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Tueguem Moyo T, Jéhannin P, Le Pabic E, Le Faucheur A, Omarjee L, Mahe G. Test-retest Reliability and Minimal Detectable Change in Exercise Oximetry in Claudicants. Ann Vasc Surg 2024; 99:19-25. [PMID: 37922963 DOI: 10.1016/j.avsg.2023.09.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Exercise transcutaneous oxygen pressure measurement (Exercise-TcPO2) can be used to diagnose Lower Extremity Artery Disease (LEAD) and allows the quantification of limb ischemia during exercise on treadmill. Exercise-TcPO2 test-retest reliability in patients with LEAD and severe walking impairment is unknown. The aim of this study was to evaluate the test-retest reliability, standard error of measurement (SEM), and Minimal Detectable Change (MDC) of exercise-TcPO2 in patients with claudication. METHODS Data were collected from patients that performed 2 treadmill tests within a 1-month interval. Delta from Rest of Oxygen Pressure (DROP) values were measured at both buttocks (proximal) and both calves (distal). Test-retest reproducibility was assessed by recording transcutaneous oximetry measurements twice and expressed as SEM and intra-class correlation coefficients. MDC was calculated using the formula MDC = SEM x 1.96 x √ 2. RESULTS Twenty eight LEAD patients (61 ± 9 years old) were included. Intra-class correlation coefficients were 0.66 [0.50, 0.79] and 0.65 [0.49, 0.79] for the proximal and distal levels, respectively. The SEM of DROP at the proximal and distal levels were 7 [6, 9] mm Hg and 9 [8, 11] mm Hg, respectively. The SEM for all (proximal and distal) DROP values was 8 [7, 10] mm Hg and the MDC of DROP was 23 mm Hg. CONCLUSIONS Exercise-TcPO2 with measurement of DROP values has a moderate test-retest reliability in LEAD patients with a maximal walking distance ≤ 300m. For an individual, an improvement or deterioration in DROP of ≥ 23 mm Hg after an intervention would be required to be 95% confident that the change is significant. It should be considered in evaluating the impact of treatment in patients with claudication.
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Affiliation(s)
| | - Pierre Jéhannin
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Estelle Le Pabic
- CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), Rennes, France
| | | | - Loukman Omarjee
- Vascular Medicine Unit, University Hospital, Rennes, France; CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), Rennes, France; Vascular Medicine Unit, Hospital, Redon, France; Inserm UMR 1241, Numecan Institute, Express Team, Univ Rennes, Rennes, France
| | - Guillaume Mahe
- Vascular Medicine Unit, University Hospital, Rennes, France; Univ Rennes, M2S - EA 7470, Rennes, France; CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), Rennes, France; Faculty of Medicine, Univ Rennes, Rennes, France.
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2
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Stivalet O, Paisant A, Belabbas D, Le Faucheur A, Landreau P, Le Pabic E, Omarjee L, Mahé G. Combination of Exercise Testing Criteria to Diagnose Lower Extremity Peripheral Artery Disease. Front Cardiovasc Med 2021; 8:759666. [PMID: 34901219 PMCID: PMC8660124 DOI: 10.3389/fcvm.2021.759666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Nothing is known about the interest of the combination of exercise tests to diagnose Lower-extremity Peripheral Artery Disease (LEPAD). The aim of this study was to assess if combining exercise testing criteria [post-exercise Ankle-Brachial Index (ABI) + exercise-oximetry (exercise-TcPO2)] improves the detection of lower limbs arterial stenoses as compared with post-exercise ABI using American Heart Association (AHA) criteria, or exercise-TcPO2 alone. Material and Methods: In a prospective monocentric study, consecutive patients with exertional-limb pain and normal resting-ABI referred to our vascular center (Rennes, France) were assessed from May 2016 to February 2018. All included patients had a computed tomography angiography (CTA), a resting-ABI, a post-exercise ABI and an exercise-TcPO2. AHA post-exercise criteria, new validated post-exercise criteria (post-exercise ABI decrease ≥18.5%, post-exercise ABI decrease <0.90), and Delta from Rest of Oxygen Pressure (Total-DROP) ≤-15mmHg (criterion for exercise-TcPO2) were used to diagnose arterial stenoses ≥50%. For the different combinations of exercise testing criteria, sensitivity or specificity or accuracies were compared with McNemar's test. Results: Fifty-six patients (mean age 62 ± 11 years old and 84% men) were included. The sensitivity of the combination of exercise testing criteria (post-exercise ABI decrease ≥18.5%, or post-exercise ABI decrease <0.90 or a Total-DROP ≤-15mmHg) was significantly higher (sensitivity = 81% [95% CI, 71-92]) than using only one exercise test (post-exercise AHA criteria (sensitivity = 57% [43-70]) or exercise-TcPO2 alone (sensitivity = 59% [45-72]). Conclusions: Combination of post-exercise ABI with Exercise-TcPO2 criteria shows better sensitivity to diagnose arterial stenoses compared with the AHA post-exercise criteria alone or Exercise-TcPO2 criteria used alone. A trend of a better accuracy of this combined strategy was observed but an external validation should be performed to confirm this diagnostic strategy.
