with the detection of cardiovascular risk factors. This new profession led to an increase in the number of tests performed of more than 50% over the period and reduced the time to access the test.
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Affiliation(s)
- G Dumas
- Service de Médecine Vasculaire, department of Vascular Medicine, Grenoble University Hospital, BP 217, 38043 Grenoble cedex 09, France
| | - A Danjou
- Grenoble Alpes Data Institute, TIMC, UMR 5525 CNRS, University Grenoble Alpes, Grenoble, France; IFSI, CHU de Grenoble Alpes, CS10217, 38043 Grenoble cedex 9, France
| | - C Richaud
- Service de Médecine Vasculaire, department of Vascular Medicine, Grenoble University Hospital, BP 217, 38043 Grenoble cedex 09, France
| | - R Spear
- Service de Chirurgie Vasculaire, department of Vascular Surgery, Grenoble University Hospital, BP 217, 38043 Grenoble cedex 09, France
| | - M Joly
- Service de Médecine Vasculaire, department of Vascular Medicine, Grenoble University Hospital, BP 217, 38043 Grenoble cedex 09, France
| | - S Blaise
- Service de Médecine Vasculaire, department of Vascular Medicine, Grenoble University Hospital, BP 217, 38043 Grenoble cedex 09, France; Inserm U1300, HP2, University Grenoble Alpes, Grenoble, France.
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5
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Trihan JE, Croquette M, Hersant J, Prigent R, Fontaine C, Henni S, Lanéelle D. Accuracy of maximal acceleration time of pedal arteries to diagnose critical limb-threatening ischemia. Vasc Med 2024; 29:153-162. [PMID: 38469710 DOI: 10.1177/1358863x231226216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Maximal acceleration time of distal arteries of the foot (ATmax) is correlated to ankle-brachial index (ABI) and toe-brachial index (TBI), and seems very promising in diagnosing severe peripheral artery disease (PAD) and especially critical limb-threatening ischemia (CLTI). Our goal was to confirm the cut-off value of 215 ms to predict a toe pressure (TP) ⩽ 30 mmHg. METHODS A 4-month retrospective study was conducted on patients addressed for suspicion of PAD. Demographic data, ABI, TBI, and Doppler ultrasound scanning parameters of the dorsal pedis and lateral plantar arteries (DPA and LPA) were recorded. RESULTS A total of 137 patients with 258 lower limbs were included. ATmax was highly correlated to TBI (r = -0.89, p < 0.001). With the cut-off value of 215 ms, ATmax was effective to diagnose TP ⩽ 30 mmHg with a sensitivity of 93% [95% CI 77-99], a specificity of 96% [95% CI 92-98], a positive predictive value of 73% [95% CI 56-86], a negative predictive value of 99% [95% CI 97-100], and an area under the receiver operating characteristics curve of 0.99 [95% CI 0.98-1.00]. ATmax also showed promising results to rule out PAD in healthy patients. CONCLUSION ATmax is a reliable diagnostic tool to diagnose low TP and could be a new easily performed hemodynamic criterion for diagnosis of CLTI.
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Affiliation(s)
- Jean-Eudes Trihan
- Vascular Medicine Unit, Hospital of Cholet, Cholet, Pays de la Loire, France
- Vascular Medicine Department, University Hospital Angers, Angers, Pays de la Loire, France
| | - Magali Croquette
- Vascular Medicine Unit, University Hospital Centre Poitiers, Poitiers, Nouvelle-Aquitaine, France
| | - Jeanne Hersant
- Vascular Medicine Department, University Hospital Angers, Angers, Pays de la Loire, France
- UMR CNRS 1083, INSERM 6015, LUNAM University, Angers, France
| | - Romain Prigent
- Vascular Medicine Unit, Hospital of Cholet, Cholet, Pays de la Loire, France
| | - Cedric Fontaine
- Vascular Medicine Unit, Hospital of Cholet, Cholet, Pays de la Loire, France
| | - Samir Henni
- Vascular Medicine Department, University Hospital Angers, Angers, Pays de la Loire, France
- UMR CNRS 1083, INSERM 6015, LUNAM University, Angers, France
| | - Damien Lanéelle
- Vascular Medicine Unit, University Hospital Côte de Nacre, Caen, Normandie, France
- UNICAEN, INSERM 1075, COMETE, Caen, Normandie, France
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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. Update About the Management of Low-Density Lipoprotein Cholesterol and Hypertriglyceridemia in Lower Extremity Peripheral Artery Disease Patients: Consensus of the French Society of Vascular Medicine and the French Society for Vascular and Endovascular Surgery. Ann Vasc Surg 2024; 100:148-154. [PMID: 37806655 DOI: 10.1016/j.avsg.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND A French intersociety consensus on behalf the Société Française de Médecine Vasculaire and the Société de Chirurgie Vasculaire et Endovasculaire was proposed in 2021 for the management of patients with lower extremity peripheral artery disease (LEAD). Recent studies have been published and an update of this consensus about the management of low-density lipoprotein cholesterol (LDLc) and hypertriglyceridemia was required. METHODS A steering committee of 12 vascular physicians and surgeons defined questions of interest about LDLc and hypertriglyceridemia management. A French expert panel voted the proposals. Consensus was considered to have been achieved if more than 80% of the responses corresponded to either "Agreement" or "Disagreement". RESULTS Among the 56 experts who were asked to participate, 46 (82%) accepted. After the first round of the Delphi procedure, the 4 proposals reached consensus. The following suggestions and recommendations were approved: 1. For LEAD patients treated by the highest tolerated statin dose ± ezetimibe and who have an LDLc ≥0.70 g/L, we recommend adding a proprotein convertase subtilisin/kexin type 9 inhibitor. 2. For LEAD patients treated by statin and who have elevated triglyceride level between ≥150 mg/dL and ≤500 mg/dL, we suggest adding Icosapent Ethyl. 3. Before adding Icosapent Ethyl in LEAD patients treated with statin, we suggest looking for symptoms that may suggest atrial fibrillation. 4. For LEAD patients treated by Icosapent Ethyl and who have symptoms that suggest atrial fibrillation, we recommend performing an electrocardiogram. CONCLUSIONS This update will help clinicians to improve LEAD patient management.
