1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Bierowski M, Galanis T, Majeed A, Mofid A. Peripheral Artery Disease: Overview of Diagnosis and Medical Therapy. Med Clin North Am 2023; 107:807-822. [PMID: 37541709 DOI: 10.1016/j.mcna.2023.05.007] [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: 08/06/2023]
Abstract
Peripheral artery disease (PAD) affects approximately 230 million people worldwide and is associated with an increased risk of major adverse cardiovascular and limb events. Even though this condition is considered a cardiovascular equivalent, it remains an underrecognized and undertreated entity. Antiplatelet and statin therapy, along with smoking cessation, are the foundations of therapy to reduce adverse events but are challenging to fully implement in this patient population. Race and socioeconomic status also have profound impacts on PAD outcomes.
Collapse
Affiliation(s)
- Matthew Bierowski
- Internal Medicine, Thomas Jefferson University Hospital, 1025 Walnut Street, Philadelphia, PA 19107, USA
| | - Taki Galanis
- Division Vascular Medicine, Jefferson Vascular Center, Sidney Kimmel Medical College, Philadelphia, PA, USA.
| | - Amry Majeed
- Internal Medicine, Thomas Jefferson University Hospital, 1025 Walnut Street, Philadelphia, PA 19107, USA
| | - Alireza Mofid
- Vascular Surgery, Thomas Jefferson University Hospital, 111 South 11th Street, Suite 6210 Gibbon, Philadelphia, PA 19107, USA
| |
Collapse
|
3
|
Endovascular Revascularization of Isolated Internal Iliac Artery for symptomatic occlusive atherosclerotic disease is a viable and underutilized option for patients with gluteal muscle claudication. J Vasc Surg Cases Innov Tech 2023; 9:101090. [PMID: 36992706 PMCID: PMC10041555 DOI: 10.1016/j.jvscit.2022.101090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 11/29/2022] [Indexed: 02/19/2023] Open
Abstract
Often confused with pseudoclaudication, gluteal muscle claudication is a difficult condition to diagnose and treat. We present the case of a 67-year-old man with a history of back and buttock claudication. He had undergone lumbosacral decompression with no relief of buttock claudication. Computed tomography angiography of the abdomen and pelvis showed occlusion of the bilateral internal iliac arteries. Exercise transcutaneous oxygen pressure measurements obtained on referral to our institution revealed a significant decrease. He underwent successful recanalization and stenting of the bilateral hypogastric arteries with complete resolution of his symptoms. We also reviewed the reported data to highlight the trend in the management of patients with this condition.
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Lower Extremity Arterial Disease and Lumbar Spinal Stenosis: A Study of Exercise-Induced Arterial Ischemia in 5197 Patients Complaining of Claudication. J Clin Med 2022; 11:jcm11195550. [PMID: 36233418 PMCID: PMC9572820 DOI: 10.3390/jcm11195550] [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: 08/16/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 12/24/2022] Open
Abstract
Only few studies have analyzed the associations of lower extremity artery disease (LEAD) with lumbar spinal stenosis (LSS), although it is expected to be a frequent association. With exercise-oximetry, we determined the presence of exercise-induced regional blood flow impairment (ischemia) in 5197 different patients complaining of claudication and referred for treadmill testing. We recorded height, weight, age, sex, ongoing treatments, cardiovascular risk factor (diabetes, high blood pressure, current smoking habit), and history of suspected or treated LSS and/or lower limb revascularization. An ankle-brachial index at rest < 0.90 or >1.40 on at least one side was considered indicative of the presence of LEAD (ABI+). Ischemia was defined as a minimal DROP (Limb-changes minus chest-changes from rest) value < −15 mmHg during exercise oximetry. We analyzed the clinical factors associated to the presence of exercise-induced ischemia in patients without a history of LSS, using step-by-step linear regression, and defined a score from these factors. This score was then tested in patients with a history of LSS. In 4690 patients without a history of (suspected, diagnosed, or treated) LSS, we observed that ABI+, male sex, antiplatelet treatment, BMI< 26.5 kg//m2, age ≤ 64 years old, and a history of lower limb arterial revascularization, were associated to the presence of ischemia. The value of the score derived from these factors was associated with the probability of exercise-induced ischemia in the 507 patients with a history of LSS. This score may help to suspect the presence of ischemia as a factor of walking impairment in patients with a history of lumbar spinal stenosis.
Collapse
|
6
|
Leutzinger TJ, Koutakis P, Fuglestad MA, Rahman H, Despiegelaere H, Hassan M, Schieber M, Johanning JM, Stergiou N, Longo GM, Casale GP, Myers SA, Pipinos II. Peripheral artery disease affects the function of the legs of claudicating patients in a diffuse manner irrespective of the segment of the arterial tree primarily involved. PLoS One 2022; 17:e0264598. [PMID: 35830421 PMCID: PMC9278728 DOI: 10.1371/journal.pone.0264598] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022] Open
Abstract
Different levels of arterial occlusive disease (aortoiliac, femoropopliteal, multi-level disease) can produce claudication symptoms in different leg muscle groups (buttocks, thighs, calves) in patients with peripheral artery disease (PAD). We tested the hypothesis that different locations of occlusive disease uniquely affect the muscles of PAD legs and produce distinctive patterns in the way claudicating patients walk. Ninety-seven PAD patients and 35 healthy controls were recruited. PAD patients were categorized to aortoiliac, femoropopliteal and multi-level disease groups using computerized tomographic angiography. Subjects performed walking trials both pain-free and during claudication pain and joint kinematics, kinetics, and spatiotemporal parameters were calculated to evaluate the net contribution of the calf, thigh and buttock muscles. PAD patients with occlusive disease affecting different segments of the arterial tree (aortoiliac, femoropopliteal, multi-level disease) presented with symptoms affecting different muscle groups of the lower extremity (calves, thighs and buttocks alone or in combination). However, no significant biomechanical differences were found between PAD groups during the pain-free conditions with minimal differences between PAD groups in the claudicating state. All statistical differences in the pain-free condition occurred between healthy controls and one or more PAD groups. A discriminant analysis function was able to adequately predict if a subject was a control with over 70% accuracy, but the function was unable to differentiate between PAD groups. In-depth gait analyses of claudicating PAD patients indicate that different locations of arterial disease produce claudication symptoms that affect different muscle groups across the lower extremity but impact the function of the leg muscles in a diffuse manner generating similar walking impairments.
Collapse
Affiliation(s)
- Todd J. Leutzinger
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, Nebraska, United States of America
| | - Panagiotis Koutakis
- Department of Biology, Baylor University, Wako, Texas, United States of America
| | - Matthew A. Fuglestad
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Hafizur Rahman
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, Nebraska, United States of America
- Department of Surgery and Research Service, Nebraska and Western Iowa Veterans Affairs Medical Center, Omaha, Nebraska, United States of America
| | - Holly Despiegelaere
- Department of Surgery and Research Service, Nebraska and Western Iowa Veterans Affairs Medical Center, Omaha, Nebraska, United States of America
| | - Mahdi Hassan
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, Nebraska, United States of America
- Department of Surgery and Research Service, Nebraska and Western Iowa Veterans Affairs Medical Center, Omaha, Nebraska, United States of America
| | - Molly Schieber
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Jason M. Johanning
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
- Department of Surgery and Research Service, Nebraska and Western Iowa Veterans Affairs Medical Center, Omaha, Nebraska, United States of America
| | - Nick Stergiou
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, Nebraska, United States of America
- Department of Environmental Agricultural and Occupational Health, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - G. Matthew Longo
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - George P. Casale
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Sara A. Myers
- Department of Biomechanics and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, Nebraska, United States of America
- Department of Surgery and Research Service, Nebraska and Western Iowa Veterans Affairs Medical Center, Omaha, Nebraska, United States of America
- * E-mail: (SAM); (IIP)
| | - Iraklis I. Pipinos
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
- Department of Surgery and Research Service, Nebraska and Western Iowa Veterans Affairs Medical Center, Omaha, Nebraska, United States of America
- * E-mail: (SAM); (IIP)
| |
Collapse
|
7
|
Semporé WY, Hersant J, Ramondou P, Hamel JF, Abraham P, Henni S. Exercise Oximetry Correlates Better With Exercise-Induced Lactate Increase, than Ankle Brachial Index or Walking Time, in Vascular Claudicants. Angiology 2022; 74:526-535. [PMID: 35816616 DOI: 10.1177/00033197221112132] [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: 11/17/2022]
Abstract
In claudication, the correlation between walking-induced biomarkers and indices of clinical severity (e.g., walking distance or ankle brachial index (ABI)), is fair. We hypothesized that a correlation would be observed between the clinical estimation of ischemia severity with exercise transcutaneous oximetry (Ex-TcpO2) and lactate increase. A prospective study was performed among 377 patients with arterial claudication. We recorded age, sex, ABI, body mass index (BMI), systolic arterial blood pressure (SBP), and glycemia. Capillary blood lactate was measured at rest and 3 min after a constant load treadmill test. We recorded maximum walking time (MWT), heart rate (HRmax), the sum of minimal decrease from oxygen values for buttocks, thighs and calves Ex-TcpO2 (DROPmin), as well as the amplitude of chest-TcpO2 decrease. A multilinear regression model was used to assess the variables associated with lactate increase. BMI, SBP, HRmax, the amplitude of decrease in chest-TcpO2 and DROPmin, but not age, sex, ABI, MWT, diabetes mellitus nor glycemia, were significantly associated to lactate increase in the model. Because it accounts for the severity and diffusion of lower-limb exercise-induced ischemia and detects exercise induced hypoxemia, TcpO2 may be preferable to ABI or MWT to estimate the metabolic consequences of walking in claudicants.