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Affiliation(s)
| | | | | | | | | | - Estelle Le Pabic
- Institut National de la Santé Et de la Recherche Médicale (INSERM), CIC1414, Rennes, France
| | - Loukman Omarjee
- Vascular Medicine Unit, CHU Rennes, Rennes, France.,Vascular Medicine, Centre Hospitalier de Redon, Redon, France
| | - Guillaume Mahé
- Vascular Medicine Unit, CHU Rennes, Rennes, France.,University of Rennes 2, M2S-EA 7470, Rennes, France.,Institut National de la Santé Et de la Recherche Médicale (INSERM), CIC1414, Rennes, France.,University of Rennes 1, Rennes, France
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3
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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.
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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
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4
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Miossec A, Tollenaere Q, Lanéelle D, Guilcher A, Métairie A, Le Pabic E, Carel A, Le Faucheur A, Mahé G. Arterial Doppler Waveforms Are Independently Associated With Maximal Walking Distance in Suspected Peripheral Artery Disease Patients. Front Cardiovasc Med 2021; 8:608008. [PMID: 33959640 PMCID: PMC8093382 DOI: 10.3389/fcvm.2021.608008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 03/16/2021] [Indexed: 01/15/2023] Open
Abstract
Objective: Arterial Doppler waveform recordings are commonly used to assess lower extremity arterial disease (LEAD) severity. However, little is known about the relationship between arterial Doppler waveform profiles and patients' walking capacity. The purpose of this study was to assess whether arterial Doppler waveforms are independently associated with maximal walking distance (MWD) in patients experiencing exertional limb symptoms. Materials and Methods: This cross-sectional study included suspected LEAD patients experiencing exertional limb symptoms. In both lower extremities, arterial Doppler waveforms and ankle-brachial index (ABI) values were obtained from the pedis and tibial posterior arteries. Each arterial flow measurement was ranked using the Saint-Bonnet classification system. Treadmill stress testing (3.2 km/h, 10% slope) coupled with exercise oximetry (Exercise-TcPO2) were used to determine MWD. Delta from rest oxygen pressure (DROP) was calculated. Following treadmill stress testing, post-exercise ABI values were recorded. Univariate and multivariate analyses were used to determine the clinical variables associated with MWD. Results: 186 patients experiencing exertional limb symptoms (62 ± 12 years and 26.8 ± 4.5 kg/m2) were included between May 2016 and June 2019. Median [25th; 75th] treadmill MWD was 235 [125;500]m. Better arterial Doppler waveforms were associated with better walking distance (p = 0.0012). Whereas, median MWD was 524 [185;525]m in the group that yielded the best Doppler waveforms, it was 182 [125,305]m in the group with the poorest Doppler waveforms (p = 0.0012). MWD was significantly better (p = 0.006) in the patients with the best ABIs. However, arterial Doppler waveforms alone were significantly associated with MWD (p = 0.0009) in the multivariate model. When exercise variables (post-exercise ABI or DROP) were incorporated into the multivariate model, these were the only variables to be associated with MWD. Conclusion: Of the various clinical parameters at rest, Doppler flow waveform profiles were associated with MWD in suspected LEAD patients. A stronger link was however found between exercise variables and MWD.