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Affiliation(s)
- Guillaume Mahé
- Vascular Medicine Department, Radiology and Medical Imaging Department, Rennes University Hospital Centre, Rennes, France.
| | - Gudrun Boge
- Vascular Medicine Department, Montpellier University Hospital Centre, Montpellier, France
| | - Alessandra Bura-Rivière
- Vascular Medicine Department, Toulouse University Hospital Centre, Rangueil Hospital, Toulouse, France
| | - Nabil Chakfé
- Vascular Surgery and Kidney Transplantation Department, Strasbourg University Hospital Centre, Strasbourg, France
| | - Joël Constans
- Vascular Medicine Department, Bordeaux University Hospital Centre, Saint André Hospital, Bordeaux, France
| | - Yann Goueffic
- Vascular Surgery Department, Saint-Joseph Paris Hospital Group, Paris, France
| | - Philippe Lacroix
- Vascular Medicine Department, Limoges University Hospital Centre, Limoges, France
| | - Claire Le Hello
- Vascular Medicine Department, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Gilles Pernod
- Vascular Medicine Department, Grenoble University Hospital Centre, Grenoble, France
| | - Antonia Perez-Martin
- Vascular Investigation and Vascular Medicine Department, Nimes University Hospital Centre, Nimes, France
| | - Jean Picquet
- Vascular and Thoracic Surgery Department, Angers University Hospital Centre, Angers, France
| | - Muriel Sprynger
- Cardiology Department, Sart Tilman University Hospital Centre, Liège, Belgium
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Tueguem Moyo T, Jéhannin P, Le Pabic E, Le Faucheur A, Omarjee L, Mahe G. Test-retest Reliability and Minimal Detectable Change in Exercise Oximetry in Claudicants. Ann Vasc Surg 2024; 99:19-25. [PMID: 37922963 DOI: 10.1016/j.avsg.2023.09.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Exercise transcutaneous oxygen pressure measurement (Exercise-TcPO2) can be used to diagnose Lower Extremity Artery Disease (LEAD) and allows the quantification of limb ischemia during exercise on treadmill. Exercise-TcPO2 test-retest reliability in patients with LEAD and severe walking impairment is unknown. The aim of this study was to evaluate the test-retest reliability, standard error of measurement (SEM), and Minimal Detectable Change (MDC) of exercise-TcPO2 in patients with claudication. METHODS Data were collected from patients that performed 2 treadmill tests within a 1-month interval. Delta from Rest of Oxygen Pressure (DROP) values were measured at both buttocks (proximal) and both calves (distal). Test-retest reproducibility was assessed by recording transcutaneous oximetry measurements twice and expressed as SEM and intra-class correlation coefficients. MDC was calculated using the formula MDC = SEM x 1.96 x √ 2. RESULTS Twenty eight LEAD patients (61 ± 9 years old) were included. Intra-class correlation coefficients were 0.66 [0.50, 0.79] and 0.65 [0.49, 0.79] for the proximal and distal levels, respectively. The SEM of DROP at the proximal and distal levels were 7 [6, 9] mm Hg and 9 [8, 11] mm Hg, respectively. The SEM for all (proximal and distal) DROP values was 8 [7, 10] mm Hg and the MDC of DROP was 23 mm Hg. CONCLUSIONS Exercise-TcPO2 with measurement of DROP values has a moderate test-retest reliability in LEAD patients with a maximal walking distance ≤ 300m. For an individual, an improvement or deterioration in DROP of ≥ 23 mm Hg after an intervention would be required to be 95% confident that the change is significant. It should be considered in evaluating the impact of treatment in patients with claudication.
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Affiliation(s)
| | - Pierre Jéhannin
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Estelle Le Pabic
- CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), Rennes, France
| | | | - Loukman Omarjee
- Vascular Medicine Unit, University Hospital, Rennes, France; CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), Rennes, France; Vascular Medicine Unit, Hospital, Redon, France; Inserm UMR 1241, Numecan Institute, Express Team, Univ Rennes, Rennes, France
| | - Guillaume Mahe
- Vascular Medicine Unit, University Hospital, Rennes, France; Univ Rennes, M2S - EA 7470, Rennes, France; CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), Rennes, France; Faculty of Medicine, Univ Rennes, Rennes, France.
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8
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Pan D, Guo J, Su Z, Meng W, Wang C, Guo J, Gu Y. Safety and Efficacy of Excimer Laser Atherectomy Combined with a Drug-Coated Balloon in De Novo Femoral Popliteal Artery Disease: A Retrospective Study. Ann Vasc Surg 2024; 99:26-32. [PMID: 37914073 DOI: 10.1016/j.avsg.2023.09.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/10/2023] [Accepted: 09/05/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND The effectiveness of excimer laser atherectomy (ELA) combined with drug-coated balloon (DCB) for de novo femoropopliteal artery disease (FPAD) is currently unknown. This case series evaluated the clinical outcomes of ELA combined with DCB in de novo FPAD from a real-world clinical perspective. METHODS We conducted a retrospective study of patients treated with ELA + DCB for de novo FPAD between November 2016 and January 2020. The primary efficacy endpoint was the initial patency rate; secondary endpoints included target lesion revascularization without clinically driven target lesion revascularization (CD-TLR) and technical success. Primary safety endpoints included all-cause death, unplanned major amputation, and postoperative complications. RESULTS The mean follow-up was 37.8 ± 25.3 months and included 56 consecutive patients (68.23 ± 8.01 years, 41 men). Forty-three patients had lifestyle-restricted claudication, and 13 patients had critical limb-threatening ischemia. The mean length of the lesion was 178.41 mm in all patients. The total lesion occlusion rate was 48.2 (n = 27), and the overall technical success rate was 100%. The 12-month, 24-month, 36-month, and 48-month primary patency rates of the ELA + DCB group were 75%, 66.1%, 58.9%, and 42.8%, respectively. Freedom from CD-TLR at 12, 24, 36, and 48 months was 83.9%, 80.3%, 76.8%, and 57.1%, respectively. CONCLUSIONS In real-world clinical practice, ELA + DCB appears to be a safe and effective endovascular treatment for de novo FPAD, with a low rate of freedom from CD-TLR and a good patency rate.