Collapse
Affiliation(s)
- Wendsèndaté Yves Semporé
- 307960Centre MURAZ, National Institute of Public Health, Bobo Dioulasso, Burkina Faso.,MitoVasc Institute UMR CNRS 6015 / INSERM 1083, Angers, France
| | - Jeanne Hersant
- MitoVasc Institute UMR CNRS 6015 / INSERM 1083, Angers, France.,Vascular Medicine, 551564University Hospital of Angers, Pays de la Loire, France
| | - Pierre Ramondou
- MitoVasc Institute UMR CNRS 6015 / INSERM 1083, Angers, France.,Vascular Medicine, 551564University Hospital of Angers, Pays de la Loire, France
| | - Jean François Hamel
- Department of Biostatistics, 26966University Hospital of Angers, Pays de la Loire, France
| | - Pierre Abraham
- MitoVasc Institute UMR CNRS 6015 / INSERM 1083, Angers, France.,Vascular Medicine, 551564University Hospital of Angers, Pays de la Loire, France.,Sports Medicine, 26966University Hospital of Angers, Pays de la Loire, France
| | - Samir Henni
- Vascular Medicine, 551564University Hospital of Angers, Pays de la Loire, France
| |
Collapse
|
8
|
Relationship Between the Severity of Exercise Induced Ischaemia and the Prevalence of Exercise Induced Calf Symptoms During Treadmill Testing With Transcutaneous Oximetry. Eur J Vasc Endovasc Surg 2022; 63:707-713. [DOI: 10.1016/j.ejvs.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/30/2021] [Accepted: 01/16/2022] [Indexed: 11/21/2022]
|
9
|
Hersant J, Lecoq S, Ramondou P, Papon X, Feuilloy M, Abraham P, Henni S. Relationship Between Inflow Impairment and Skin Oxygen Availability to the Upper Limb During Standardized Arm Abduction in Patients With Suspected Thoracic Outlet Syndrome. Front Physiol 2022; 13:726315. [PMID: 35222068 PMCID: PMC8874319 DOI: 10.3389/fphys.2022.726315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Thoracic outlet syndrome (TOS) should be considered of arterial origin only if patients have clinical symptoms that are the result of documented symptomatic ischemia. Simultaneous recording of inflow impairment and forearm ischemia in patients with suspected TOS has never been reported to date. We hypothesized that ischemia would occur in cases of severely impaired inflow, resulting in a non-linear relationship between changes in pulse amplitude (PA) and the estimation of ischemia during provocative attitudinal upper limb positioning. Design Prospective single center interventional study. Material Fifty-five patients with suspected thoracic outlet syndrome. Methods We measured the minimal decrease from rest of transcutaneous oximetry pressure (DROPm) as an estimation of oxygen deficit and arterial pulse photo-plethysmography to measure pulse amplitude changes from rest (PA-change) on both arms during the candlestick phase of a “Ca + Pra” maneuver. “Ca + Pra” is a modified Roos test allowing the estimation of maximal PA-change during the “Pra” phase. We compared the DROPm values between deciles of PA-changes with ANOVA. We then analyzed the relationship between mean PA-change and mean DROPm of each decile with linear and second-degree polynomial (non-linear) models. Results are reported as median [25/75 centiles]. Statistical significance was p < 0.05. Results DROPm values ranged −11.5 [−22.9/−7.2] and − 12.3 [−23.3/−7.4] mmHg and PA-change ranged 36.4 [4.6/63.8]% and 38.4 [−2.0/62.1]% in the right and left forearms, respectively. The coefficient of determination between median DROPm and median PA-change was r2 = 0.922 with a second-degree polynomial fitting, but only r2 = 0.847 with a linear approach. Conclusion Oxygen availability was decreased in cases of severe but not moderate attitudinal inflow impairments. Undertaking simultaneous A-PPG and forearm oximetry during the “Ca + Pra” maneuver is an interesting approach for providing objective proof of ischemia in patients with symptoms of TOS suspected of arterial origin.
Collapse
Affiliation(s)
| | - Simon Lecoq
- Vascular Medicine, University Hospital, Angers, France
| | - Pierre Ramondou
- Vascular Medicine, University Hospital, Angers, France
- UMR CNRS 1083 INSERM 6015, LUNAM University, Angers, France
| | - Xavier Papon
- Service of Thoracic and Vascular Surgery, University Hospital, Angers, France
| | - Mathieu Feuilloy
- School of Electronics (ESEO), Angers, France
- UMR CNRS 6613 LAUM, Le Mans, France
| | - Pierre Abraham
- Vascular Medicine, University Hospital, Angers, France
- UMR CNRS 1083 INSERM 6015, LUNAM University, Angers, France
- Sports and Exercise Medicine, University Hospital, Angers, France
- *Correspondence: Pierre Abraham,
| | - Samir Henni
- Vascular Medicine, University Hospital, Angers, France
- UMR CNRS 1083 INSERM 6015, LUNAM University, Angers, France
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Semporé WY, Chao De La Barca JM, Hersant J, Ouédraogo N, Yaméogo TM, Henni S, Reynier P, Abraham P. Exercise-Induced Plasma Metabolomic Profiles in Patients With Peripheral Arterial Disease. Front Physiol 2021; 12:758085. [PMID: 34867463 PMCID: PMC8637284 DOI: 10.3389/fphys.2021.758085] [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] [Accepted: 10/19/2021] [Indexed: 11/26/2022] Open
Abstract
Aim: A better knowledge of the biological consequences in the blood of these exercise-induced ischemic events in lower extremity artery disease (LEAD) may improve the prospects of disease management. We explored the preminus postexercise metabolomic difference in 39 patients with LEAD referred for a treadmill oximetry test [transcutaneous oximetry (TcPO2)]. Methods: Ischemia was estimated through the sum of decrease from rest of oxygen pressure (DROPs) (limb TcPO2 changes minus chest TcPO2 changes) at buttocks, thighs, and calves regions. Targeted metabolomic analyses measuring 188 metabolites were performed on a few microliters blood samples taken at the earlobe at rest and 3 min after exercise. Results: Maximum walking distance (MWD) was 290 m (120–652 m) and ankle brachial index (ABI) was 0.67 ± 0.17. Supervised paired partial least squares discriminant analysis based on 23,345 models showed good predictive performance for test sets with a median area under the receiver operating characteristic (AUROC) curve value of 0.99 and a p-value of 0.00049. The best discriminant metabolites contributing to the model included a subset of 71 (47%) of the 150 accurately measured metabolites in the plasma, comprising 3 acylcarnitines, 3 amino acids, 5 biogenic amines, 9 sphingomyelin, 7 lysophosphatidylcholines, and 44 phosphatidylcholines. In addition, 16 of these metabolites were found to correlate with one or more severity scores of the LEAD. Conclusion: Our results provide new insights into the biological changes that accompany exercise in LEAD and contribute to a better understanding of walking impairment pathophysiology in LEAD, highlighting new candidate biomarkers.
Collapse
Affiliation(s)
- Wendsèndaté Yves Semporé
- Centre MURAZ, National Institute of Public Health, Bobo Dioulasso, Burkina Faso.,Sports Medicine Department, University Hospital of Angers, Angers, France.,MitoVasc Research Unit, CNRS 6015, INSERM U-1083, University of Angers, Angers, France
| | - Juan Manuel Chao De La Barca
- MitoVasc Research Unit, CNRS 6015, INSERM U-1083, University of Angers, Angers, France.,Biochemistry and Molecular Biology Laboratory, University Hospital of Angers, Angers, France
| | - Jeanne Hersant
- Vascular Medicine Department, University Hospital of Angers, Angers, France
| | - Nafi Ouédraogo
- Physiology, Nazi Boni University, Bobo Dioulasso, Burkina Faso
| | | | - Samir Henni
- MitoVasc Research Unit, CNRS 6015, INSERM U-1083, University of Angers, Angers, France.,Vascular Medicine Department, University Hospital of Angers, Angers, France
| | - Pascal Reynier
- MitoVasc Research Unit, CNRS 6015, INSERM U-1083, University of Angers, Angers, France.,Biochemistry and Molecular Biology Laboratory, University Hospital of Angers, Angers, France
| | - Pierre Abraham
- Sports Medicine Department, University Hospital of Angers, Angers, France.,MitoVasc Research Unit, CNRS 6015, INSERM U-1083, University of Angers, Angers, France.,Vascular Medicine Department, University Hospital of Angers, Angers, France
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
de Müllenheim PY, Rouvière L, Emily M, Chaudru S, Kaladji A, Mahé G, Le Faucheur A. "Should I stay or should I go now?" Recovery time effect on walking capacity in symptomatic peripheral artery disease. J Appl Physiol (1985) 2021; 131:207-219. [PMID: 33982591 DOI: 10.1152/japplphysiol.00441.2020] [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: 11/22/2022] Open
Abstract
The objective of the study was to investigate the effect of recovery time on walking capacity (WC) throughout repeated maximal walking bouts in symptomatic lower-extremity peripheral artery disease (PAD). The effect of recovery time on WC (maximal walking time) was determined in 21 participants with PAD in three experimental conditions [recovery time from 0.5 to 9.5 min + a self-selected recovery time (SSRT)]: 1) 11 repeated sequences of two treadmill walking bouts (TW-ISO); 2) a single sequence of seven treadmill walking bouts (TW-CONS); 3) a single sequence of seven outdoor walking bouts (OW-CONS). Exercise transcutaneous oxygen pressure changes were continuously recorded as an indirect measure of ischemia. An individual recovery time (IRT) beyond which WC did not substantially increased was determined in participants with a logarithmic fit. At the group level, mixed models showed a significant effect (P < 0.001) of recovery time on WC restoration. At the participant level, strong logarithmic relationships were found (median significant R2 ≥ 0.78). The median SSRT corresponded to a median work-to-rest ratio >1:1 (i.e., a lower recovery time in view of the corresponding previous walking time) and was related to unrecovered ischemia and a WC restoration level of <80%. A median work-to-rest ratio of ≤1:2 allowed full recovery of ischemia and full restoration of WC. The IRT ratio was between 1:1 and 1:2 and corresponded to the start of recovery from ischemia. Recovery time affects the restoration level of WC during repeated maximal walking bouts in symptomatic PAD. Meaningful variations in WC restoration were related to specific levels of work-to-rest ratios.NEW & NOTEWORTHY This study demonstrated that there is a significant and mostly logarithmic effect of recovery time on walking capacity in people with symptomatic PAD. This study revealed that a median work-to-rest ratio >1:1 leads to the resumption of walking with unrecovered ischemia and precludes the restoration of full walking capacity, whereas a work-to-rest ratio ≤1:2 allowed walking capacity to fully be restored.
