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Rochoy M, Doublali A, Berkhout C. [Use of the ankle-brachial index in the detection of peripheral arterial disease of the lower extremities in general medicine]. Ann Cardiol Angeiol (Paris) 2021; 70:75-80. [PMID: 33642048 DOI: 10.1016/j.ancard.2020.12.006] [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: 11/15/2020] [Accepted: 12/30/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Peripheral arterial disease of the lower extremities (PAD) is a serious condition, frequently under-evaluated. Long asymptomatic, it is easily detected by measuring the ankle-brachial index (ABI), a reference tool that is reliable, reproducible, simple and inexpensive. The objective of this thesis was to determine the rate of achievement of ABI in French Haute Autorité de santé indications, identify the associated factors and prioritize the obstacles to achieving ABI. METHODS Descriptive and analytical epidemiological study, with analysis of practices, prospectively addressed by postal questionnaire to a randomized sample of 220 general practitioners practicing in the European Metropolis of Lille between December 15, 2016 and February 15, 2017. RESULTS Our sample consisted of 92 GPs (42% participation). Among them, only 6 practiced ABI, notably for: intermittent claudication (n=5: 5%, IC95% [1; 10]), the existence of at least 2 cardiovascular risk factors (n=2: 2%, IC95% [0; 5]), diabetic patients over 40 years of age (n=2: 2%, IC95% [0; 5]), patients with diabetes (n=2: 2%, IC95% [0; 5]), patients with diabetes (n=2: 1%, IC95% [0; 5]), patients with diabetes (n=2: 1%, IC95% [0; 5]), and patients with diabetes (n=2: 1%, IC95% [0; 5]): 2%, CI95% [0; 5]), patients over 50 years of age with a history of diabetes or smoking (n=2: 2%, CI95% [0; 5]), or those with an unhealed lower extremity skin lesion (n=5: 5%, CI95% [1; 10]). The most frequently cited barriers were: the prescription of a routine echo-doppler (61%, 95% CI [51; 71]), lack of control (46%, 95% CI [36; 56]), time considered too long (17%, 95% CI [10; 25]), and equipment purchase or maintenance (19%, 95% CI [10.5; 26.4]). CONCLUSION ABI is few used in our sample, mainly due to delegation to angiologists.
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Affiliation(s)
- Michaël Rochoy
- Département de médecine générale, faculté de médecine, University Lille, 59000 Lille, France; ULR 2694 - METRICS, CERIM, CHU de Lille, 59000 Lille, France.
| | - Abdelkrim Doublali
- Département de médecine générale, faculté de médecine, University Lille, 59000 Lille, France
| | - Christophe Berkhout
- Département de médecine générale, faculté de médecine, University Lille, 59000 Lille, France; Department of primary and interprofessional care, University of Antwerp, 2000 Antwerp, Belgique
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[Lower limb peripheral arterial disease in 268 patients in Guadeloupe]. JOURNAL DES MALADIES VASCULAIRES 2016; 41:246-52. [PMID: 27289257 DOI: 10.1016/j.jmv.2016.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 04/30/2016] [Indexed: 11/23/2022]
Abstract
UNLABELLED Peripheral arterial disease of the lower limbs is a serious condition because of its local and general prognosis. OBJECTIVES To identify the localization of peripheral arterial disease, associated risk factors, topography and features of the disease in Guadeloupe. PATIENTS AND METHODS A descriptive non-interventional study was performed in Guadeloupe located in French West Indies from March to June 2014. Data for all patients, who underwent Doppler ultrasound of the lower limb in a vascular outpatient clinic and in the University Hospital in Guadeloupe for known or suspected peripheral arterial disease were included. RESULTS The study included 268 patients. Localizations were: infrapopliteal (n=227 patients), popliteal (n=148), femoral (n=185) and aorto-iliac (n=115). Smoking was associated with aorto-iliac (16 patients; P<0.05) and femoral (27 patients; P<0.05) localizations. Diabetes was associated with infrapopliteal localizations (133 patients; P<0.05), and high blood pressure was associated with infrapopliteal, popliteal and femoral localizations. Mean age was 73.1±10.8 years; half of patients (51 %) were women. Peripheral arterial disease was known for 52 % of the population; 147 patients were asymptomatic. Associated factors were high blood pressure (88 %), diabetes (63 %), dyslipidemia (45 %), and smoking (7 %). Ischemic heart disease was found in 14 % of patients, cerebrovascular disease in 18 % and all three localizations in 4 %. A history of amputation, bypass or endovascular treatment was found in 11 %, 20 % and 32 % of patients respectively. CONCLUSION In our population, an infrapopliteal site was more often found than a proximal site. Distal localization was associated with diabetes, and proximal localization with smoking. Cardiovascular risk factors exhibited an atypical pattern with a large majority of patients (88 %) having high blood pressure, two-thirds diabetes, but with very few (7 %) smokers. Peripheral arterial disease was more often associated with a history of stroke than with ischemic heart disease.