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Affiliation(s)
- Dikang Pan
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Julong Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhixiang Su
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenzhuo Meng
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Cong Wang
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianming Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Nordanstig J, Behrendt CA, Baumgartner I, Belch J, Bäck M, Fitridge R, Hinchliffe R, Lejay A, Mills JL, Rother U, Sigvant B, Spanos K, Szeberin Z, van de Water W, Antoniou GA, Björck M, Gonçalves FB, Coscas R, Dias NV, Van Herzeele I, Lepidi S, Mees BME, Resch TA, Ricco JB, Trimarchi S, Twine CP, Tulamo R, Wanhainen A, Boyle JR, Brodmann M, Dardik A, Dick F, Goëffic Y, Holden A, Kakkos SK, Kolh P, McDermott MM. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication. Eur J Vasc Endovasc Surg 2024; 67:9-96. [PMID: 37949800 DOI: 10.1016/j.ejvs.2023.08.067] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 11/12/2023]
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10
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Blaise S, Sinniger V, Seinturier C. Literature review of transcutaneous electrical nerve stimulation in peripheral arterial occlusive disease of the lower limbs. JOURNAL DE MEDECINE VASCULAIRE 2023; 48:116-123. [PMID: 37914456 DOI: 10.1016/j.jdmv.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/20/2023] [Indexed: 11/03/2023]
Abstract
The therapeutic challenge in peripheral arterial occlusive disease (PAD) is often to increase walking distance, improve pain or heal a wound when PAD is symptomatic. Walking rehabilitation or surgical revascularization techniques are limited. Others strategies as alternatives and/or complementary treatments are needed. Among alternative options, Transcutaneous Electrical Nerve Stimulations (TENS) could be of interest, both for improved walking distance or pain reduction. The Transcutaneous Electrical Nerve Stimulation (TENS) is a non-pharmacological, mini-invasive technique involving transcutaneous electrical stimulation. However, there are other transcutaneous electrical nerve stimulation techniques based on the principle of vagus nerve stimulation with different mechanistics. Trans-auricular Vagus nerve stimulation (Ta-VNS) is another TENS technique (electrode on the external ear) which relies on the anti-inflammatory pathways of efferent and afferent vagal fibers. We propose here to review the literature of mini-invasive electrical stimulations, whatever the anatomical zone concerned, in PAD. METHOD The aim was to evaluate the use of non-invasive transcutaneous electrical stimulation therapies (regardless of location) in PAD of the lower limbs, whatever the disease grade. A review of the literature was carried out via a search of the MEDLINE/PubMed database from 1975 to 2023. The articles were selected via abstracts by checking (1) medical indications: PAD patients with claudication were retained, excluding neurological or venous claudication, PAD whatever the disease grade (intermittent claudication or critical limb ischemia [CLI]) and (2) non invasive electrical stimulations were considered (neuromuscular electrical stimulation and spinal cord stimulation were excluded) whatever the anatomical site. Non-electrical stimuli such as acupuncture and reflexotherapy were excluded. RESULTS Only 9 items were selected, including 7 studies with TENS treatment on the calf, one with trans-auricular vagus nerve stimulation and one with electro-acupuncture points of stimulation. CONCLUSION Even if the mechanisms involved are different, TENS on the calves or in the external ears show an improvement of walking distance in PAD patients with intermittent claudication. The results of the studies show few positive effects in arteriopathy but we should keep vigilant in the technics used since mechanisms are different and not fully understood. Electro-stimulation of the calf and external ear appears to be an easy-to-use and accessible therapeutic option, especially since some PAD patients are still failing to be released from pain, despite the rise of endovascular interventional techniques.
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Affiliation(s)
- S Blaise
- Service de médecine vasculaire, Grenoble University Hospital, BP 217, 38043 Grenoble Cedex 09, France; Université de Grenoble Alpes, Inserm U1300, HP2, Grenoble, France.
| | - V Sinniger
- Université de Grenoble Alpes, U1216, Grenoble Institut des Neurosciences, CHU deGrenoble Alpes, 38000 Grenoble, France
| | - C Seinturier
- Service de médecine vasculaire, Grenoble University Hospital, BP 217, 38043 Grenoble Cedex 09, France
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11
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Avina-Bravo EG, Sodre Ferreira de Sousa FA, Escriba C, Acco P, Giraud F, Fourniols JY, Soto-Romero G. Design and Validity of a Smart Healthcare and Control System for Electric Bikes. SENSORS (BASEL, SWITZERLAND) 2023; 23:4079. [PMID: 37112419 PMCID: PMC10146227 DOI: 10.3390/s23084079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/26/2023] [Accepted: 04/14/2023] [Indexed: 06/19/2023]
Abstract
This paper presents the development of an electronic system that converts an electrically assisted bicycle into an intelligent health monitoring system, allowing people who are not athletic or who have a history of health issues to progressively start the physical activity by following a medical protocol (e.g., max heart rate and power output, training time). The developed system aims to monitor the health state of the rider, analyze data in real-time, and provide electric assistance, thus diminishing muscular exertion. Furthermore, such a system can recover the same physiological data used in medical centers and program it into the e-bike to track the patient's health. System validation is conducted by replicating a standard medical protocol used in physiotherapy centers and hospitals, typically conducted in indoor conditions. However, the presented work differentiates itself by implementing this protocol in outdoor environments, which is impossible with the equipment used in medical centers. The experimental results show that the developed electronic prototypes and the algorithm effectively monitored the subject's physiological condition. Moreover, when necessary, the system can change the training load and help the subject remain in their prescribed cardiac zone. This system allows whoever needs to follow a rehabilitation program to do so not only in their physician's office, but whenever they want, including while commuting.