Collapse
Affiliation(s)
- Pierre-Yves de Müllenheim
- Institute of Physical Education and Sports Sciences (IFEPSA), West Catholic University (UCO), Les Ponts-de-Cé, France
| | | | - Mathieu Emily
- Institut Agro, CNRS, University of Rennes, IRMAR-UMR CNRS 6625, Rennes, France
| | - Ségolène Chaudru
- Clinical Investigation Center, INSERM CIC, Rennes, France.,University of Rennes, Rennes, France
| | - Adrien Kaladji
- Department of Cardiothoracic and Vascular Surgery, University Hospital Rennes, Rennes, France
| | - Guillaume Mahé
- Clinical Investigation Center, INSERM CIC, Rennes, France.,University of Rennes, Rennes, France.,Vascular Medicine Unit, University Hospital Rennes, Rennes, France
| | - Alexis Le Faucheur
- Clinical Investigation Center, INSERM CIC, Rennes, France.,Univ Rennes, M2S-EA 7470, Rennes, France
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
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, Behar T, Bérard X, Breteau C, Brisot D, Chleir F, Choquenet C, Coscas R, Detriché G, Elias M, Ezzaki K, Fiori S, Gaertner S, Gaillard C, Gaudout C, Gauthier CE, Georg Y, Hertault A, Jean-Baptiste E, Joly M, Kaladji A, Laffont J, Laneelle D, Laroche JP, Lejay A, Long A, Loric T, Madika AL, Magnou B, Maillard JP, Malloizel J, Miserey G, Moukarzel A, Mounier-Vehier C, Nasr B, Nelzy ML, Nicolini P, Phelipot JY, Sabatier J, Schaumann G, Soudet S, Tissot A, Tribout L, Wautrecht JC, Zarca C, Zuber A. Disparities Between International Guidelines (AHA/ESC/ESVS/ESVM/SVS) Concerning Lower Extremity Arterial Disease: Consensus of the French Society of Vascular Medicine (SFMV) and the French Society for Vascular and Endovascular Surgery (SCVE). Ann Vasc Surg 2021; 72:1-56. [DOI: 10.1016/j.avsg.2020.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/05/2020] [Indexed: 12/24/2022]
|
16
|
Guilleron C, Abraham P, Beaune B, Pouliquen C, Henni S, Durand S. Location of ischemia and ischemic pain intensity affect spatiotemporal parameters and leg muscles activity during walking in patients with intermittent claudication. Sci Rep 2021; 11:6809. [PMID: 33762658 PMCID: PMC7990938 DOI: 10.1038/s41598-021-86351-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 03/07/2021] [Indexed: 12/31/2022] Open
Abstract
The ways in which locations of ischemia and ischemic pain affect spatiotemporal gait parameters and leg electromyographic activity during walking have never been investigated in patients with peripheral arterial disease presenting intermittent claudication. Two groups were classified according to unilateral location of ischemia (distal, n = 10, or proximo-distal, n = 12). Patients described pain and three gait phases-initial pain-free, onset of pain and maximum pain-were analyzed. Patients with proximo-distal ischemia walked less (230 ± 111 m vs 384 ± 220 m), with increased step length, step time (+ 5.4% and + 5.8%) and reduced cadence (- 8.2%), than patients with distal ischemia. In both, the peaks of vertical ground reaction force were reduced in maximum pain (Peak1-distal: - 11.4%, Peak1-proximo-distal: - 10.3%; Peak2-distal: - 11.8%, Peak2-proximo-distal: - 9.0%). In the proximo-distal group, tibialis anterior activation peak and time were lower than in the distal group (- 4.5% and - 19.7%). During the maximum pain phase, this peak decreased only in the proximo-distal group (- 13.0%), and gastrocnemius medialis activation peak and time decreased in both groups (- 2.5% in distal and - 4.5% in proximo-distal). Thus, proximo-distal ischemia leads to more adverse consequences in gait than distal ischemia only. Increasing ischemic pain until maximum, but not onset of pain, induced gait adaptations.
Collapse
Affiliation(s)
- Céline Guilleron
- Le Mans Université, Movement-Interactions-Performance, MIP, EA 4334, 72000, Le Mans, France.,UMR CNRS 6015 INSERM 1083, University of Angers, 4 rue Larrey, 49100, Angers, France.,Department of Vascular Medicine, University Hospital of Angers, 4 rue Larrey, 49100, Angers, France
| | - Pierre Abraham
- Sports Medicine, University Hospital of Angers, 4 rue Larrey, 49100, Angers, France.,UMR CNRS 6015 INSERM 1083, University of Angers, 4 rue Larrey, 49100, Angers, France
| | - Bruno Beaune
- Le Mans Université, Movement-Interactions-Performance, MIP, EA 4334, 72000, Le Mans, France
| | - Camille Pouliquen
- Le Mans Université, Movement-Interactions-Performance, MIP, EA 4334, 72000, Le Mans, France
| | - Samir Henni
- UMR CNRS 6015 INSERM 1083, University of Angers, 4 rue Larrey, 49100, Angers, France.,Department of Vascular Medicine, University Hospital of Angers, 4 rue Larrey, 49100, Angers, France
| | - Sylvain Durand
- Le Mans Université, Movement-Interactions-Performance, MIP, EA 4334, 72000, Le Mans, France. .,Laboratory "Movement, Interactions, Performance", MIP, EA 4334, Le Mans University, Avenue Olivier Messiaen, 72085, Le Mans Cedex 9, France.
| |
Collapse
|
17
|
Guilleron C, Beaune B, Durand S, Pouliquen C, Henni S, Abraham P. Gait alterations in patient with intermittent claudication: Effect of unilateral vs bilateral ischemia. Clin Physiol Funct Imaging 2021; 41:292-301. [PMID: 33675152 DOI: 10.1111/cpf.12698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND We seek to evaluate whether ischemia extent (unilateral or bilateral) impacts spatiotemporal and neuromuscular gait parameters differently in patients with peripheral arterial disease and presenting intermittent claudication (PAD-IC). METHODS Two groups of PAD-IC patients: unilateral (Unilat-IC; n = 15), bilateral (Bilat-IC; n = 15) and a group of control subjects with similar risk factors (n = 15) were evaluated during a constant load treadmill walking test. Spatiotemporal parameters and neuromuscular activation in tibialis anterior and gastrocnemius medialis were recorded. Patients were instructed to describe their pain during walking test, and three phases were analysed: pain-free, onset of pain and maximum pain in PAD-IC patients. FINDINGS Single leg stance in the asymptomatic leg of Unilat-IC increases and becomes higher than the symptomatic leg and the Bilat-IC legs at maximum pain. Step time is higher and cadence is lower in PAC-IC than in controls. Tibialis anterior activation peak in Unilat-IC continuously decreases between phases and becomes lower than in Bilat-IC during maximum pain. Tibialis anterior activation time is higher in Bilat-IC and in the asymptomatic leg than in the symptomatic of Unilat-IC during all the phases. Gastrocnemius medialis activation peak in Bilat-IC decreases with pain. Gastrocnemius medialis activation time in the symptomatic leg of Unilat-IC presents a significant decrease between pain-free and maximum pain phases. INTERPRETATION Ischemia impacts gait in PAD-IC patients differently according to its extent between legs compared to controls. Imbalance between legs in Unilat-IC induces compensatory mechanism and an asymmetrical pattern. Bilat-IC should not be simply considered as a 'double' Unilat-IC when evaluating gait.
Collapse
Affiliation(s)
- Céline Guilleron
- Le Mans Université, Movement - Interactions - Performance, MIP, Le Mans, France.,UMR CNRS 6015 INSERM 1083, University of Angers, Angers, France.,Department of Vascular Medicine, University hospital of Angers, Angers, France
| | - Bruno Beaune
- Le Mans Université, Movement - Interactions - Performance, MIP, Le Mans, France
| | - Sylvain Durand
- Le Mans Université, Movement - Interactions - Performance, MIP, Le Mans, France
| | - Camille Pouliquen
- Le Mans Université, Movement - Interactions - Performance, MIP, Le Mans, France
| | - Samir Henni
- UMR CNRS 6015 INSERM 1083, University of Angers, Angers, France.,Department of Vascular Medicine, University hospital of Angers, Angers, France
| | - Pierre Abraham
- UMR CNRS 6015 INSERM 1083, University of Angers, Angers, France.,Sports Medicine, University Hospital of Angers, Angers, France
| |
Collapse
|
18
|
Guilleron C, Maktouf W, Beaune B, Henni S, Abraham P, Durand S. Coactivation pattern in leg muscles during treadmill walking in patients suffering from intermittent claudication. Gait Posture 2021; 84:245-253. [PMID: 33383535 DOI: 10.1016/j.gaitpost.2020.12.008] [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: 01/21/2020] [Revised: 10/26/2020] [Accepted: 12/08/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND In patients with peripheral arterial disease and presenting intermittent claudication (PAD-IC), the pain due to ischemia impacts gait parameters, particularly in cases of unilateral disease. Deterioration of gait parameters in a pathological context is frequently associated with increased coactivation (simultaneous activation of agonist and antagonist muscles around a joint). RESEARCH QUESTION Does unilateral PAD-IC affect the coactivation pattern during walking? Does the coactivation pattern change with increasing pain intensity? METHOD We evaluated symptomatic and asymptomatic legs in 17 subjects with unilateral PAD-IC and 16 without PAD-IC (control group), during walking. Tibialis anterior (TA) and gastrocnemius medialis (GM) electromyographic activity, and peaks of vertical ground reaction force were recorded in this prospective study. We analyzed the coactivation index (CI(GM/TA)) during three periods (pain-free, pain and maximum pain) and phases of the gait cycle. Statistical analysis was carried out using the ANOVA procedure. RESULTS During single support, CI(GM/TA) increases in the symptomatic leg during the pain period (+28 %) and in the asymptomatic leg during the maximum pain period (+29 %). During second double support, CI(GM/TA) increases in the symptomatic leg only (+49 %). In these gait phases, pain elicits differences in CI(GM/TA) between legs (p < 0.05). Second peak force decreases in the symptomatic leg only (-9%) and is negatively correlated with CI(GM/TA) during the three periods (r = -0.57; -0.76 and -0.78 respectively, p < 0.05). No difference is found in the control group. SIGNIFICANCE The appearance and development of pain in the lower limbs is associated with a higher level of CI(GM/TA), revealing a compensatory gait pattern in PAD-IC patients. Optimal prevention, rehabilitation and re-training strategies for PAD-IC patients should take into consideration neuromuscular compensatory mechanisms between asymptomatic and symptomatic legs.