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Sfeir D, Lazareth I, Stansal A, Ghaffari P, Michon Pasturel U, Bonhomme S, Priollet P. [Leg ulcers: Should general practitioners hospitalize their patients?]. ACTA ACUST UNITED AC 2016; 41:18-25. [PMID: 26809200 DOI: 10.1016/j.jmv.2015.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 11/28/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Determine whether general practitioners have sufficient expertise in the field of leg ulcers. METHOD A cross-sectional survey was conducted among 179 general practitioners working in the region Île-de-France to evaluate the implementation of leg ulcer guidelines issued by the Superior Health Authority (HAS) in 2006. Participating physicians were either internship supervisors or practitioners in Paris' 14th district. RESULTS The first hundred usable answers (response rate 65%) came from 71 internship supervisors and 29 practitioners of Paris' 14th district. Only 40% of the physicians were aware of the guidelines, with no significant difference noted between the two groups. 9/10 practitioners examined less than 10 patients with leg ulcers per year. Physical examinations were done according to the guidelines and a venous Doppler was prescribed in two thirds of the cases. The ankle-brachial pressure index (ABPI) essential to diagnose lower limb arteriopathy was measured for only 10% of the patients. In accordance with the guidelines, compression was by far (73%) considered as the main treatment as compared to dressing (37%), but compression therapy was well prescribed in only one-third of the cases. Despite poor prognosis criteria (characteristic and time course), referral for a specialized opinion was rare. CONCLUSION Even if they were not always aware of the detailed guidelines, the practitioners applied the main recommendations. Nevertheless, practices could be improved by measuring the ABPI, searching for a diagnosis of arteriopathy, and better prescription of compression therapy. General practitioners should refer patients with leg ulcers to a specialized hospital unit.
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Affiliation(s)
- D Sfeir
- Service de médecine vasculaire, institut de la cicatrisation Jean-Paul-Belmondo, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
| | - I Lazareth
- Service de médecine vasculaire, institut de la cicatrisation Jean-Paul-Belmondo, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - A Stansal
- Service de médecine vasculaire, institut de la cicatrisation Jean-Paul-Belmondo, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - P Ghaffari
- Service de médecine vasculaire, institut de la cicatrisation Jean-Paul-Belmondo, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - U Michon Pasturel
- Service de médecine vasculaire, institut de la cicatrisation Jean-Paul-Belmondo, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - S Bonhomme
- Service de médecine vasculaire, institut de la cicatrisation Jean-Paul-Belmondo, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - P Priollet
- Service de médecine vasculaire, institut de la cicatrisation Jean-Paul-Belmondo, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
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Lederlin M, Trédaniel J, Priollet P. Pourquoi dépister le cancer du poumon chez les artériopathes ? ACTA ACUST UNITED AC 2015; 40:359-64. [DOI: 10.1016/j.jmv.2015.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/12/2015] [Indexed: 12/26/2022]
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Laroche JP, Becker F, Baud JM, Miserey G, Jaussent A, Picot MC, Bura-Rivière A, Quéré I. [Ultrasound screening of abdominal aortic aneurysm: Lessons from Vesale 2013]. ACTA ACUST UNITED AC 2015; 40:340-9. [PMID: 26371387 DOI: 10.1016/j.jmv.2015.07.104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 07/10/2015] [Indexed: 01/16/2023]
Abstract
Although aneurysm of the abdominal infra-renal aorta (AAA) meets criteria warranting B mode ultrasound screening, the advantages of mass screening versus selective targeted opportunistic screening remain a subject of debate. In France, the French Society of Vascular Medicine (SFMV) and the Health Authority (HAS) published recommendations for targeted opportunistic screening in 2006 and 2013 respectively. The SFMV held a mainstream communication day on November 21, 2013 in France involving participants from metropolitan France and overseas departments that led to a proposal for free AAA ultrasound screening: the Vesalius operation. Being a consumer operation, the selection criteria were limited to age (men and women between 60 and 75 years); the age limit was lowered to 50 years in case of direct family history of AAA. More than 7000 people (as many women as men) were screened in 83 centers with a 1.70% prevalence of AAA in the age-based target population (3.12% for men, 0.27% for women). The median diameter of detected AAA was 33 mm (range 20 to 74 mm). The prevalence of AAA was 1.7% in this population. Vesalius data are consistent with those of the literature both in terms of prevalence and for cardiovascular risk factors with the important role of smoking. Lessons from Vesalius to take into consideration are: screening is warranted in men 60 years and over, especially smokers, and in female smokers. Screening beyond 75 years should be discussed. Given the importance of screening, the SFMV set up a year of national screening for AAA (Vesalius operation 2014/2015) in order to increase public and physician awareness about AAA detection, therapeutic management, and monitoring. AAA is a serious, common, disease that kills 6000 people each year. The goal of screening is cost-effective reduction in the death toll.