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Affiliation(s)
| | | | | | | | | | - Estelle Le Pabic
- CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), Rennes, France
| | - Awenig Carel
- Vascular Medicine Unit, CHU Rennes, Rennes, France
| | - Alexis Le Faucheur
- CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), Rennes, France.,Univ Rennes, M2S-EA 7470, Rennes, France
| | - Guillaume Mahé
- Vascular Medicine Unit, CHU Rennes, Rennes, France.,CHU Rennes, Inserm, CIC 1414 (Clinical Investigation Center), Rennes, France.,Univ Rennes, M2S-EA 7470, Rennes, France.,Univ Rennes 1, Rennes, France
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5
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Mahé G, Boge G, Bura-Rivière A, Chakfé N, Constans J, Goueffic Y, Lacroix P, Le Hello C, Pernod G, Perez-Martin A, Picquet J, Sprynger M, 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]
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6
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Berli MC, Jundt-Ecker M, Meier MR, Hofer M, Schöni M, Götschi T, Uçkay I, Böni T, Waibel FWA. Resting TcPO2 levels decrease during liner wear in persons with a transtibial amputation. PLoS One 2020; 15:e0239930. [PMID: 32986780 PMCID: PMC7521692 DOI: 10.1371/journal.pone.0239930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 09/16/2020] [Indexed: 11/30/2022] Open
Abstract
Background In our clinic, a substantial number of patients present with transtibial residual limb pain of no specific somatic origin. Silicone liner induced tissue compression may reduce blood flow, possibly causing residual limb pain. Thus, as a first step we investigated if the liner itself has an effect on transcutaneous oxygen pressure (TcPO2). Methods Persons with unilateral transtibial amputation and residual limb pain of unknown origin were included. Medical history, including residual limb pain, was recorded, and the SF-36 administered. Resting TcPO2 levels were measured in the supine position and without a liner at 0, 10, 20 and 30 minutes using two sensors: one placed in the Transverse plane over the tip of the Tibia End (= TTE), the other placed in the Sagittal plane, distally over the Peroneal Compartment (= SPC). Measurements were repeated with specially prepared liners avoiding additional pressure due to sensor placement. Statistical analyses were performed using SPSS. Results Twenty persons (9 women, 11 men) with a mean age of 68.65 years (range 47–86 years) participated. The transtibial amputation occurred on average 43 months prior to study entry (range 3–119 months). With liner wear, both sensors measured TcPO2 levels that were significantly lower than those measured without a liner (TTE: p < 0.001; SPC: p = 0.002) after 10, 20 and 30 minutes. No significant differences were found between TcPO2 levels over time between the sensors. There were no significant associations between TcPO2 levels and pain, smoking status, age, duration of daily liner use, mobility level, and revision history. Conclusion Resting TcPO2 levels decreased significantly while wearing a liner alone, without a prosthetic socket. Further studies are required to investigate the effect of liner wear on exercise TcPO2 levels.
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Affiliation(s)
- Martin C. Berli
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Michèle Jundt-Ecker
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | | | | | - Madlaina Schöni
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Tobias Götschi
- Department of Orthopaedic Surgery, Institute for Biomechanics, University of Zurich, ETH Zurich, Balgrist Campus, Zurich, Switzerland
| | - Ilker Uçkay
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Thomas Böni
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Felix W. A. Waibel
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
- * E-mail:
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7
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Mirza AK, Tenorio ER, Karkkainen JM, Wennberg P, Macedo TA, Oderich GS. Paraspinal muscle claudication after fenestrated-branched endovascular aortic repair of thoracoabdominal aortic aneurysms. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:464-468. [PMID: 32875181 PMCID: PMC7451728 DOI: 10.1016/j.jvscit.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/09/2020] [Indexed: 11/20/2022]
Abstract
Fenestrated-branched endovascular repair of thoracoabdominal aneurysms carries a risk of spinal cord ischemia owing to extensive coverage of intercostal arteries, but other consequences of decreased flow to the paraspinal muscles have not been delineated. We describe a 54-year-old woman treated by multibranched thoracoabdominal aneurysm repair who developed severe disabling exertional thoracic and lumbar back pain after the operation. Despite physical therapy, the patient remains with disabling symptoms at 2 years of follow-up. Transcutaneous oxygen pressures confirmed exercise-induced decrease in oxygen pressure, consistent with decreased muscle perfusion. We propose the term paraspinal muscle claudication to describe these symptoms.