Collapse
Affiliation(s)
- Céline Guilleron
- Le Mans Université, Movement - Interactions - Performance, MIP, EA 4334, F-72000, Le Mans, France; UMR CNRS 6015 INSERM 1083, University of Angers, 4 rue Larrey, 49100, Angers, France; Department of Vascular Medicine, University Hospital of Angers, 4 rue Larrey, 49100 Angers, France
| | - Waël Maktouf
- Le Mans Université, Movement - Interactions - Performance, MIP, EA 4334, F-72000, Le Mans, France
| | - Bruno Beaune
- Le Mans Université, Movement - Interactions - Performance, MIP, EA 4334, F-72000, Le Mans, France
| | - Samir Henni
- UMR CNRS 6015 INSERM 1083, University of Angers, 4 rue Larrey, 49100, Angers, France; Department of Vascular Medicine, University Hospital of Angers, 4 rue Larrey, 49100 Angers, France
| | - Pierre Abraham
- Sports Medicine, University Hospital of Angers, 4 rue Larrey, 49100, Angers, France; UMR CNRS 6015 INSERM 1083, University of Angers, 4 rue Larrey, 49100, Angers, France
| | - Sylvain Durand
- Le Mans Université, Movement - Interactions - Performance, MIP, EA 4334, F-72000, Le Mans, France.
| |
Collapse
|
19
|
Hersant J, Ramondou P, Picquet J, Feuilloy M, Abraham P, Henni S. Calf and non-calf hemodynamic recovery in patients with arterial claudication: Implication for exercise training. Microvasc Res 2021; 135:104143. [PMID: 33515566 DOI: 10.1016/j.mvr.2021.104143] [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: 01/04/2021] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Previous studies in patients with arterial claudication have focused on calf hemodynamic recovery. We hypothesized that the duration of hemodynamic recovery with TcpO2 at calf and non-calf levels would be shorter than 10 min. We analyzed the factors that influence the recovery time. METHODS We monitored limb changes minus chest changes from rest (DROP) of transcutaneous oximetry on buttocks, thighs and calves, during and following a treadmill test (3.2 km/h; 10% grade). We calculated the time required to reach 50% (50%RT) and 10% (90%RT) of minimal DROP value (DROPm) from walking cessation. Regression analyses were used to determine the factors associated to 50%RT and 90%RT. RESULTS Of the 132 patients studied, 18.2% reported isolated non-calf pain by history. Of the 792 recovery time values, only 3 (0.4%) and 23 (2.9%) were in excess of 10 min for 50%RT and for 90%RT, respectively. A weak correlation was found between each of the 792 DROPm and 50%RT (r = -0.270, p < 0.001) as well as for 90%RT (r = -0.311 p < 0.001). Lowest DROPm and BMI (but not age, sex, the use of beta-blockers, the duration of the walking period) were associated to both 50%RT and 90%RT. CONCLUSION Although recovery duration correlates significantly with the severity of ischemia of the same location, a wide discrepancy exists and the longest recovery time does not always correlate to the localization of the most severe ischemia. Non-calf ischemia should be measured when one aims at objectifying the biological effects of exercise or the effects of treatments on recovery from exercise.
Collapse
Affiliation(s)
| | | | - Jean Picquet
- MitoVasc Institute UMR CNRS 6015/INSERM 1083, Faculty of Medicine, Angers University, France; Thoracic and Vascular Surgery, University Hospital, Angers, France
| | | | - Pierre Abraham
- MitoVasc Institute UMR CNRS 6015/INSERM 1083, Faculty of Medicine, Angers University, France; Sports Medicine, University Hospital Center, Angers, France.
| | - Samir Henni
- Vascular Medicine, University Hospital, Angers, France; MitoVasc Institute UMR CNRS 6015/INSERM 1083, Faculty of Medicine, Angers University, France
| |
Collapse
|
20
|
The hidden side of calf claudication: Hemodynamic and clinical results of treadmill testing in 584 patients complaining of isolated exertional calf pain. Atherosclerosis 2020; 314:41-47. [DOI: 10.1016/j.atherosclerosis.2020.10.891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/07/2020] [Accepted: 10/28/2020] [Indexed: 12/25/2022]
|
21
|
Abraham P, Hersant J, Ramondou P, Thouveny F, Feuilloy M, Picquet J, Henni S. Comparison of transcutaneous oximetry with symptoms and arteriography in thoracic outlet syndrome. Clin Hemorheol Microcirc 2020; 75:107-119. [PMID: 31929152 DOI: 10.3233/ch-190751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Non-invasive tests are still required to improve the holistic diagnostic approach of thoracic outlet syndrome (TOS). OBJECTIVES We aimed to analyze the diagnostic accuracy of the decrease from rest oxygen pressure (DROP) index of transcutaneous oximetry (TcpO2) in TOS. METHODS Seventy-six patients and 40 asymptomatic volunteers (Controls) were enrolled. In TOS-suspected patients, the arteriograms were investigated for the presence of≥75% stenosis. The area under receiver operating characteristics curve (AUC) analysis tested the ability of forearm TcpO2 during provocative maneuvers to discriminate patients from controls and, to predict a positive arteriographic findings in the 44 TOS-suspected patients that had an arteriography. RESULTS The media [25/75° centile] DROP values of controls and patients were -14 [-8/-22] mmHg and -22 [-12/-42] mmHg, respectively (p for Mann-Whitney<0.02). AUC analysis showed a significant ability of TcpO2 to predict the presence of subclavian arterial compression on arteriography (AUC, 0.694). CONCLUSIONS Although time consuming, tcpO2 is independent of the observer expertise and could be useful in TOS-suspected patients to select the patients that should undergo arteriography.
Collapse
Affiliation(s)
- Pierre Abraham
- Exercise investigation and Sports Medicine, University Hospital, Angers, France.,UMR CNRS 6015, INSERM 1228, Medical School, University of Angers, France
| | | | | | | | | | - Jean Picquet
- UMR CNRS 6015, INSERM 1228, Medical School, University of Angers, France.,Thoracic and Vascular Surgery, University Hospital, Angers, France
| | - Samir Henni
- UMR CNRS 6015, INSERM 1228, Medical School, University of Angers, France.,Vascular Radiology, University Hospital, Angers, France
| |
Collapse
|
22
|
Swartz HM, Flood AB, Schaner PE, Halpern H, Williams BB, Pogue BW, Gallez B, Vaupel P. How best to interpret measures of levels of oxygen in tissues to make them effective clinical tools for care of patients with cancer and other oxygen-dependent pathologies. Physiol Rep 2020; 8:e14541. [PMID: 32786045 PMCID: PMC7422807 DOI: 10.14814/phy2.14541] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 02/07/2023] Open
Abstract
It is well understood that the level of molecular oxygen (O2 ) in tissue is a very important factor impacting both physiology and pathological processes as well as responsiveness to some treatments. Data on O2 in tissue could be effectively utilized to enhance precision medicine. However, the nature of the data that can be obtained using existing clinically applicable techniques is often misunderstood, and this can confound the effective use of the information. Attempts to make clinical measurements of O2 in tissues will inevitably provide data that are aggregated over time and space and therefore will not fully represent the inherent heterogeneity of O2 in tissues. Additionally, the nature of existing techniques to measure O2 may result in uneven sampling of the volume of interest and therefore may not provide accurate information on the "average" O2 in the measured volume. By recognizing the potential limitations of the O2 measurements, one can focus on the important and useful information that can be obtained from these techniques. The most valuable clinical characterizations of oxygen are likely to be derived from a series of measurements that provide data about factors that can change levels of O2 , which then can be exploited both diagnostically and therapeutically. The clinical utility of such data ultimately needs to be verified by careful studies of outcomes related to the measured changes in levels of O2 .
Collapse
Affiliation(s)
- Harold M Swartz
- Department of Radiology, Dartmouth Medical School, Hanover, NH, USA
- Department of Medicine, Section of Radiation Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Ann Barry Flood
- Department of Radiology, Dartmouth Medical School, Hanover, NH, USA
| | - Philip E Schaner
- Department of Medicine, Section of Radiation Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Howard Halpern
- Department Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
| | - Benjamin B Williams
- Department of Radiology, Dartmouth Medical School, Hanover, NH, USA
- Department of Medicine, Section of Radiation Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Bernard Gallez
- Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Peter Vaupel
- Department Radiation Oncology, University Medical Center, University of Freiburg, Freiburg, Germany
- German Cancer Center Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| |
Collapse
|
23
|
Guilleron C, Durand S, Maktouf W, Henni S, Abraham P, Beaune B. Rearfoot-forefoot profile defined by vertical ground reaction forces during gait is altered in patients with unilateral intermittent claudication. J Biomech 2020; 109:109966. [DOI: 10.1016/j.jbiomech.2020.109966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
|
24
|
Gahier M, Hersant J, Hamel JF, Sempore Y, Bruneau A, Henni S, Abraham P. A Simple Scale for Screening Lower-Extremity Arterial Disease as a Possible Cause of Low Back Pain: a Cross-sectional Study Among 542 Subjects. J Gen Intern Med 2020; 35:1963-1970. [PMID: 32367389 PMCID: PMC7351938 DOI: 10.1007/s11606-020-05670-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/13/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Epidemiological, imaging, and anatomical studies suggest an association between proximal arterial atherosclerosis and development of low back pain (LBP). OBJECTIVES We aimed to define (1) the frequency and (2) factors associated with exercise-induced proximal ischemia (EIPI) in individuals with LBP and (3) develop a clinical screening scale. DESIGN Monocentric cross-sectional study. PARTICIPANTS All patients with history of ongoing LBP referred to our exercise investigation laboratory for exercise transcutaneous oximetry (ex-tcPO2) between January 2011 and December 2017 (n = 542; mean age, 65.4 ± 10.9; 83.9% men). MAIN MEASURES EIPI was defined as a decrease from rest of oxygen pressure (DROP) below - 15 mmHg on the lumbar and/or buttock probes. Ex-tcPO2 is a reliable validated tool for diagnosing EIPI in comparison with arteriography and computed tomography angiography. Ex-tcPO2 was performed on a treadmill until symptom manifestation or exhaustion. Clinical data were collected using interview questionnaires, medical file review, and clinical examination. KEY RESULTS EIPI was diagnosed in 282 patients (52%). Age ≤ 70 years (OR, 2.22; 95% CI, 1.35-3.57; p = 0.002), a history of proximal revascularization (OR, 2.64; 95% CI, 1.50-4.65; p = 0.001), use of antiplatelet medication (OR, 1.71; 95% CI, 0.96-3.06; p = 0.069), a relationship between exercise and LBP (OR, 2.61; 95% CI, 1.49-4.57; p = 0.001), and an abnormal ankle to brachial index (OR, 2.87; 95% CI, 1.77-4.66; p < 0.0001) were identified as EIPI predictors. Using these items, we developed a screening scale that showed an area under the receiver operating characteristics curve of .756. At a score of ≥ 3, the sensitivity, specificity, and accuracy for EIPI were 84%, 55%, and 71%, respectively. CONCLUSIONS EIPI was common among our patients with LBP undergoing ex-TcPO2. Our screening scale could help better select the patients who require angiography.