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Affiliation(s)
- J P Laroche
- Médecine interne et médecine vasculaire, hôpital Saint-Éloi, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
| | - F Becker
- 40, chemin des Favrands, 74400 Chamonix-Mont-Blanc, France
| | - J M Baud
- Centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - G Miserey
- 55, rue Gambetta, 78120 Rambouillet, France
| | - A Jaussent
- Unité de recherche clinique et épidémiologie, CHRU de Montpellier, 191, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - M C Picot
- Unité de recherche clinique et épidémiologie, CHRU de Montpellier, 191, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - A Bura-Rivière
- Médecine vasculaire, hôpital Rangueil, CHRU de Toulouse, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
| | - I Quéré
- Médecine interne et médecine vasculaire, hôpital Saint-Éloi, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
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Mahé G. Mesure de l’index de pression systolique de cheville : mode d’enseignement en deuxième et troisième cycles en France et revue de la littérature. ACTA ACUST UNITED AC 2015; 40:165-72. [DOI: 10.1016/j.jmv.2015.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 03/01/2015] [Indexed: 10/23/2022]
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Liu Y, Xu Y, Fang F, Zhang J, Guo L, Weng Z. Therapeutic Efficacy of Stem Cell-based Therapy in Peripheral Arterial Disease: A Meta-Analysis. PLoS One 2015; 10:e0125032. [PMID: 25923119 PMCID: PMC4414514 DOI: 10.1371/journal.pone.0125032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 03/19/2015] [Indexed: 11/18/2022] Open
Abstract
Several cell-based therapies for peripheral arterial disease (PAD) have been studied in multiple clinical trials; however, the outcome of this treatment remains controversial. The aim of this study was to perform a meta-analysis of the clinical trials on stem cell-based therapy after PAD. We searched for clinical trials that investigated the effect of stem cell-based therapy on patients with PAD and were published between January 2000 and October 2014. The outcomes of interest comprised all-cause mortality, amputation rate, ulcer healing, and ankle-brachial index (ABI). In addition, pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to assess the safety and efficacy of the stem cell-based therapies for PAD. Thirteen studies were retrieved from 261 citations for the analysis, and in total, 527 patients (mean age: 64.2 years; median follow up: 6 months) were included in the analysis. After synthesizing data, the meta-analysis showed significant improvement in the amputation rate (OR=0.33, 95%CI=0.22-0.51; P<0.001), ulcer healing (OR=6.11, 95%CI=3.04-12.28; P<0.001), and ABI (SMD=0.65, 95%CI=0.33-0.97; P<0.001) for the stem cell-based therapy group compared with the controls. Moreover, significant improvement in the amputation rate, ulcer healing, and ABI were also found based on the time point and stem cell source. In addition, no significant difference was found in the all-cause mortality (OR=0.80, 95%CI=0.39-1.641; P=0.546) between the stem cell-based therapy and control groups. Therefore, according to the results of our meta-analysis, stem cell-based therapy is safe and shows a beneficial outcome for patients with PAD, especially in the short term.