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Affiliation(s)
- Aleem K. Mirza
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Emanuel R. Tenorio
- Division of Vascular and Endovascular Surgery, University of Texas Health Science, Houston, Tex
| | | | - Paul Wennberg
- Division of Vascular Medicine, Mayo Clinic, Rochester, Minn
| | - Thanila A. Macedo
- Department of Radiology, University of Texas Health Science, Houston, Tex
| | - Gustavo S. Oderich
- Division of Vascular and Endovascular Surgery, University of Texas Health Science, Houston, Tex
- Correspondence: Gustavo S. Oderich, MD, Memorial Hermann Medical Plaza, University of Texas Health Science, 6400 Fannin St, Ste 2850, Houston, TX 77030
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8
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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]
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9
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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.
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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
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10
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[Lower-limb peripheral arterial disease]. Rev Med Interne 2020; 41:667-672. [PMID: 32359979 DOI: 10.1016/j.revmed.2020.03.009] [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: 01/12/2020] [Accepted: 03/06/2020] [Indexed: 12/24/2022]
Abstract
Peripheral arterial disease is a result of atheroma. This disease is frequent in subjects with vascular risk factors. This disease is also frequent in low income countries. The detection and the diagnosis of peripheral arterial disease is obtained by calculating the ankle brachial index. Patients with peripheral arterial disease are not always symptomatic thus explaining how this disease is under diagnosed. The symptoms can be absent, and especially in case of diabetes or in women. In case of peripheral arterial disease, atheroma often involves other arterial vascular networks especially the coronaries. An adapted treatment reduces the morbi-mortality linked to this disease. This treatment is based on the correction of the vascular risk factors and especially tobacco cessation, walking rehabilitation and drugs (antiplatelet agent, statin, renin angiotensin system blocker). In case of rest or critic ischemia, the first-line treatment is a revascularisation. In peripheral arterial disease, management of patients is often non optimal and therapeutic targets fairly often obtained.
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11
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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.
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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
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12
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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]
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13
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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.
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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
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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.
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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
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15
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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]
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16
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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.
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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
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17
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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]
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18
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Functional Assessment of Intermediate Vascular Disease. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7619092. [PMID: 29850561 PMCID: PMC5925208 DOI: 10.1155/2018/7619092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/12/2017] [Accepted: 01/28/2018] [Indexed: 11/19/2022]
Abstract
Interventional treatment in various vascular beds has advanced tremendously. However, there are several problems to be considered. We searched the literature and tried to analyze major parts of it. One is safety and applicability of coronary proven methods in other vascular beds. An unresolved problem is the functional assessment of intermediate lesions, as far as various target organs have quite different circulation from the coronary one and the functional tests should be modified in order to be applicable and meaningful. In the majority of the acute vascular syndromes, the culprit lesion is of intermediate size on visual assessment. On the other hand, a procedurally successfully managed high-degree stenosis is not always followed by clinical and prognostic benefit. In vascular beds, where collateral network naturally exists, the readings from the functional assessment are complicated and thus the decision for interventional treatment is even more difficult. Here come into help the functional assessment and imaging with IVUS, OCT, high-resolution MRI, and contrast enhanced CT or SPECT. The focus of the current review is on the functional assessment of intermediate stenosis in other vascular beds, unlike the coronary arteries.
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19
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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.
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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.
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20
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Kovacs D, Csiszar B, Biro K, Koltai K, Endrei D, Juricskay I, Sandor B, Praksch D, Toth K, Kesmarky G. Toe-brachial index and exercise test can improve the exploration of peripheral artery disease. Atherosclerosis 2018; 269:151-158. [DOI: 10.1016/j.atherosclerosis.2018.01.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/11/2017] [Accepted: 01/12/2018] [Indexed: 10/18/2022]
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21
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Abraham P, Colas-Ribas C, Signolet I, Ammi M, Feuilloy M, Picquet J, Henni S. Transcutaneous Exercise Oximetry for Patients With Claudication ― A Retrospective Review of Approximately 5,000 Consecutive Tests Over 15 Years ―. Circ J 2018; 82:1161-1167. [PMID: 29343673 DOI: 10.1253/circj.cj-17-0948] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Pierre Abraham
- Laboratory for Vascular Investigations, University Hospital
- Institut MITOVASC, UMR CNRS 6015, INSERM U1083, University of Angers
| | | | | | - Myriam Ammi
- Department of Vascular and Thoracic Surgery, University Hospital
| | | | - Jean Picquet
- Department of Vascular and Thoracic Surgery, University Hospital
- Institut MITOVASC, UMR CNRS 6015, INSERM U1083, University of Angers
| | - Samir Henni
- Laboratory for Vascular Investigations, University Hospital
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22
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Abstract
Lower limb peripheral artery disease is highly prevalent worldwide and in France. Three different stages can be found: asymptomatic stage, exercise ischemia stage, rest ischemia stage. This review based on current recommendations presents how to diagnose the different stages (Ankle brachial index, Toe-brachial index, oxymetry at rest and exercise oxymetry) in order to manage these patients.