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Affiliation(s)
- Eli Gabriel Avina-Bravo
- Laboratory for Analysis and Architecture of Systems (LAAS-CNRS), University of Toulouse, 31077 Toulouse, France
- TNP Consulting, 92200 Neuilly sur-Seine, France
| | | | - Christophe Escriba
- Laboratory for Analysis and Architecture of Systems (LAAS-CNRS), University of Toulouse, 31077 Toulouse, France
| | - Pascal Acco
- Laboratory for Analysis and Architecture of Systems (LAAS-CNRS), University of Toulouse, 31077 Toulouse, France
| | | | - Jean-Yves Fourniols
- Laboratory for Analysis and Architecture of Systems (LAAS-CNRS), University of Toulouse, 31077 Toulouse, France
| | - Georges Soto-Romero
- Laboratory for Analysis and Architecture of Systems (LAAS-CNRS), University of Toulouse, 31077 Toulouse, France
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12
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Tollenaere Q, Métairie A, Le Pabic E, Le Faucheur A, Mahé G. Use of the Walking Impairment Questionnaire and Walking Estimated-Limitation Calculated by History questionnaire to detect maximal walking distance equal to or lower than 250 m in patients with lower extremity arterial disease. Front Cardiovasc Med 2023; 10:968213. [PMID: 37025694 PMCID: PMC10072320 DOI: 10.3389/fcvm.2023.968213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 02/06/2023] [Indexed: 04/08/2023] Open
Abstract
Objective The objective was to assess the accuracy and optimal threshold of the Walking Impairment Questionnaire (WIQ) and the Walking Estimated-Limitation Calculated by History (WELCH) questionnaire in identifying patients with a maximal walking distance (MWD) below or equal to 250 m. Methods This retrospective study screened 388 consecutive patients with suspected symptomatic lower extremity arterial disease (LEAD). Collected data included the patient's history, resting ankle-brachial index, WIQ, and WELCH. MWD was assessed with a treadmill test at 2 mph (3.2 km/h) with a 10% grade. An optimized threshold for detection of MWD ≤ 250 m was determined for each questionnaire via receiver operating characteristic (ROC) curves. Subsequently, multivariate analysis was performed to build a new simple score to detect MWD ≤ 250 m. Results The study included 297 patients (63 ± 10 years old). With a threshold of ≤ 64%, the WIQ predicted MWD ≤ 250 m with an accuracy of 71.4% (66.2, 76.5%). With a threshold of ≤ 22, the WELCH predicted a treadmill walking distance of ≤ 250 m with an accuracy of 68.7% (63.4, 74.0%). A new score with only four "yes or no" questions had an accuracy of 71.4% (66.3, 76.6%). Items on this new score consisted of the level of difficulty of walking 1 block, declared maximum walking distance, usual walking speed, and maximum duration of slow walking. Conclusion A WIQ score ≤ 64% and a WELCH score ≤ 22 help to predict a walking distance of ≤ 250 m in a treadmill test at 2 mph (3.2 km/h) with a 10% grade. A 4-item score could be used for rapid evaluation of walking distance among patients with LEAD, but the validity of this 4-item score requires further confirmation studies.
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Affiliation(s)
- Quentin Tollenaere
- Vascular Medicine Unit, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Antoine Métairie
- Vascular Medicine Unit, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Estelle Le Pabic
- CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), Rennes, France
| | | | - Guillaume Mahé
- Vascular Medicine Unit, Centre Hospitalier Universitaire de Rennes, Rennes, France
- Univ Rennes, M2S – EA 7470, Rennes, France
- *Correspondence: Guillaume Mahé
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13
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Le Faucheur A, Jéhannin P, Chanteau A, Blanc-Petitjean P, Donnelly A, Hoffmann C, Henni S, Bura-Rivière A, Kaladji A, Lanéelle D, Mahé G. A Multicenter, Investigator-Blinded, Randomized Controlled Trial to Assess the Efficacy of Calf Neuromuscular Electrical Stimulation Program on Walking Performance in Peripheral Artery Disease: The ELECTRO-PAD Study Protocol. J Clin Med 2022; 11:jcm11247261. [PMID: 36555879 PMCID: PMC9784261 DOI: 10.3390/jcm11247261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
This paper describes a currently on-going multicenter, randomized controlled trial designed to assess the efficacy of calf neuromuscular electrical stimulation (NMES) on changes in maximal walking distance in people with lower extremity peripheral artery disease (PAD), compared with a non-intervention control-group. This study (NCT03795103) encompasses five participating centers in France. PAD participants with a predominant claudication at the calf level and a maximal treadmill walking distance ≤300 m are randomized into one of the two groups: NMES group or Control group. The NMES program consists of a 12-week program of electrical stimulations at the calf-muscle level. The primary outcome of the study is the change in maximal treadmill walking distance at 12 weeks. Main secondary outcomes include changes in the pain-free treadmill walking distance; 6 min total walking distance; global positioning system (GPS)-measured outdoor walking capacity; daily physical activity level by accelerometry; self-reported walking impairment; self-reported quality of life; ankle-brachial index; and skin microvascular function, both at the forearm and calf levels. Recruitment started in September 2019 and data collection is expected to end in November 2022.