Collapse
Affiliation(s)
- M Gahier
- Sports Medicine and Exercise Investigations, University Hospital, Angers, France.
| | - J Hersant
- Vascular Medicine, University Hospital, Angers, France
| | - J F Hamel
- Methodology and Biostatistics Department, Angers University Hospital, Angers, France
| | - Y Sempore
- Sports Medicine and Exercise Investigations, University Hospital, Angers, France
| | - A Bruneau
- Sports Medicine and Exercise Investigations, University Hospital, Angers, France
| | - S Henni
- Vascular Medicine, University Hospital, Angers, France
- UMR INSERM 1083 - CNRS 6015, Angers University Hospital, Angers, France
| | - P Abraham
- Sports Medicine and Exercise Investigations, University Hospital, Angers, France
- Vascular Medicine, University Hospital, Angers, France
- UMR INSERM 1083 - CNRS 6015, Angers University Hospital, Angers, France
| |
Collapse
|
25
|
Capsule Commentary on Gahier et al., a Simple Scale for Screening Lower-Extremity Arterial Disease as a Possible Cause of Low Back Pain. A Cross Sectional Study Among 542 Subjects. J Gen Intern Med 2020; 35:2250. [PMID: 32076971 PMCID: PMC7351904 DOI: 10.1007/s11606-020-05709-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
26
|
Ritti-Dias RM. Editorial Commentary: The use of transcutaneous oxygen pressure measurement during exercise to assess buttock claudication: The importance to test interventions. Trends Cardiovasc Med 2020; 31:224. [PMID: 32380074 DOI: 10.1016/j.tcm.2020.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
|
27
|
Mahé G, Catillon F, Tollenaere Q, Jéhannin P, Guilcher A, Le Pabic E, Lesager G, Omarjee L, Le Faucheur A. Discordance of peripheral artery disease diagnosis using exercise transcutaneous oxygen pressure measurement and post-exercise ankle-brachial index. Sci Rep 2020; 10:7419. [PMID: 32366896 PMCID: PMC7198590 DOI: 10.1038/s41598-020-64276-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/07/2020] [Indexed: 12/24/2022] Open
Abstract
In patients with exertional limb symptoms and normal ankle-brachial index (ABI) at rest, exercise testing can be used to diagnose lower extremity arterial disease (LEAD). Post-exercise ABI decrease or Exercise transcutaneous oxygen pressure measurement (Exercise-TcPO2) can be used to diagnose LEAD. Objectives were (i) to assess the agreement between both methods (ii) to define the variables associated with the discordance, and (iii) to present results of healthy subjects. In this prospective cross-sectional study, patients with exertional limb symptoms and normal rest ABI were consecutively included. ABI was measured at rest and after standardized exercise protocol as well as Exercise-TcPO2. A kappa coefficient with a 95% confidence interval was used to assess the agreement between the two methods. Logistic regression analysis was performed to outline variables potentially responsible for discordance. Ninety-six patients were included. The agreement between the tests was weak with a k value of 0.23 [0.04–0.41]. Logistic regression analysis found that a medical history of lower extremity arterial stenting (odds ratio 5.85[1.68–20.44]) and age (odds ratio 1.06[1.01–1.11]) were the main cause of discordance. This study suggests that post-exercise ABI and Exercise-TcPO2 cannot be used interchangeably for the diagnosis of LEAD in patients with exertional symptoms and normal rest ABI.
Collapse
Affiliation(s)
- G Mahé
- Vascular Medicine Unit, CHU, Rennes, France. .,Univ Rennes 1; INSERM CIC 1414, Rennes, France.
| | - F Catillon
- Vascular Medicine Unit, CHU, Rennes, France
| | | | - P Jéhannin
- Univ Rennes 1; INSERM CIC 1414, Rennes, France
| | - A Guilcher
- Vascular Medicine Unit, CHU, Rennes, France
| | - E Le Pabic
- CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), F-35000, Rennes, France
| | - G Lesager
- Vascular Medicine Unit, CHU, Rennes, France.,CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), F-35000, Rennes, France
| | - L Omarjee
- Vascular Medicine Unit, CHU, Rennes, France.,CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), F-35000, Rennes, France.,Vascular Medicine, Hospital, Redon, France
| | - A Le Faucheur
- Ecole Normale Supérieure, Bruz, France.,Univ Rennes, M2S - EA 7470, F-35000, Rennes, France
| |
Collapse
|
28
|
Sempore WY, Ramondou P, Hersant J, Feuilloy M, Guilleron C, Henni S, Abraham P. Specific slow tests are not mandatory in patients with extremely short standard (3.2 km/hr 10% slope) test durations during exercise oximetry. Clin Physiol Funct Imaging 2020; 40:232-237. [DOI: 10.1111/cpf.12626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/10/2019] [Accepted: 02/23/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Wendsèndaté Yves Sempore
- Department of Vascular Medicine University Hospital Angers Angers France
- Centre Muraz National Institut of Public Health Bobo dioulaso Burkina Faso
| | - Pierre Ramondou
- Department of Vascular Medicine University Hospital Angers Angers France
| | - Jeanne Hersant
- Department of Vascular Medicine University Hospital Angers Angers France
| | | | - Celine Guilleron
- Department of Sports medicine University Hospital Angers Angers France
- Department of Sports Sciences University Le mans Le mans France
| | - Samir Henni
- Department of Vascular Medicine University Hospital Angers Angers France
- UMR Mitovasc CNRS6015‐INSERM 1083 University of Angers Angers France
| | - Pierre Abraham
- Department of Vascular Medicine University Hospital Angers Angers France
- Department of Sports medicine University Hospital Angers Angers France
- UMR Mitovasc CNRS6015‐INSERM 1083 University of Angers Angers France
| |
Collapse
|
29
|
Abraham P, Ramondou P, Hersant J, Sempore WY, Feuilloy M, Henni S. Investigation of arterial claudication with transcutaneous oxygen pressure at exercise: Interests and limits. Trends Cardiovasc Med 2020; 31:218-223. [PMID: 32234333 DOI: 10.1016/j.tcm.2020.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/19/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
Transcutaneous oxygen pressure (TcpO2) measurement has been used for years at rest in patients with lower extremity artery disease. It was proposed for exercise testing (Ex-TcpO2) in the 80ies to evaluate regional blood flow impairment (RBFI) at the proximal and distal levels simultaneously and on both sides, in case of claudication. It was suggested that the use of a chest electrode was mandatory to show that decreases in TcpO2 at the limb level result from limb RBFI and not from a systemic pO2 decrease of cardiopulmonary origin (exercise-induced hypoxemia). Unfortunately, a major pitfall of Ex-TcpO2 was the low absolute reliability of the regional perfusion index (RPI: ratio of limb to chest values) and the technique was almost abandoned until 2003, when the DROP index (Decrease from rest of oxygen pressure: limb changes minus chest changes from rest) was proposed. The DROP mathematical formula makes Tcpo2 results independent from the absolute pO2 starting values, improving reliability of Ex-TcpO2 as compared to the RPI. Since then, Ex-TcpO2 has been of renewed interest. The present paper addresses the physiology of Ex-TcpO2, interpretation of its results, and common misunderstandings about its use.
Collapse
Affiliation(s)
- Pierre Abraham
- Department of Sports Medicine, University Hospital, Angers, France; Department of Vascular Medicine, University Hospital, Angers, France; Department of Physiology, UMR Mitovasc CNRS6015-INSERM 1083, Faculty of Medicine, University of Angers and LUNAM University, Angers, France.
| | - Pierre Ramondou
- Department of Vascular Medicine, University Hospital, Angers, France
| | - Jeanne Hersant
- Department of Vascular Medicine, University Hospital, Angers, France
| | - Wendsèndaté Yves Sempore
- Department of Sports Medicine, University Hospital, Angers, France; Department of Physiology, UMR Mitovasc CNRS6015-INSERM 1083, Faculty of Medicine, University of Angers and LUNAM University, Angers, France; Centre Muraz, National Institute of Public Health, Burkina Faso
| | | | - Samir Henni
- Department of Vascular Medicine, University Hospital, Angers, France; Department of Physiology, UMR Mitovasc CNRS6015-INSERM 1083, Faculty of Medicine, University of Angers and LUNAM University, Angers, France
| |
Collapse
|
30
|
Mahé G, Catillon F, Tollenaere Q, Stivalet O, Guilcher A, Le Pabic E, Jegou V, Omarjee L, Le Faucheur A. Confirmation of discrepancies between exercise oximetry and American Heart Association post-exercise criteria to diagnose peripheral artery disease in patients with normal ankle-brachial index at rest. Pflugers Arch 2020; 472:321-322. [DOI: 10.1007/s00424-020-02360-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 02/13/2020] [Accepted: 02/18/2020] [Indexed: 10/24/2022]
|
31
|
Abraham P, Hersant J, Ramondou P, Picquet J, Feuilloy M, Henni S. Comparison of exercise oximetry and ankle pressure measurements for patients with intermittent claudication: an observational study of 433 patients. Pflugers Arch 2020; 472:293-301. [DOI: 10.1007/s00424-019-02340-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/21/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022]
|
32
|
Hersant J, Ramondou P, Guilleron C, Picquet J, Henni S, Abraham P. A pilot study of forearm microvascular impairment and pain while using a telephone. Microvasc Res 2019; 129:103963. [PMID: 31790665 DOI: 10.1016/j.mvr.2019.103963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine if using a telephone can induce forearm pain and ischemia. DESIGN Prospective case-control trial. SETTING Vascular laboratory in the university hospital in Angers between September 2018 and March 2019. PARTICIPANTS Fifteen apparently healthy subjects (controls) and 32 patients with suspected thoracic outlet syndrome (TOS) of vascular or non-vascular origin. INTERVENTION Hand-holding a cellular phone to answer a call from investigators. MAIN OUTCOME MEASURES Presence of forearm fatigue or pain (primary outcome), ability to hold the phone with each hand for 1 min (secondary outcome 1) and decrease in forearm transcutaneous oxygen pressure DROP index indicating forearm ischemia (secondary outcome 2). A DROP < -15 mm Hg defined ischemia. RESULTS Answering a phone call resulted in 25(78%) patients with forearm fatigue or pain and in 18 (56%) cases in the inability to hold the phone for 1 min, on one or both arms in patients with suspected TOS, but never occurred in healthy volunteers (p < .05 and p < .001). The presence of ischemia was observed in one or both arms in 10 (31%) patients with proved TOS and was always associated to phone-induced pain. Three (20%) of the controls had phone-induced ischemia. All had asymptomatic TOS and remained asymptomatic during the phone test (p = .42 from suspected-TOS patients). CONCLUSION The phone conversation resulted in pain in many patients with suspected TOS. Transcutaneous oximetry can document the underlying ischemia. Forearm phone-call-induced pain may be indicative of TOS provided that no earplug or headset is used. Trial registrationClinicalTrials.govNCT03355274.