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Affiliation(s)
- Yumeng Liu
- Department of Radiology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yunyun Xu
- Institute of Pediatrics, Children’s Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
| | - Fang Fang
- Institute of Pediatrics, Children’s Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
| | - Jianting Zhang
- Key Laboratory of Nano-Bio Interface, Division of Nanobiomedicine and i-Lab, Suzhou Institute of Nano-Tech and Nano-Bionics, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Liang Guo
- Department of Radiology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- * E-mail: (ZW); (LG)
| | - Zhen Weng
- Key Laboratory of Nano-Bio Interface, Division of Nanobiomedicine and i-Lab, Suzhou Institute of Nano-Tech and Nano-Bionics, Chinese Academy of Sciences, Suzhou, Jiangsu, China
- * E-mail: (ZW); (LG)
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Stève-Dumont M, Baldin B, Legros L, Thyss A, Re D, Rocher F, Ajmia F, Spreux A, Drici MD. Are nilotinib-associated vascular adverse events an under-estimated problem? Fundam Clin Pharmacol 2015; 29:204-8. [PMID: 25619238 DOI: 10.1111/fcp.12102] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 12/29/2014] [Accepted: 01/21/2015] [Indexed: 01/19/2023]
Abstract
Vascular adverse events have been reported with nilotinib, a tyrosine kinase inhibitor prescribed for chronic myeloid leukaemia. However, few data specify their incidence, or whether they occur in predisposed patients. Hence, we prospectively studied 30 consecutive patients to assess the frequency of such adverse reactions and determine whether the patients presenting with these adverse events bear predisposing factors. From 3 to 73 months after nilotinib initiation, 10 of the 30 patients experienced vascular events. Three patients of these 10 were devoid of any patent cardiovascular risk factor, except for age. This study points out an occurrence more frequent than expected of vascular adverse events associated with nilotinib (> 30% vs. < 1% in summary of product characteristics), and particularly of vascular events of late onset in patients with no pre-existing risk factors.
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Affiliation(s)
- Marie Stève-Dumont
- Department of Pharmacology, Regional Pharmacovigilance Center, Nice, France
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Claisse G, Maldonado P, Kpogbemabou N, Boudghène-Stambouli F, Delsart P, Devos P, Mounier-Vehier C. [Systematic screening of masked hypertension in patients with peripheral arterial disease: a pilot study]. JOURNAL DES MALADIES VASCULAIRES 2015; 40:10-17. [PMID: 25631643 DOI: 10.1016/j.jmv.2014.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 12/04/2014] [Indexed: 06/04/2023]
Abstract
AIM Masked hypertension (MH) is defined by a normal office blood pressure (BP) and a high ambulatory BP. MH is characterized by high prevalence and poor cardiovascular prognosis. The aim of this study was to evaluate the usefulness of routine MH screening, using 24-h blood pressure monitoring (BPM), among patients with peripheral arterial disease (PAD). METHODS Between 2011 and 2013, 54 patients with PAD were included in the Hypertension and Vascular Medicine Unit of the Lille Hospital. They had normal office BP (< 140/90mmHg). A 24 h-BPM device was set on each patient. MH diagnosis was established if the BP average over 24 hours was ≥ 130/80 mmHg and/or the daytime average ≥ 135/85 mmHg and/or the nighttime average ≥ 120/70 mmHg. RESULTS MH prevalence was about 42.6% (23 patients). It was significantly more frequent in diabetic patients (odds ratio: 3.8 [1.1-12.8]), in patients with known hypertension (odds ratio: 5 [1.5-16.9]) or with high normal office BP (<140/90 mmHg but ≥ 130/85 mmHg) (odds ratio: 5.6 [1.7-18.2]). By multivariate analysis, only known hypertension and high normal office BP were associated with masked hypertension. CONCLUSION The high prevalence of MH in patients with PAD shows us the importance of a careful screening of MH in this population, especially in diabetic patients, in patients with known hypertension or with a high normal office BP.
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Affiliation(s)
- G Claisse
- Service de médecine vasculaire et hypertension artérielle, hôpital cardiologique, CHRU de Lille, 59037 Lille, France
| | - P Maldonado
- Service de médecine vasculaire et hypertension artérielle, hôpital cardiologique, CHRU de Lille, 59037 Lille, France
| | - N Kpogbemabou
- Service de cardiologie et médecine polyvalente, centre hospitalier de Wattrelos, 59150 Wattrelos, France
| | - F Boudghène-Stambouli
- Service de médecine vasculaire et hypertension artérielle, hôpital cardiologique, CHRU de Lille, 59037 Lille, France
| | - P Delsart
- Service de médecine vasculaire et hypertension artérielle, hôpital cardiologique, CHRU de Lille, 59037 Lille, France
| | - P Devos
- Département de biostatistiques, CHRU de Lille, 59037 Lille, France
| | - C Mounier-Vehier
- Service de médecine vasculaire et hypertension artérielle, hôpital cardiologique, CHRU de Lille, 59037 Lille, France.