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23
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Fouasson-Chailloux A, Abraham P, Colas-Ribas C, Feuilloy M, Vielle B, Henni S. Simultaneous pain intensity rating and quantification of ischemia throughout exercise and recovery in proximal versus distal arterial claudication. Vasc Med 2017; 22:490-497. [DOI: 10.1177/1358863x17734304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Data on simultaneous hemodynamic changes and pain rating estimation in arterial claudication while walking are lacking. This study was conducted to determine if a difference in transcutaneous oxygen pressure (tc pO2) exists between proximal and distal localization at pain appearance (PAINapp), maximal pain (PAINmax) and pain relief (PAINrel) in proximal or distal claudication and if a relationship exists between tc pO2 changes and pain intensity. We analyzed the pain rating (Visual Analog Scale (VAS)) to lower limb ischemia, measured with the decrease from rest of oxygen pressure (DROP) tc pO2 index during constant-load treadmill tests in patients with calf ( n = 41) or buttock ( n = 19) claudication. Calves versus buttocks results were analyzed with ANOVA tests. The R2 correlation coefficient between individual VAS versus DROP was calculated. Ischemia intensity versus pain rating changes were correlated. Significant ischemia was required for pain appearance, but pain disappeared despite the persistence of ischemia. We observed no statistical difference for DROP at PAINapp, PAINmax or PAINrel between proximal or distal claudication. A significant correlation between pain rating versus DROP was found: from PAINapp to PAINmax, R2 = 0.750 (calves) and 0.829 (buttocks), and from PAINmax to PAINrel, R2 = 0.608 (calves) and 0.560 (buttocks); p<0.05. Pain appeared after a significant decrease of hemodynamic parameters but disappeared while parameters were not normalized. No difference in pain rating was found in proximal versus distal claudication.
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Affiliation(s)
- Alban Fouasson-Chailloux
- Vascular and Exercise Investigations, University Hospital of Angers, Angers, France
- Physical Medicine and Rehabilitation Centre, University Hospital of Nantes, Nantes, France
- INSERM UMR 1229-RMES (Regenerative Medicine and Skeleton), Team STEP (Skeletal Physiopathology and Joint Regenerative Medicine), Nantes University Hospital, Nantes, France
| | - Pierre Abraham
- Vascular and Exercise Investigations, University Hospital of Angers, Angers, France
- MitoVasc, INSERM 1083 – CNRS 6214, LUNAM University, Angers, France
| | | | - Mathieu Feuilloy
- Graduate School of Engineering, Angers – Laboratoire d’Acoustique de l’Université du Maine – Unité Mixte de Recherche, Centre National de la Recherche Scientifique U6613, Angers, France
| | - Bruno Vielle
- Cellule de Méthodologie et Biostatistiques, University Hospital of Angers, Angers, France
| | - Samir Henni
- Vascular and Exercise Investigations, University Hospital of Angers, Angers, France
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24
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Jaquinandi V, Kaladji A, Le Faucheur A, Léderlin M, Mahé G. Exercise Oximetry and Exercise Near-infrared Spectroscopy to Assess Peripheral Artery Disease. Radiographics 2017; 37:363-364. [PMID: 28076013 DOI: 10.1148/rg.2017160196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Adrien Kaladji
- Department of Vascular Surgery, University Hospital, Rennes, France
| | | | | | - Guillaume Mahé
- Univ Rennes, Unité de Médecine Vasculaire, INSERM CIC 1414, Rennes, France
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25
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Audonnet M, Signolet I, Colas-Ribas C, Ammi M, Abraham P, Henni S. Exercise Transcutaneous Oximetry of the Buttocks ― External Validation With Computed Tomography Angiography ―. Circ J 2017; 81:1123-1128. [DOI: 10.1253/circj.cj-16-1316] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Martin Audonnet
- Laboratory for Vascular Investigations, University Hospital of Angers
- Department of Cardiology, University Hospital of Angers
| | - Isabelle Signolet
- Laboratory for Vascular Investigations, University Hospital of Angers
- Biochemistry Laboratory, University Hospital of Angers
| | | | - Myriam Ammi
- Vascular and Cardiothoracic Surgery, University Hospital of Angers
| | - Pierre Abraham
- Laboratory for Vascular Investigations, University Hospital of Angers