Collapse
Affiliation(s)
- Jeanne Hersant
- Vascular Medicine, University Hospital Center, Angers, France
| | - Pierre Ramondou
- Vascular Medicine, University Hospital Center, Angers, France; Sports Medicine, University Hospital Center, Angers, France
| | - Celine Guilleron
- Sports Medicine, University Hospital Center, Angers, France; Laboratory Movement Interactions performance; MIP EA4334, F-72000 Le Mans, France
| | - Jean Picquet
- Vascular and thoracic surgery, University Hospital Center, Angers, France; UMR INSERM 1083-CNRS 6015, Mitovasc Institute, Angers, France
| | - Samir Henni
- Vascular Medicine, University Hospital Center, Angers, France; UMR INSERM 1083-CNRS 6015, Mitovasc Institute, Angers, France
| | - Pierre Abraham
- Vascular Medicine, University Hospital Center, Angers, France; Sports Medicine, University Hospital Center, Angers, France; UMR INSERM 1083-CNRS 6015, Mitovasc Institute, Angers, France.
| |
Collapse
|
33
|
Abraham P, Guilleron C, Bigou Y, Henni S. Microcirculation study to determine the anaerobic threshold during exercise. Clin Biomech (Bristol, Avon) 2019; 70:80. [PMID: 31415949 DOI: 10.1016/j.clinbiomech.2019.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/23/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Pierre Abraham
- Faculty of Health Sciences, University of Angers, Angers, France; Sports Medicine and Exercise Investigations, University Hospital, Angers, France.
| | - Celine Guilleron
- Faculty of Health Sciences, University of Angers, Angers, France; Sports Medicine and Exercise Investigations, University Hospital, Angers, France
| | - Yannick Bigou
- Sports Medicine and Exercise Investigations, University Hospital, Angers, France; Vascular Medicine, University Hospital, Angers, France
| | - Samir Henni
- Sports Medicine and Exercise Investigations, University Hospital, Angers, France; Vascular Medicine, University Hospital, Angers, France
| |
Collapse
|
34
|
|
35
|
Omarjee L, Le Pabic E, Custaud MA, Fontaine C, Locher C, Renault A, Jaquinandi V, Azzola V, Barbeau-Terrier C, Laporte I, Ripoche M, Onillon Y, Chretien JM, Daniel V, Chao de la Barca JM, Homedan C, Reynier P, Abraham P, Mahé G. Effects of sildenafil on maximum walking time in patients with arterial claudication: The ARTERIOFIL study. Vascul Pharmacol 2019; 118-119:106563. [DOI: 10.1016/j.vph.2019.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 05/07/2019] [Accepted: 05/26/2019] [Indexed: 01/18/2023]
|
36
|
Stivalet O, Paisant A, Belabbas D, Omarjee L, Le Faucheur A, Landreau P, Garlantezec R, Jaquinandi V, Liedl DA, Wennberg PW, Mahé G. Exercise testing criteria to diagnose lower extremity peripheral artery disease assessed by computed-tomography angiography. PLoS One 2019; 14:e0219082. [PMID: 31247050 PMCID: PMC6597112 DOI: 10.1371/journal.pone.0219082] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 06/15/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The sensitivity and specificity of exercise testing have never been studied simultaneously against an objective quantification of arterial stenosis. Aims were to define the sensitivity and specificity of several exercise tests to detect peripheral artery disease (PAD), and to assess whether or not defined criteria defined in patients suspected of having a PAD show a difference dependent on the resting ABI. METHODS In this prospective study, consecutive patients with exertional limb pain referred to our vascular center were included. All patients had an ABI, a treadmill exercise-oximetry test, a second treadmill test (both 10% slope; 3.2km/h speed) with post-exercise pressures, and a computed-tomography-angiography (CTA). The receiver-operating-characteristic curve was used to define a cut-off point corresponding to the best area under the curve (AUC; [CI95%]) to detect arterial stenosis ≥50% as determined by the CTA. RESULTS Sixty-three patients (61+/-11 years-old) were included. Similar AUCs from 0.72[0.63-0.79] to 0.83[0.75-0.89] were found for the different tests in the overall population. To detect arterial stenosis ≥50%, cut-off values of ABI, post-exercise ABI, post-exercise ABI decrease, post-exercise ankle pressure decrease, and distal delta from rest oxygen pressure (DROP) index were ≤0.91, ≤0.52, ≥43%, ≥20mmHg and ≤-15mmHg, respectively (p<0.01). In the subset of patients with an ABI >0.91, cut-off values of post-exercise ABI decrease (AUC = 0.67[0.53-0.78]), and DROP (AUC = 0.67[0.53-0.78]) were ≥18.5%, and ≤-15mmHg respectively (p<0.05). CONCLUSION Resting ABI is as accurate as exercise testing in patients with exertional limb pain. Specific exercise testing cut-off values should be used in patients with normal ABI to diagnose PAD.
Collapse
Affiliation(s)
- O. Stivalet
- Vascular Medicine Unit, CHU Rennes, Rennes, France
- Vascular Medicine, CH de Saint Malo, Saint-Malo, France
| | - A. Paisant
- Radiology Department, CHU Rennes, Rennes, France
| | - D. Belabbas
- Radiology Department, CHU Rennes, Rennes, France
| | - L. Omarjee
- Vascular Medicine Unit, CHU Rennes, Rennes, France
- Vascular Medicine Unit, CH de Redon, Redon, France
| | - A. Le Faucheur
- Univ Rennes; INSERM CIC, Rennes, France
- Ecole Normale Supérieure, Bruz, France
| | - P. Landreau
- Vascular Medicine Unit, CHU Rennes, Rennes, France
| | | | - V. Jaquinandi
- Vascular Medicine Unit, CHU Rennes, Rennes, France
- Univ Rennes; INSERM CIC, Rennes, France
| | - D. A. Liedl
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, United States of Amerca
| | - P. W. Wennberg
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, United States of Amerca
| | - G. Mahé
- Vascular Medicine Unit, CHU Rennes, Rennes, France
- Univ Rennes; INSERM CIC, Rennes, France
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, United States of Amerca
- * E-mail:
| |
Collapse
|
37
|
Henni S, Bauer P, Le Meliner T, Hersant J, Papon X, Daligault M, Chretien JM, Ammi M, Picquet J, Abraham P. High prevalence of exercise-induced ischemia in the asymptomatic limb of patients with apparently strictly unilateral symptoms and unilateral peripheral artery disease. Ther Adv Cardiovasc Dis 2019; 13:1753944718819063. [PMID: 30803404 PMCID: PMC6348574 DOI: 10.1177/1753944718819063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND: The prevalence of exercise-induced ischemia in the asymptomatic limb of patients with unilateral claudication based on history and treadmill evaluation, and with unilateral ipsilateral peripheral artery disease (i.e ankle-to-brachial systolic pressure index <0.90) is unknown. METHODS: We detected exercise-induced ischemia in the asymptomatic limb of patients with apparently unilateral claudication. Among 6059 exercise-oximetry tests performed in 3407 nondiabetic and 961 diabetic patients. We estimated the intensity of ischemia in the both limb (buttocks and calves) using the lowest minimum value of the decrease from rest of oxygen pressure (DROP; limb changes minus chest changes from rest), with significant ischemia defined as DROP lower than -15 mmHg. RESULTS: We found 152 tests performed in 142 nondiabetic patients and 40 tests performed in 38 diabetic patients. The asymptomatic limb showed significant ischemia in 46.7% and 37.5% of the tests. Strictly unilateral exercise-induced claudication with apparently unilateral peripheral artery disease was rare (<4% of all tests). However, among these highly selected tests, significant ischemia was found in the asymptomatic limb in more than one-third of cases. CONCLUSION: The asymptomatic limb of patients with peripheral artery disease should not be considered a normal limb.
Collapse
Affiliation(s)
- Samir Henni
- Department of Vascular Investigation, University of Angers Hospital, France.,UMR Mitovasc CNRS6015-INSERM 1083, University of Angers, France
| | - Pascal Bauer
- Cardiology and Angiology, University Hospital Giessen, Germany
| | - Tanguy Le Meliner
- Department of Vascular Investigation, University of Angers Hospital, France
| | - Jeanne Hersant
- Department of Vascular Investigation, University of Angers Hospital, France
| | - Xavier Papon
- Department of Vascular and thoracic Surgery, University of Angers Hospital, France
| | - Mickael Daligault
- Department of Vascular and thoracic Surgery, University of Angers Hospital, France
| | - Jean-Marie Chretien
- Department of Biostatistics and Data Management, University of Angers Hospital, France
| | - Myriam Ammi
- Department of Vascular and thoracic Surgery, University of Angers Hospital, France
| | - Jean Picquet
- Department of Vascular and thoracic Surgery, University of Angers Hospital, France.,UMR Mitovasc CNRS6015-INSERM 1083, University of Angers, France
| | - Pierre Abraham
- Laboratoire d'Explorations Vasculaires; Centre Hospitalier Universitaire, 49033 Angers Cedex 01, France
| |
Collapse
|
38
|
Henni S, Hersant J, Ammi M, Mortaki FE, Picquet J, Feuilloy M, Abraham P. Microvascular Response to the Roos Test Has Excellent Feasibility and Good Reliability in Patients With Suspected Thoracic Outlet Syndrome. Front Physiol 2019; 10:136. [PMID: 30846945 PMCID: PMC6393400 DOI: 10.3389/fphys.2019.00136] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/06/2019] [Indexed: 12/03/2022] Open
Abstract
Background: Exercise oximetry allows operator-independent recordings of microvascular blood flow impairments during exercise and can be used during upper arm provocative maneuvers. Objective: To study the test-retest reliability of upper-limb oximetry during the Roos test in patients with suspected thoracic outlet syndrome (TOS). Materials and Methods: Forty-two patients (28 men, 14 women; mean age: 40.8 years) were examined via transcutaneous oxygen pressure (TcpO2) recordings during two consecutive Roos tests in the standing position. The minimal decrease from rest of oxygen pressure (DROPmin) value was recorded after each maneuver was performed on both arms. The area under the receiver operating characteristic (ROC) curve defined the DROPmin diagnostic performance in the presence of symptoms during the tests. The Mann–Whitney U-test was used to compare the DROPmin in the symptomatic vs. asymptomatic arms. The test-retest reliability was analyzed with Bland-Altman representations. The results are presented as means ± standard deviations (SD) or medians [25–75 percentiles]. Results: The symptoms by history were different from the symptoms expressed during the Roos maneuvers in one-third of the patients. The DROPmin measurements were −19 [−36; −7] mmHg and −8 [−16; −5] mmHg in the symptomatic (n = 108) and asymptomatic (n = 60) arms, respectively. When TOS observed on ultrasound imaging was the endpoint, the area under the ROC curve (AUC) was 0.725 ± 0.058, with an optimal cutoff point of −15 mmHg. This value provided 67% sensitivity and 78% specificity for the presence TOS via ultrasound. When symptoms occurring during the test represented the endpoint, the AUC was 0.698 ± 0.04, with a cutoff point of −10 mmHg. This provided 62% sensitivity and 66% specificity for the presence of pain in the ipsilateral arm during the test. The test-retest reliability of DROPmin proved to be good but not perfect, partly because of unreliability of the provocation maneuvers. Conclusion: To the best of our knowledge, this study is the first to investigate microvascular responses during the Roos maneuver in patients with suspected TOS. The presence of symptoms was significantly associated with ischemia. TcpO2 facilitated the recording of both macrovascular and microvascular responses to the Roos test. The Roos maneuver should probably be performed at least twice in patients with suspected TOS.