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Affiliation(s)
- Alexis Le Faucheur
- Clinical Investigation Center, INSERM, CIC 1414, F-35033 Rennes, France
- Univ. Rennes, M2S—EA 7470, F-35000 Rennes, France
| | - Pierre Jéhannin
- Clinical Investigation Center, INSERM, CIC 1414, F-35033 Rennes, France
- Univ. Rennes, F-35000 Rennes, France
| | | | | | - Alan Donnelly
- PESS Department, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | | | - Samir Henni
- Vascular Medicine Department, CHU Angers, F-49000 Angers, France
- UMR CNRS 6015, INSERM 1083, Univ. Angers, F-49000 Angers, France
| | | | - Adrien Kaladji
- Vascular Surgery Unit, CHU Rennes, University Hospital, F-35033 Rennes, France
| | - Damien Lanéelle
- Vascular Medicine Unit, CHU Caen-Normandie, University Hospital, F-14033 Caen, France
| | - Guillaume Mahé
- Clinical Investigation Center, INSERM, CIC 1414, F-35033 Rennes, France
- Univ. Rennes, M2S—EA 7470, F-35000 Rennes, France
- Univ. Rennes, F-35000 Rennes, France
- Vascular Medicine Unit, CHU Rennes, University Hospital, F-35033 Rennes, France
- Correspondence: ; Tel.: +33-299-289-672
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14
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Zhao R, Zheng H, Wang W, Du Y, Tong Y, Mahé G, Wen C. Phasicity and resistance of the arterial spectral Doppler waveform in a canine femoral focal artery stenosis model. Vasc Med 2022; 27:542-550. [PMID: 36000474 DOI: 10.1177/1358863x221117608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION This study aims to evaluate changes in the arterial spectral Doppler waveform in a canine artery stenosis model. METHODS Canine femoral artery stenosis models were established in 12 beagle dogs. Doppler waveforms were recorded in the femoral artery preoperatively and postoperatively in the femoral artery and at the ankle after formation of a 50%, 70%, and 90% stenosis or occlusion. Major descriptors for arterial Doppler waveform were used to analyse waveforms. RESULTS The proportion of multiphasic waveforms proximal to a moderate stenosis decreased compared to normal baseline, although the difference was not statistically significant, whereas the decreases at the stenosis, distal to the stenosis, and at the ankle were significant (p < 0.05). The decreases in arteries with a more severe stenosis or occlusion were significant at all locations (p < 0.05). The proportion of high resistive waveforms decreased significantly at the ankle in the arteries with a moderate stenosis (50%) (p = 0.002), but the decreases proximal to, at, and distal to the stenosis were not significant. The decreases were significant at all locations in the arteries with a more severe stenosis (p < 0.05). The decrease was significant at the ankle in the arteries with an occlusion (p < 0.001) but not significant pre, at, and post an occlusion. CONCLUSIONS Phasicity and resistance of Doppler waveforms alter in canine femoral arteries with a stenosis. Phasicity change seems more sensitive in response to an arterial stenosis than resistance change. Additional information on arterial resistance could be obtained using end-diastolic ratios, resistive indices, and potentially end-systolic notch velocity measurements.
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Affiliation(s)
- Rui Zhao
- Department of Ultrasound, Peking University International Hospital, Beijing, China
| | - Haining Zheng
- Department of Ultrasound, Peking University International Hospital, Beijing, China
| | - Wei Wang
- Department of Ultrasound, the Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Yigang Du
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Yisha Tong
- Department of Vascular Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia
| | - Guillaume Mahé
- Vascular Medicine Department, Centre Hospitalier Universitaire (CHU) de Rennes, Rennes, France.,INSERM CIC1414 CIC Rennes, Rennes, France.,Université de Rennes 2, M2S-EA 7470, Rennes, France
| | - Chaoyang Wen
- Department of Ultrasound, Peking University International Hospital, Beijing, China
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15
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Métairie A, Tollenaere Q, Lanéelle D, Le Faucheur A, Le Pabic E, Omarjee L, Mahé G. Simplification of ankle-brachial-index measurement using Doppler-waveform classification in symptomatic patients suspected of lower extremity artery disease. Front Cardiovasc Med 2022; 9:941600. [PMID: 36158813 PMCID: PMC9500167 DOI: 10.3389/fcvm.2022.941600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Ankle-brachial index (ABI) is commonly used for screening lower extremity peripheral artery disease (PAD) according to the international guidelines. Arterial Doppler waveform recordings is a tool to diagnose and assess PAD severity. We hypothesized that ABI measurement could be simplified by measuring only the pressure where the best arterial flow is recorded. The aim of this study was to evaluate the concordance between ABI performed according to the American Heart Association guidelines (AHA-ABI) and ABI measured according to best arterial waveform (FLOW-ABI). Design This was a monocentric cross-sectional study. Methods We included patients with exertional limb symptoms suspected of PAD. Arterial Doppler waveforms and ABI were acquired on both lower extremities at the pedis and tibial posterior arteries. Each arterial waveform was classified using the Saint-Bonnet classification. Concordances were analyzed with the kappa coefficient (confidence interval 95%). Exercise PAD study was registered n° NCT03186391. Results In total, one hundred and eighty-eight patients (62+/−12 years and 26.8+/−4.5 kg/m2) with exertional limb symptoms were included from May 2016 to June 2019. On each extremity, FLOW-ABI had excellent concordance for the diagnosis of PAD with the AHA-ABI with a kappa of 0.95 (95% CI: 0.90, 0.99) in the right extremity and 0.91 (95% CI: 0.86, 0.97) in the left extremity. Conclusion There is almost perfect concordance between AHA-ABI and FLOW-ABI. Thus, ABI can be simplified into five pressure measurements instead of seven in patient suspected of PAD with exertional limb symptoms. The question remains in patients with chronic limb ischemia.