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Konin C, Essam N'loo AS, Adoubi A, Coulibaly I, N'guetta R, Boka B, N'djessan JJ, Koffi J, Yao H, Angoran I, Adoh M. [Peripheral arterial disease of the lower limbs in African diabetic patients: ultrasonography and determining factors]. JOURNAL DES MALADIES VASCULAIRES 2014; 39:373-381. [PMID: 25234283 DOI: 10.1016/j.jmv.2014.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 05/28/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Diabetic peripheral arterial disease (PAD) of the lower limbs is underdiagnosed. METHODOLOGY This was a prospective study conducted over a six-month period from November 2012 to April 2013. A total of 308 diabetic patients were included from three diabetes centers in Abidjan (Ivory Coast). AIM To screen for PAD of the lower limbs in a diabetic population and to identify the determining factors. RESULTS Among the 308 patients, the ankle-brachial index (ABI) was<0.9 in 68 (22.07%) patients considered to have PAD; the ABI was>1.3 in 56 (18.2%) patients who had suspected mediacalcosis. The average age of the PAD patients was 60.2 years. Female gender predominated (55.9%). The mean duration of diabetes was 9.6 years: 97.1% type 2 diabetes. The other cardiovascular risk factors in this population were hypertension (58.8%) and dyslipidemia (40.9%). Smoking was present in 29.4% of patients and obesity in 23.9%. PAD of the lower limbs was mild in 46 patients (67.6%), moderate in 16 (23.5%) and severe in 6 (8.8%). Duplex Doppler commonly showed lesions of the tibial arteries. Determining factors of diabetic PAD of the lower limbs were hypertension (58.8% vs 36.6%; OR=2.46; 95% CI: 1.13-5.36; P=0.034) and dyslipidemia (40.9% vs 8.3%; OR=7.6; 95% CI: 2.31-25.08; P=0.0009). For mediacalcosis, male gender (71.5% vs 39.7; OR=0.26 95% CI/0.10-0.64. P=0.004) was the only factor identified. CONCLUSION Hypertension and dyslipidemia were predictive factors for diabetic PAD of the lower limbs in our African population.
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Affiliation(s)
- C Konin
- Institut de cardiologie d'Abidjan, Abidjan, Côte d'Ivoire.
| | | | - A Adoubi
- Institut de cardiologie d'Abidjan, Abidjan, Côte d'Ivoire
| | - I Coulibaly
- Institut de cardiologie d'Abidjan, Abidjan, Côte d'Ivoire
| | - R N'guetta
- Institut de cardiologie d'Abidjan, Abidjan, Côte d'Ivoire
| | - B Boka
- Institut de cardiologie d'Abidjan, Abidjan, Côte d'Ivoire
| | - J J N'djessan
- Institut de cardiologie d'Abidjan, Abidjan, Côte d'Ivoire
| | - J Koffi
- Institut de cardiologie d'Abidjan, Abidjan, Côte d'Ivoire
| | - H Yao
- Institut de cardiologie d'Abidjan, Abidjan, Côte d'Ivoire
| | - I Angoran
- Institut de cardiologie d'Abidjan, Abidjan, Côte d'Ivoire
| | - M Adoh
- Institut de cardiologie d'Abidjan, Abidjan, Côte d'Ivoire
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Lamina C, Linsenmeyer J, Weissensteiner H, Kollerits B, Meisinger C, Rantner B, Stöckl D, Stadler M, Klein-Weigel P, Peters A, Fraedrich G, Kronenberg F. Correlation between a positive family risk score and peripheral artery disease in one case-control and two population-based studies. Atherosclerosis 2014; 237:243-50. [DOI: 10.1016/j.atherosclerosis.2014.08.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/16/2014] [Accepted: 08/12/2014] [Indexed: 02/02/2023]
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Abstract
BACKGROUND In the general population, up to 10% of people younger than 70 years and 15% to 20% of people older than 70 years have peripheral arterial disease (PAD). Symptomatic and asymptomatic PAD has an estimated prevalence of 13% in the over 50 years age group. However, asymptomatic PAD can account for up to 75% of PAD patients and only 10% of PAD patients have typical intermittent claudication. People with PAD are at an increased risk of death, heart and cerebrovascular disease and are recommended to receive treatment to manage their cardiac risk. They suffer from significant functional limitations in their daily activities and the most severely affected are at risk of limb loss. Many people with PAD do not have any symptoms. Only some people have discomfort or pain in the lower legs when walking, so PAD often goes undetected. Given the high incidence of asymptomatic and undiagnosed PAD, it is important to determine the effectiveness of a screening intervention in preventing cardiovascular adverse outcomes, both fatal and non-fatal. OBJECTIVES