Collapse
Affiliation(s)
- Samir Henni
- Vascular Medicine, University Hospital Center, Angers, France.,UMR INSERM 1083 - CNRS 6015, Mitovasc Institute, Angers, France
| | - Jeanne Hersant
- Vascular Medicine, University Hospital Center, Angers, France
| | - Myriam Ammi
- Department of Cardiovascular and Thoracic Surgery, University Hospital Center, Angers, France
| | | | - Jean Picquet
- UMR INSERM 1083 - CNRS 6015, Mitovasc Institute, Angers, France.,Department of Cardiovascular and Thoracic Surgery, University Hospital Center, Angers, France
| | | | - Pierre Abraham
- UMR INSERM 1083 - CNRS 6015, Mitovasc Institute, Angers, France.,Sports Medicine, University Hospital Center, Angers, France
| |
Collapse
|
39
|
Henni S, Hersant J, Gourdier AS, Ammi M, Abraham P. A new electron paramagnetic resonance device to measure transcutaneous oxygen in humans. Magn Reson Med 2019; 81:2835-2836. [DOI: 10.1002/mrm.27618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 11/06/2018] [Accepted: 11/06/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Samir Henni
- Vascular Medicine Department; University Hospital Center of Angers; Angers France
| | - Jeanne Hersant
- Vascular Medicine Department; University Hospital Center of Angers; Angers France
| | - Anne Sophie Gourdier
- Vascular Medicine Department; University Hospital Center of Angers; Angers France
| | - Myriam Ammi
- Thoracic and Vascular Surgery; University Hospital Center of Angers; Angers France
| | - Pierre Abraham
- Sports Medicine; University Hospital Center of Angers; Angers France
- UMR INSERM 1083- CNRS 6015; Mitovasc Institute; 49045 Angers France
| |
Collapse
|
40
|
Mezdad T, Henni S, Feuilloy M, Chauvet P, Schang D, Abraham P. Identification of new factors associated to walking impairment in patients with vascular-type claudication. Vascular 2018; 27:260-269. [PMID: 30442076 DOI: 10.1177/1708538118813708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Mechanisms of walking limitation in arterial claudication are incompletely elucidated. We aimed to identify new variables associated to walking limitation in patients with claudication. METHODS We retrospectively analyzed data of 1120 patients referred for transcutaneous exercise oxygen pressure recordings (TcpO2). The outcome measurement was the absolute walking time on treadmill (3.2 km/h, 10% slope). We used both: linear regression analysis and a non-linear analysis, combining support vector machines and genetic explanatory in 800 patients with the following resting variables: age, gender, body mass index, the presence of diabetes, minimal ankle to brachial index at rest, usual walking speed over 10 m (usual-pace), number of comorbid conditions, active smoking, resting heart rate, pre-test glycaemia and hemoglobin, beta-blocker use, and exercise-derived variables: minimal value of pulse oximetry, resting chest-TcpO2, decrease in chest TcpO2 during exercise, presence of buttock ischemia defined as a decrease from rest of oxygen pressure index ≤15 mmHg. We tested the models over 320 other patients. RESULTS Independent variables associated to walking time, by decreasing importance in the models, were: age, ankle to brachial index, usual-pace; resting TcpO2, body mass index, smoking, buttock ischemia, heart rate and beta-blockers for the linear regression analysis, and were ankle to brachial index, age, body mass index, usual-pace, decrease in chest TcpO2, smoking, buttock ischemia, glycaemia, heart rate for the non-linear analysis. Testing of models over 320 new patients gave r = 0.509 for linear and 0.575 for non-linear analysis (both p < 0.05). CONCLUSION Buttock ischemia, heart rate and usual-pace are new variables associated to walking time.
Collapse
Affiliation(s)
| | - Samir Henni
- 1 Vascular Medicine, University Hospital, Angers, France
| | | | | | | | - Pierre Abraham
- 4 Exercise and Sports Medicine, University Hospital, Angers, France.,5 INSERM 1083, CNRS 6015, LUNAM Université, Angers, France
| |
Collapse
|
41
|
Software analysis of transcutaneous oxygen pressure measurements at exercise in patients with arterial claudication. Atherosclerosis 2018; 278:328-329. [DOI: 10.1016/j.atherosclerosis.2018.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/14/2018] [Indexed: 11/23/2022]
|
42
|
Validation of a software to perform exercise oximetry to diagnose arterial stenosis of the lower limbs. Atherosclerosis 2018; 278:325-327. [PMID: 30177345 DOI: 10.1016/j.atherosclerosis.2018.08.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/23/2018] [Indexed: 11/21/2022]
|
43
|
Brewer MB, Lau DL, Lee JT. Endovascular Treatment of Claudication due to Isolated Internal Iliac Artery Occlusive Disease. Ann Vasc Surg 2018; 57:48.e1-48.e5. [PMID: 30114502 DOI: 10.1016/j.avsg.2018.07.034] [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: 05/11/2018] [Revised: 07/17/2018] [Accepted: 07/17/2018] [Indexed: 11/19/2022]
Abstract
Aortoiliac occlusive disease is a common cause of lower extremity claudication. Patients are typically found to have diminished femoral pulses and abnormal noninvasive vascular studies of the lower extremities. Isolated lesions of the internal iliac arteries are much less commonly treated but can cause similar claudication symptoms in the buttocks, hips, or thighs. Occlusive disease in the internal iliac artery is more challenging to diagnose because the lower extremity pulses and vascular studies can be normal. This may falsely steer the diagnosis away from a vascular etiology. We present a case of disabling buttock claudication in a patient with normal pulses and isolated ipsilateral internal iliac artery stenosis. This was treated successfully with drug-eluting balloon angioplasty. We review the literature for similar cases of isolated internal iliac artery occlusive disease and summarize the disease characteristics and treatment modalities.
Collapse
Affiliation(s)
- Michael B Brewer
- Vascular & Endovascular Surgery, Department of Surgery, Kaiser Permanente Downey Medical Center, Downey, CA.
| | - David L Lau
- Vascular & Endovascular Surgery, Department of Surgery, Kaiser Permanente Downey Medical Center, Downey, CA
| | - James T Lee
- Vascular & Endovascular Surgery, Department of Surgery, Kaiser Permanente Downey Medical Center, Downey, CA; Department Chief, Department of Surgery, Kaiser Permanente Downey Medical Center, Downey, CA
| |
Collapse
|
44
|
Abraham P, Gu Y, Guo L, Kroeger K, Ouedraogo N, Wennberg P, Henni S. Clinical application of transcutaneous oxygen pressure measurements during exercise. Atherosclerosis 2018; 276:117-123. [PMID: 30059842 DOI: 10.1016/j.atherosclerosis.2018.07.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/06/2018] [Accepted: 07/18/2018] [Indexed: 11/29/2022]
Abstract
Exertional lower limb pain is a frequent diagnostic issue in elderly patients. Arterial claudication results from the mismatch between the oxygen requirement of, and oxygen delivery to the exercising muscles. Non-invasive vascular investigations (ultrasound imaging, plethysmography or segmental pressure) are used in routine at rest or following exercise, but none can be used during walking or to directly monitor cutaneous oxygen delivery to the limb. Here, we review the methods, tips and traps of the transcutaneous oxygen pressure measurement technique and potential applications. Transcutaneous oxygen pressure measurement is largely used in vascular medicine for patients with critical limb ischemia. It can also detect regional blood flow impairment at the proximal and distal limb simultaneously and bilaterally during exercise. Exercise-oximetry can also analyze systemic oxygen pressure changes on a reference area on the chest, to screen for occult pulmonary disease. As a surface technique, it does not directly measure muscle oxygen content but provides a reliable estimation of regional blood flow impairment. With the use of a recently reported index that is independent of the unknown transcutaneous gradient for oxygen, exercise-oximetry provides some accurate information compared to classical non-invasive vascular investigations to argue for a vascular or non-vascular origin of exertional lower limb pain during exercise. Although a time consuming technique, it is a simple test and it is progressively spreading among referral vascular centers as a useful non-invasive diagnostic tool for patients suspected of arterial claudication.
Collapse
Affiliation(s)
- Pierre Abraham
- Exercise and Sports Medicine, University Hospital, Angers, France; UMR CNRS 6015 INSERM 1083, Université Bretagne-Loire, Angers, France.
| | - Yongquan Gu
- Vascular Surgery, Institute of Capital Medical University, Beijing, China
| | - Lianrui Guo
- Vascular Surgery, Institute of Capital Medical University, Beijing, China
| | - Knut Kroeger
- Helios, Klinikum Krefeld GmbH, 47805, Krefeld, Germany
| | - Nafi Ouedraogo
- CHU, Souro Sanou 01 BP 2161, Bobo Dioulasso, Burkina Faso
| | | | - Samir Henni
- Vascular Medicine, University Hospital, Angers, France
| |
Collapse
|
45
|
Exercise Oximetry and Laser Speckle Contrast Imaging to Assess Microvascular Function in Lower Extremity Peripheral Artery Disease. Cardiovasc Drugs Ther 2018; 32:405-407. [PMID: 29987479 DOI: 10.1007/s10557-018-6806-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
46
|
Henni S, Ammi M, Gourdier AS, Besnier L, Signolet I, Colas-Ribas C, Picquet J, Abraham P. Ankle brachial index is equally predictive of exercise-induced limb ischemia in diabetic and non-diabetic patients with walking limitation. J Diabetes Complications 2018; 32:702-707. [PMID: 29724591 DOI: 10.1016/j.jdiacomp.2018.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/20/2018] [Accepted: 03/25/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND In diabetic patients, arterial stiffness may impair compressibility of vessels and result in higher ankle to brachial index (ABI) than in non-diabetic subjects. METHODS We studied 1972 non-diabetic and 601 diabetic patients, with suspected peripheral artery disease, Exercise transcutaneous oxygen pressure (Ex-tcpO2), expressed in DROP index (limb tcpO2 change minus chest tcpO2 change), is insensitive to arterial stiffness and can estimate exercise-induced regional blood flow impairment (RBFI). A minimal DROP <-15 mm Hg indicates the presence of RBFI (positive test). ABI was simplified to a category variable (ABIc) by rounding ABI to the closest first decimal. RESULTS In the ABIc range 0.4 to 1.1 linear regression for mean DROP values were: y = 34 x - 53; (R2 = 0.211) and y = 33 x - 52; (R2 = 0.186) in diabetic and Non-diabetic patients, respectively. Both Db and non-D patients showed a high proportion of positive Ex-tcpO2 tests for ABIc in the normal range (ABIc: 1.0 and over) from 27.1 to up to 58%. More than half of patients with borderline ABI (ABIc = 0.9) had RBFI during exercise. it was 65.6% in diabetic and 58.5% non-diabetic patients. CONCLUSIONS Resting ABI was not a better predictor of exercise-induced RBFI in non-Db than in Diabetic patients. Our results highlights the interest of still measuring resting-ABI in diabetic patients to argue for the vascular origin of exertional limb pain, but also of performing exercise tests in patients with walking impairment.