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Affiliation(s)
| | | | | | | | - Estelle Le Pabic
- CHU Rennes, Inserm, Clinical Investigation Center (CIC), Rennes, France
| | | | - Guillaume Mahé
- Vascular Medicine Unit, CHU Rennes, Rennes, France
- University of Rennes, Rennes, France
- CHU Rennes, Inserm, Clinical Investigation Center (CIC), Rennes, France
- Pôle Imagerie Médicale et Explorations Fonctionnelles, Hôpital Pontchaillou, Rennes, France
- *Correspondence: Guillaume Mahé
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16
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Catella J, Della Schiava N, Calanca L, Steinmetz E, Millon A, Mahé G, Long A, Mazzolai L. Real-world practices of TcPO 2 measurements: A French national survey. Vasc Med 2022; 27:377-379. [DOI: 10.1177/1358863x221094080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Judith Catella
- Department of Internal Medicine, Division of Vascular Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Laboratoire d’Excellence du Globule Rouge (Labex GR-Ex), Paris, France
- Interuniversity Laboratory of Human Movement Biology, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Laboratory of Tissue Biology and Therapeutic Engineering, CNRS/Université Claude Bernard Lyon 1, Institut de Biologie et Chimie des Protéines, Lyon, France
| | - Nellie Della Schiava
- Department of Vascular and Endovascular Surgery, Groupement Hospitalier Est, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
- Laboratory of Electrical Engineering and Ferroelectricity, Institut National des Sciences Appliquées Lyon, Villeurbanne, France
| | - Luca Calanca
- Department of Angiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Eric Steinmetz
- Department of Vascular Surgery, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Antoine Millon
- Department of Vascular and Endovascular Surgery, Groupement Hospitalier Est, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
- Laboratoire CarMeN, INSERM U1060, Université Claude Bernard Lyon 1, Bron, France
| | - Guillaume Mahé
- Department of Vascular Medicine, CHU de Rennes, Rennes, France
- INSERM CIC 1414, Université de Rennes 1, Rennes, France
| | - Anne Long
- Department of Internal Medicine, Division of Vascular Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Interuniversity Laboratory of Human Movement Biology, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Lucia Mazzolai
- Department of Angiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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17
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Trihan JE, Mahé G, Croquette M, Coutant V, Thollot C, Guillaumat J, Lanéelle D. Accuracy of Acceleration Time of Distal Arteries to Diagnose Severe Peripheral Arterial Disease. Front Cardiovasc Med 2022; 8:744354. [PMID: 35127845 PMCID: PMC8810631 DOI: 10.3389/fcvm.2021.744354] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/15/2021] [Indexed: 01/22/2023] Open
Abstract
ContextAnkle-brachial index (ABI) and toe-brachial index (TBI) are the recommended tests for the diagnosis of lower extremity peripheral artery disease (PAD) and the assessment of its severity, whereas Doppler ultrasound (DUS) is usually used to localize vascular lesions. However, the performance of DUS as an alternative to TBI and ABI measurement is unknown.ObjectiveThe goals were (i) to evaluate the correlation between DUS parameters of distal arteries of the lower extremities with TBI in patients with PAD; (ii) to evaluate the correlation between DUS parameters of distal arteries with ABI; and (iii) to assess the diagnostic accuracy of maximal acceleration time of pedal arteries to detect toe pressure ≤30 mmHg.MethodsAn observational retrospective study was conducted for 1 year on patients with the diagnosis of PAD on DUS. Demographic data, ABI, TBI, and DUS parameters of the dorsal pedis and lateral plantar arteries (DPA and LPA) were recorded.ResultsSeventy-seven patients with 88 limbs were included, aged 69 [interquartile range: 11 years] with 28.6% of diabetic patients. The highest acceleration time of either DPA or LPA (ATmax) was the most correlated to TBI on both univariate (r = −0.78, p < 0.0001) and multivariate analysis (p < 0.0001). DUS parameters had a weaker correlation with ABI. ATmax > 215 ms showed high diagnosis accuracy to a toe pressure of 30 mmHg or less [sensitivity of 86% [0.57–0.98] and negative predictive value of 97% [0.89–1.00]].ConclusionATmax demonstrates a high correlation with TBI in patients with PAD, and high diagnostic accuracy for detection of critical limb ischemia. Based on these results, ATmax can represent the next step in evaluating PAD severity with DUS, in patients with advanced lower extremity PAD.
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Affiliation(s)
- Jean-Eudes Trihan
- Vascular Medicine Unit, University Hospital of Poitiers, Poitiers, France
- *Correspondence: Jean-Eudes Trihan
| | - Guillaume Mahé
- Univ Rennes, M2S – EA 7470, Rennes, France
- Vascular Medicine Unit, University Hospital Rennes, Rennes, France
- Clinical Investigation Center, INSERM CIC 1414, Rennes, France
| | - Magali Croquette
- Vascular Medicine Unit, University Hospital of Poitiers, Poitiers, France
| | - Vicky Coutant
- Vascular Medicine Unit, University Hospital of Poitiers, Poitiers, France
| | - Cécile Thollot
- Vascular Medicine Unit, University Hospital of Poitiers, Poitiers, France
| | - Jérôme Guillaumat
- Vascular Medicine Unit, University Hospital Côte de Nacre, Caen, France
| | - Damien Lanéelle
- Vascular Medicine Unit, University Hospital Côte de Nacre, Caen, France
- UNICAEN, INSERM 1075, COMETE, Caen, France
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18
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Stivalet O, Paisant A, Belabbas D, Le Faucheur A, Landreau P, Le Pabic E, Omarjee L, Mahé G. Combination of Exercise Testing Criteria to Diagnose Lower Extremity Peripheral Artery Disease. Front Cardiovasc Med 2021; 8:759666. [PMID: 34901219 PMCID: PMC8660124 DOI: 10.3389/fcvm.2021.759666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Nothing is known about the interest of the combination of exercise tests to diagnose Lower-extremity Peripheral Artery Disease (LEPAD). The aim of this study was to assess if combining exercise testing criteria [post-exercise Ankle-Brachial Index (ABI) + exercise-oximetry (exercise-TcPO2)] improves the detection of lower limbs arterial stenoses as compared with post-exercise ABI using American Heart Association (AHA) criteria, or exercise-TcPO2 alone. Material and Methods: In a prospective monocentric study, consecutive patients with exertional-limb pain and normal resting-ABI referred to our vascular center (Rennes, France) were assessed from May 2016 to February 2018. All included patients had a computed tomography angiography (CTA), a resting-ABI, a post-exercise ABI and an exercise-TcPO2. AHA post-exercise criteria, new validated post-exercise criteria (post-exercise ABI decrease ≥18.5%, post-exercise ABI decrease <0.90), and Delta from Rest of Oxygen Pressure (Total-DROP) ≤-15mmHg (criterion for exercise-TcPO2) were used to diagnose arterial stenoses ≥50%. For the different combinations of exercise testing criteria, sensitivity or specificity or accuracies were compared with McNemar's test. Results: Fifty-six patients (mean age 62 ± 11 years old and 84% men) were included. The sensitivity of the combination of exercise testing criteria (post-exercise ABI decrease ≥18.5%, or post-exercise ABI decrease <0.90 or a Total-DROP ≤-15mmHg) was significantly higher (sensitivity = 81% [95% CI, 71-92]) than using only one exercise test (post-exercise AHA criteria (sensitivity = 57% [43-70]) or exercise-TcPO2 alone (sensitivity = 59% [45-72]). Conclusions: Combination of post-exercise ABI with Exercise-TcPO2 criteria shows better sensitivity to diagnose arterial stenoses compared with the AHA post-exercise criteria alone or Exercise-TcPO2 criteria used alone. A trend of a better accuracy of this combined strategy was observed but an external validation should be performed to confirm this diagnostic strategy.