To determine the effectiveness of screening for PAD in asymptomatic and undiagnosed individuals in terms of reduction of all-cause mortality, cardiovascular events (for example myocardial infarction and stroke), morbidity from PAD (intermittent claudication, amputation, reduced walking distance) and improvement in quality of life. SEARCH METHODS The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched November 2013) and CENTRAL (2013, Issue 10). SELECTION CRITERIA All published and unpublished randomised controlled trials (RCTs) of screening for PAD were sought without language restriction. DATA COLLECTION AND ANALYSIS Studies identified for potential inclusion in the review were independently assessed by both review authors. We planned to conduct data collection and analysis in accordance with the Cochrane Handbook for Systematic Review of Interventions. MAIN RESULTS No RCTs were identified that met the inclusion criteria. AUTHORS' CONCLUSIONS Unfortunately, no randomised controlled trial data are available regarding screening for PAD. Therefore, we are unable to determine the effects of screening for PAD in order to guide decision making by healthcare providers and planners. High quality randomised controlled trials evaluating the effectiveness of screening for PAD in asymptomatic and undiagnosed individuals in terms of reduction of all-cause mortality, cardiovascular events (for example myocardial infarction and stroke), morbidity from PAD (intermittent claudication, amputation, reduced walking distance) and improvement in quality of life are needed.
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Affiliation(s)
- Alina Andras
- Freeman HospitalNorthern Vascular CentreNewcastle upon TyneUKNE7 7DN
| | - Bart Ferket
- Erasmus MCDepts. of Epidemiology and RadiologyRoom Na 2523P.O.Box 2040RotterdamNetherlands3000 CA
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Meyer D, Bureau JM, Vu Tri D. [Ankle brachial index: motivations, training, and practices among 165 general practitioners in Île-de-France]. ACTA ACUST UNITED AC 2013; 39:18-25. [PMID: 24332303 DOI: 10.1016/j.jmv.2013.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 10/26/2013] [Indexed: 10/25/2022]
Abstract
UNLABELLED Peripheral arterial disease (PAD) is under-diagnosed despite its predictive value for cardiovascular mortality. The ankle brachial index (ABI), a simple reliable measure recommended by the French health authorities to detect and evaluate the severity of PAD, is used by too few general practitioners (GPs). OBJECTIVE This study aimed at identifying motivations and barriers for using ABI in general practice. METHOD A representative, descriptive, cross-sectional survey was conducted amongst 165 GPs practicing in Île-de-France who were interviewed using stratified quotas. RESULTS Although 1 out of 5 GPs considered ABI to be an irrelevant indicator, most had a favorable opinion about its use (OR: 4.9 [CI 95 %: 4.2-5.7]). Only 42 % (CI 95 %: 34 %-49 %) of GPs knew ABI was recommended by the health authorities. This information had a critical impact on the acceptance of ABI relevancy (OR: 3.7 [CI 95 %: 3.2-4.2]). Training reinforced acceptance (OR: 5.0 [CI 95 %: 4.4-5.6]) and pre-residency education provided a better understanding of ABI (OR: 2.8 [CI 95 %: 2.3-3.4]). Time needed to measure ABI was the main barrier (OR: 0.6 [CI 95 %: 0.6-0.7]). A Doppler-calculation kit (OR: 11.8 [CI 95 %: 8.9-15.6]), equipment cost≤300Euros (OR: 3.4 [CI 99 %: 3.0-3.9]), a specific fee in addition to the regular consultation fee (OR: 2.6 [CI 95 %: 2.3-3.0]) and inclusion of ABI in the GP's evaluation scheme (OR: 2.6 [CI 95 %: 2.3-2.9]) would motivate more GPs. Seven out of 10 GPs agreed that ABI has a positive impact on patient adherence to treatment and follow-up, but ABI remained underexploited for symptomatic patients (OR: 0.4 [CI 95 %: 0.3-0.4]). CONCLUSION Better communication and training together with an upgraded status for ABI would provide motivation for GPs to measure ABI.
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Affiliation(s)
- D Meyer
- Service de chirurgie vasculaire, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
| | - J-M Bureau
- Service de rééducation vasculaire, hôpital Corentin-Celton, 92133 Issy-les-Moulineaux, France
| | - D Vu Tri
- Service de rééducation et d'appareillage, institut Robert-Merle-d'Aubigné, 94460 Valenton, France
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