Collapse
Affiliation(s)
- Samir Henni
- Department of Physiology and Functional Investigations, University Hospital, 49933 Angers Cedex 09, France; Mitovasc Institute, UMR INSERM 1083/CNRS 6015, University of Angers, Université Bretagne Loire, France
| | - Myriam Ammi
- Vascular and Thoracic Surgery, University Hospital, 49933 Angers Cedex 09, France
| | - Anne-Sophie Gourdier
- Department of Physiology and Functional Investigations, University Hospital, 49933 Angers Cedex 09, France
| | - Louis Besnier
- Radiology Department, University Hospital, 49933 Angers Cedex 09, France
| | - Isabelle Signolet
- Department of Physiology and Functional Investigations, University Hospital, 49933 Angers Cedex 09, France
| | - Christophe Colas-Ribas
- Department of Physiology and Functional Investigations, University Hospital, 49933 Angers Cedex 09, France
| | - Jean Picquet
- Mitovasc Institute, UMR INSERM 1083/CNRS 6015, University of Angers, Université Bretagne Loire, France; Vascular and Thoracic Surgery, University Hospital, 49933 Angers Cedex 09, France
| | - Pierre Abraham
- Department of Physiology and Functional Investigations, University Hospital, 49933 Angers Cedex 09, France; Mitovasc Institute, UMR INSERM 1083/CNRS 6015, University of Angers, Université Bretagne Loire, France.
| |
Collapse
|
47
|
Henni S, Mahe G, Lamotte C, Laurent R, Riviere AB, Aubourg M, Sarlon G, Laneelle D, Long A, Signolet I, Picquet J, Feuilloy M, Abraham P. Exercise transcutaneous oximetry significantly modifies the diagnostic hypotheses and impacts scheduled investigations or treatments of patients with exertional limb pain. Eur J Intern Med 2018; 52:28-34. [PMID: 29306678 DOI: 10.1016/j.ejim.2018.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/05/2017] [Accepted: 01/02/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In lower extremity peripheral artery disease (PAD), transcutaneous oximetry at exercise (Ex-TcpO2) has been largely validated in research practice, but evidence of routine practice in various vascular laboratories is missing. We hypothesized that Ex-TcPO2 would change the diagnosis hypotheses, investigations and treatments for patients referred for exertional limb pain. MATERIAL & METHODS A multicenter prospective trial was conducted in nine different referral centers. Investigators performed Ex-TcpO2 and recorded investigations and treatments already scheduled for the patient. We encoded referral physician's diagnostic hypothesis. Before Ex-TcpO2, vascular physicians were asked to give their diagnosis hypotheses. A minimal decrease from rest of oxygen pressure (DROP)<minus 15mmHg defined the presence of exercise-induced ischemia on the area of interest. After Ex-TcPO2, we recorded post-test diagnostic hypothesis and investigations and treatments to be cancelled or performed. We compared the diagnosis hypotheses, scheduled investigations and treatments, before and after the Ex-TcpO2. RESULTS We included 603 patients (485 males: 80.4%), aged 64.7±9.8years. The post-test diagnosis hypothesis differed in 266 patients (44.1%; p<0.0001) and in 96 patients (15.9%) from the pre-test hypothesis of referring and vascular physician, respectively. This led to the recommendation to cancel 27 scheduled investigations or treatments of a total cost of ~130,000 euros. DISCUSSION Ex-TcPO2 in patients with exertional limb pain is applicable in various vascular institutions, and significantly modifies the diagnostic hypotheses and impacts scheduled investigations or treatments of patients with exertional limb pain.
Collapse
Affiliation(s)
- Samir Henni
- Explorations vasculaires adulte enfant, University Hospital, Angers, France
| | - Guillaume Mahe
- Unité de Médecine Vasculaire, INSERM CIC 1414, Université de Rennes 1, University Hospital, Rennes, France
| | - Christophe Lamotte
- Department of Internal Medicine, University Hospital, 59037 Lille Cedex, France
| | - Remi Laurent
- Département de pathologie vasculaire, Hôpital St Philibert, BP 249, 59462 Lomme Cedex, France
| | | | | | - Gabrielle Sarlon
- Unité de Médecine Vasculaire, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, Marseille, France; Unité INSERM 1062, INRA 1260, Aix-Marseille Université, France
| | - Damien Laneelle
- Médecine Vasculaire, Centre Hospitalier Universitaire, 14033 Caen cedex 9, France
| | - Anne Long
- Médecine Vasculaire, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, University Hospital, Lyon, France; Univ. Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, F-69003 Lyon, France
| | - Isabelle Signolet
- Explorations vasculaires adulte enfant, University Hospital, Angers, France
| | - Jean Picquet
- Department of Vascular and Cardiothoracic Surgery, University Hospital, Angers, France; Mitovasc Institute, UMR CNRS-6015, INSERM-1083, University of Angers, France
| | | | - Pierre Abraham
- Explorations vasculaires adulte enfant, University Hospital, Angers, France; Mitovasc Institute, UMR CNRS-6015, INSERM-1083, University of Angers, France.
| |
Collapse
|
48
|
Signolet I, Abraham P, Chupin S, Ammi M, Gueguen N, Letournel F, Picquet J, Baufreton C, Daligault M, Procaccio V, Reynier P, Henni S. Mitochondrial complex I defect resulting from exercise-induced lower limb ischemia in patients with peripheral arterial disease. J Appl Physiol (1985) 2018; 125:938-946. [PMID: 29792553 DOI: 10.1152/japplphysiol.00059.2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study aims to compare the structural and mitochondrial alterations between muscle segments affected by exercise-induced ischemia and segments of the same muscle without ischemia, in the same subject. In a prospective analysis, 34 patients presenting either peripheral arterial disease or chronic coronary syndrome without any evidence of peripheral arterial disease were eligible for inclusion based on findings indicating a need for either a femoro-popliteal bypass or a saphenous harvesting for coronary bypass. Before surgery, we assessed the level of exercise-induced ischemia in proximal and distal sections of the thigh by the measurement of transcutaneous oxygen pressure during an exercise treadmill test. Distal and proximal biopsies of the sartorius muscle were procured during vascular surgical procedures to assess mitochondrial function and morphometric parameters of the sartorius myofibers. Comparisons were made between the distal and proximal biopsies, with respect to these parameters. Thirteen of the study patients that initially presented with peripheral arterial disease had evidence of an isolated distal thigh exercise-induced ischemia, associated with a 35% decrease in the mitochondrial complex I enzymatic activity in the distal muscle biopsy. This defect was also associated with a decreased expression of the manganese superoxide dismutase enzyme and with alterations of the shapes of the myofibers. No functional or structural alterations were observed in the patients with coronary syndrome. We validated a specific model ischemia in peripheral arterial disease characterized by muscular alterations. This "Distal-Proximal-Sartorius Model" would be promising to explore the physiopathological consequences specific to chronic ischemia. NEW & NOTEWORTHY We compared proximal versus distal biopsies of the sartorius muscle in patients with superficial femoral artery stenosis or occlusion and proof of, distal only, regional blood flow impairment with exercise oximetry. We identified a decrease in the mitochondrial complex I enzymatic activity and antioxidant system impairment at the distal level only. We validate a model to explore the physiopathological consequences of chronic muscle ischemia.
Collapse
Affiliation(s)
- I Signolet
- Laboratory for Vascular Investigation, University Hospital , Angers , France.,Department of Biochemistry and Genetics, University Hospital , Angers , France
| | - P Abraham
- Laboratory for Vascular Investigation, University Hospital , Angers , France.,Mitovasc Institute, CNRS 6015, INSERM U1083, University of Angers , Angers , France
| | - S Chupin
- Department of Biochemistry and Genetics, University Hospital , Angers , France.,Mitovasc Institute, CNRS 6015, INSERM U1083, University of Angers , Angers , France
| | - M Ammi
- Department of Vascular Surgery, University Hospital , Angers , France
| | - N Gueguen
- Department of Biochemistry and Genetics, University Hospital , Angers , France.,Mitovasc Institute, CNRS 6015, INSERM U1083, University of Angers , Angers , France
| | - F Letournel
- Department of Tissue and Cellular Pathology, University Hospital , Angers , France
| | - J Picquet
- Department of Vascular Surgery, University Hospital , Angers , France
| | - C Baufreton
- Department of Cardiac Surgery, University Hospital , Angers , France
| | - M Daligault
- Department of Vascular Surgery, University Hospital , Angers , France
| | - V Procaccio
- Department of Biochemistry and Genetics, University Hospital , Angers , France.,Mitovasc Institute, CNRS 6015, INSERM U1083, University of Angers , Angers , France
| | - P Reynier
- Department of Biochemistry and Genetics, University Hospital , Angers , France.,Mitovasc Institute, CNRS 6015, INSERM U1083, University of Angers , Angers , France
| | - S Henni
- Laboratory for Vascular Investigation, University Hospital , Angers , France.,Mitovasc Institute, CNRS 6015, INSERM U1083, University of Angers , Angers , France
| |
Collapse
|
49
|
Intra-test and test-retest reliability of exercise oximetry in arterial claudication. Microvasc Res 2018; 117:44-49. [DOI: 10.1016/j.mvr.2018.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/11/2017] [Accepted: 01/07/2018] [Indexed: 11/21/2022]
|
50
|
|