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Affiliation(s)
| | | | | | | | | | - Estelle Le Pabic
- Institut National de la Santé Et de la Recherche Médicale (INSERM), CIC1414, Rennes, France
| | - Loukman Omarjee
- Vascular Medicine Unit, CHU Rennes, Rennes, France
- Vascular Medicine, Centre Hospitalier de Redon, Redon, France
| | - Guillaume Mahé
- Vascular Medicine Unit, CHU Rennes, Rennes, France
- University of Rennes 2, M2S-EA 7470, Rennes, France
- Institut National de la Santé Et de la Recherche Médicale (INSERM), CIC1414, Rennes, France
- University of Rennes 1, Rennes, France
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19
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Guilcher A, Laneelle D, Mahé G. Use of a Pre-Trained Neural Network for Automatic Classification of Arterial Doppler Flow Waveforms: A Proof of Concept. J Clin Med 2021; 10:4479. [PMID: 34640497 PMCID: PMC8509437 DOI: 10.3390/jcm10194479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Arterial Doppler flow waveform analysis is a tool recommended for the management of lower extremity peripheral arterial disease (PAD). To standardize the waveform analysis, classifications have been proposed. Neural networks have shown a great ability to categorize data. The aim of the present study was to use an existing neural network to evaluate the potential for categorization of arterial Doppler flow waveforms according to a commonly used classification. METHODS The Pareto efficient ResNet-101 (ResNet-101) neural network was chosen to categorize 424 images of arterial Doppler flow waveforms according to the Simplified Saint-Bonnet classification. As a reference, the inter-operator variability between two trained vascular medicine physicians was also assessed. Accuracy was expressed in percentage, and agreement was assessed using Cohen's Kappa coefficient. RESULTS After retraining, ResNet-101 was able to categorize waveforms with 83.7 ± 4.6% accuracy resulting in a kappa coefficient of 0.79 (0.75-0.83) (CI 95%), compared with a kappa coefficient of 0.83 (0.79-0.87) (CI 95%) between the two physicians. CONCLUSION This study suggests that the use of transfer learning on a pre-trained neural network is feasible for the automatic classification of images of arterial Doppler flow waveforms.
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Affiliation(s)
| | - Damien Laneelle
- Vascular Medicine Unit, CHU Caen-Normandie, 14033 Caen, France;
| | - Guillaume Mahé
- Vascular Medicine Unit, CHU Rennes, 35000 Rennes, France;
- Clinical Investigation Center, University Rennes, INSERM CIC 1414, 35033 Rennes, France
- M2S-EA 7470, University Rennes, 35170 Bruz, France
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20
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Détriché G, Lanéelle D, Radureau C. Pharmacological management of obstructive peripheral arterial disease: two case reports. Hosp Pract (1995) 2021; 49:379-383. [PMID: 34278930 DOI: 10.1080/21548331.2021.1956805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Peripheral artery disease (PAD), also abbreviated as LEAD or lower extremity artery disease, is an important predictor of cardiovascular morbidity and mortality. Rivaroxaban, a selective direct factor Xa inhibitor, is proposed as an additional pharmacologic option for managing this disease. CASES Two patients presented with PAD and high-risk comorbidities. The first case showed how the evaluation of the cardiovascular risk guided the therapeutic management of the patient. The second case was about a patient diagnosed with LEAD who experienced worsening from exertional ischemia towards critical ischemia requiring amputation despite distal revascularization, and parenteral vasodilator therapy to relieve pain. This case suggested a comprehensive care management approach, adapted to PAD progression stages. CONCLUSION The PAD management consists nowadays of optimizing the management of cardiovascular risk factors and disease progression. Diagnosis, treatment, monitoring and patient education should be handled by a vascular specialist in a specialized care unit.
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Affiliation(s)
- Grégoire Détriché
- Department of Vascular Medicine, European Hospital Georges-Pompidou, APHP, Paris University, France
| | | | - Chloé Radureau
- Department of Vascular Medicine, CHU de Caen, Caen, France
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21
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Lanéelle D, Sauvet G, Guillaumat J, Trihan JE, Mahé G. Gender Differences in the Medical Treatment of Peripheral Artery Disease. J Clin Med 2021; 10:2855. [PMID: 34203172 PMCID: PMC8269326 DOI: 10.3390/jcm10132855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 05/29/2021] [Accepted: 06/22/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/OBJECTIVES Peripheral arterial disease is a frequent and severe disease with high cardiovascular morbidity and mortality. However, female patients appear to be undertreated. OBJECTIVES The primary goal was to compare the prescription of optimal medical treatment (OMT) of peripheral arterial disease between women and men in primary health care. MATERIAL AND METHODS An observational retrospective study was based on the data collected from general practitioners (GP) office in Brittany. RESULTS The study included 100 patients, aged 71 ± 10 years old, with 24% of women. Compared to men, women received the OMT less frequently (29.2% vs. 53.9%, p = 0.038), especially after 75 years old. Antiplatelet therapy was largely prescribed (100%), statins less frequently (70.8% women vs. 85.5% men), and prescription of renin-angiotensin-aldosterone system inhibitors was still not optimal in the two genders (41.7% women vs. 61.9% men). Active smoking is important for both women and men (33% and 30% respectively). CONCLUSION Optimal medical treatment of peripheral artery disease is insufficiently prescribed, especially in women in this region of France.
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Affiliation(s)
- Damien Lanéelle
- Vascular Medicine Unit, Centre Hospitalier Universitaire de Caen Normandie, 14000 Caen, France; (D.L.); (J.G.)
- COMETE Laboratory, INSERM 1075, Université de Caen, 14000 Caen, France
| | - Gabriella Sauvet
- Medical School, Université de Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-Le-Bretonneux, France;
| | - Jérôme Guillaumat
- Vascular Medicine Unit, Centre Hospitalier Universitaire de Caen Normandie, 14000 Caen, France; (D.L.); (J.G.)
| | - Jean Eudes Trihan
- Vascular Medicine Unit, Centre Hospitalier Universitaire de Poitiers, 86021 Poitiers, France;
| | - Guillaume Mahé
- Vascular Medicine Unit, Centre Hospitalier Universitaire de Rennes, 35033 Rennes, France
- INSERM CIC 1414, Université de Rennes, 35033 Rennes, France
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22
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Lanéelle D, Guillaumat J, Trihan JE, Pottier C, Omarjee L, Mahé G. Inter-rater Reliability of a 13-Category Arterial Doppler Waveform Classification and Practice of French Vascular Physicians. Front Cardiovasc Med 2021; 8:640838. [PMID: 34113660 PMCID: PMC8185013 DOI: 10.3389/fcvm.2021.640838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Arterial Doppler Ultrasound waveform (DW) analysis allows the detection and evaluation of lower extremity peripheral artery disease. The high heterogeneity of the reported description of DW is reduced by the use of classification. However, the reliability of these classifications is either unknown or low to moderate and practices of vascular caregivers regarding the use of these classifications remain unknown. Aims: This study aims to assess the inter-observer reliability of the Saint-Bonnet classification, a 13-category DW classification. The secondary objective was to determine the utilization rate of the most common classifications and the ability of these classifications to describe DW. Methods: A national survey was conducted among all vascular physicians of French society of vascular medicine. They were invited by email to describe on a website 20 DW without and with the display of the Saint-Bonnet classification. The reliability of this classification was estimated by Fleiss' Kappa expressed with [95% confidence interval]. A semantic analysis allowed us to classify the physicians' responses according to the terms used. Finally we have evaluated for each classification the rate of misuse, i.e., the addition of a complementary term to the defined categories. Results: One hundred and ten physicians participated and only 5% of these were familiar with Saint-Bonnet classification. Fifty-four percent of vascular physicians used no classification at all. Vascular physicians used the Spronk (four-category), Descotes (five-category) and Saint-Bonnet (13-category) classifications for respectively, 31, 10, and 5%. Kappa coefficient of Fleiss (κ) was 0.546 [0.544-0.547] (p < 0.001). Reliability by category ranges from κ of 0.075 to 0.864. In multivariate analysis, the use of a classification was associated with fewer years of experience and was dependent on geographic location. Misuse rate by classification was 88, 82, and 5% using Spronk, Descotes and Saint-Bonnet classifications respectively. Conclusion: The reliability of Saint-Bonnet classification is weak to moderate by vascular physicians who are not familiar with its use. However, unlike the other classifications, it seems to be sufficiently precise so that the user does not need to complete its description. There is a significant heterogeneity in the use of arterial Doppler classifications in France.
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Affiliation(s)
- Damien Lanéelle
- Department of Vascular Medicine, CHU Caen Normandie, Caen, France.,Université de Caen Normandie, INSERM, COMETE 1075, Caen, France
| | | | | | - Camille Pottier
- Department of Vascular Medicine, CHU Caen Normandie, Caen, France
| | - Loukman Omarjee
- Université de Rennes 1, INSERM CIC 1414, Rennes, France.,Department of Vascular Medicine, CHU Rennes, Rennes, France
| | - Guillaume Mahé
- Université de Rennes 1, INSERM CIC 1414, Rennes, France.,Department of Vascular Medicine, CHU Rennes, Rennes, France
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23
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Miossec A, Tollenaere Q, Lanéelle D, Guilcher A, Métairie A, Le Pabic E, Carel A, Le Faucheur A, Mahé G. Arterial Doppler Waveforms Are Independently Associated With Maximal Walking Distance in Suspected Peripheral Artery Disease Patients. Front Cardiovasc Med 2021; 8:608008. [PMID: 33959640 PMCID: PMC8093382 DOI: 10.3389/fcvm.2021.608008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 03/16/2021] [Indexed: 01/15/2023] Open
Abstract
Objective: Arterial Doppler waveform recordings are commonly used to assess lower extremity arterial disease (LEAD) severity. However, little is known about the relationship between arterial Doppler waveform profiles and patients' walking capacity. The purpose of this study was to assess whether arterial Doppler waveforms are independently associated with maximal walking distance (MWD) in patients experiencing exertional limb symptoms. Materials and Methods: This cross-sectional study included suspected LEAD patients experiencing exertional limb symptoms. In both lower extremities, arterial Doppler waveforms and ankle-brachial index (ABI) values were obtained from the pedis and tibial posterior arteries. Each arterial flow measurement was ranked using the Saint-Bonnet classification system. Treadmill stress testing (3.2 km/h, 10% slope) coupled with exercise oximetry (Exercise-TcPO2) were used to determine MWD. Delta from rest oxygen pressure (DROP) was calculated. Following treadmill stress testing, post-exercise ABI values were recorded. Univariate and multivariate analyses were used to determine the clinical variables associated with MWD. Results: 186 patients experiencing exertional limb symptoms (62 ± 12 years and 26.8 ± 4.5 kg/m2) were included between May 2016 and June 2019. Median [25th; 75th] treadmill MWD was 235 [125;500]m. Better arterial Doppler waveforms were associated with better walking distance (p = 0.0012). Whereas, median MWD was 524 [185;525]m in the group that yielded the best Doppler waveforms, it was 182 [125,305]m in the group with the poorest Doppler waveforms (p = 0.0012). MWD was significantly better (p = 0.006) in the patients with the best ABIs. However, arterial Doppler waveforms alone were significantly associated with MWD (p = 0.0009) in the multivariate model. When exercise variables (post-exercise ABI or DROP) were incorporated into the multivariate model, these were the only variables to be associated with MWD. Conclusion: Of the various clinical parameters at rest, Doppler flow waveform profiles were associated with MWD in suspected LEAD patients. A stronger link was however found between exercise variables and MWD.
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Affiliation(s)
| | | | | | | | | | - Estelle Le Pabic
- CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), Rennes, France
| | - Awenig Carel
- Vascular Medicine Unit, CHU Rennes, Rennes, France
| | - Alexis Le Faucheur
- CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), Rennes, France
- Univ Rennes, M2S-EA 7470, Rennes, France
| | - Guillaume Mahé
- Vascular Medicine Unit, CHU Rennes, Rennes, France
- CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), Rennes, France
- Univ Rennes, M2S-EA 7470, Rennes, France
- Univ Rennes 1, Rennes, France
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