- University Nantes Angers Le Mans, Joint Research Unit, National Center for Scientific Research U6015 and National Institute of Health and Medical Research U1083
| | - Samir Henni
- Laboratory for Vascular Investigations, University Hospital of Angers
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26
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Colas-Ribas C, Signolet I, Henni S, Feuillloy M, Gagnadoux F, Abraham P. High prevalence of known and unknown pulmonary diseases in patients with claudication during exercise oximetry: A retrospective analysis. Medicine (Baltimore) 2016; 95:e4888. [PMID: 27749546 PMCID: PMC5059048 DOI: 10.1097/md.0000000000004888] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 07/04/2016] [Accepted: 08/24/2016] [Indexed: 11/30/2022] Open
Abstract
The prevalence of pulmonary disease in patients with peripheral artery disease (PAD) has not been extensively studied. Recent evidence has shown that ∼20% of the patients have an atypical chest transcutaneous oxygen pressure (TcpO2) pattern during exercise, which suggests walking-induced hypoxemia. The main objectives of this study were to: (1) describe in a retrospective way the characteristics of the patients suffering from claudication, who attended a treadmill testing in our laboratory, (2) assess the prevalence of known or unknown pulmonary disease. The second aim of this study was to evaluate the impact of the therapeutic interventions on the walking capacities, after treatment, of the eventually detected pulmonary disorders.We retrospectively analyzed 1482 exercise TcpO2 test results. Patients that had no history of pulmonary disease, but either reported severe dyspnea or showed atypical profiles on their chest exercise-TcpO2, were advised to refer to the department of pneumology for additional investigations.In addition to the 166 patients with a history of pulmonary disease, 158 patients were suspected of unknown pulmonary disease from the result of their TcpO2 test. Many patients (n = 99/158, 62.7%) did not attend a pulmonologist visit. A pulmonary disease was established in 55 (93.2%) of the other 59 patients. Obstructive sleep apnea syndrome (OSAS) was the one and only diagnosis retained in 42/59 patients (71.2%). Among the 47 patients who had a second evaluation of their walking capacity on treadmill, 38 had treatment of the pulmonary disease found, vascular surgery treatment or a severe restricted diet, 9 had no treatment. Only the "treated" group showed a significant improvement in the maximal walking distance on treadmill between the 2 evaluations, 313 ± 251 m to 433 ± 317 m (P = 0.03).This retrospective pilot study underlines the high prevalence of both known and unknown pulmonary disease in patients whose primary complaint was lower limb claudication. Systematic screening and treatment of pulmonary disease in patients with claudication might be justified, to improve walking ability of such patients and possibly reduce or delay the requirement for revascularization. Prospective studies are required to confirm these preliminary results.
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Affiliation(s)
- Christophe Colas-Ribas
- Department of Sports Medicine and Vascular Investigations, University Hospital of Angers, Univ. Angers, Université Bretagne Loire, France
| | - Isabelle Signolet
- Department of Sports Medicine and Vascular Investigations, University Hospital of Angers, Univ. Angers, Université Bretagne Loire, France
| | - Samir Henni
- Department of Sports Medicine and Vascular Investigations, University Hospital of Angers, Univ. Angers, Université Bretagne Loire, France
| | - Mathieu Feuillloy
- Ecole supérieure d’électronique de l’Ouest, Institute of Science & Technology, France
- LAUM–UMR CNR6613, France
| | - Frédéric Gagnadoux
- Department of Pneumology, University Hospital of Angers, Univ. Angers, Université Bretagne Loire, INSERM 1063, France
| | - Pierre Abraham
- Department of Sports Medicine and Vascular Investigations, University Hospital of Angers, Univ. Angers, Université Bretagne Loire, France
- Mitovasc, UMR INSERM 1083/CNRS 6214, Univ. Angers, Université Bretagne Loire, Angers, France
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27
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Koch C, Chauve E, Chaudru S, Le Faucheur A, Jaquinandi V, Mahé G. Exercise transcutaneous oxygen pressure measurement has good sensitivity and specificity to detect lower extremity arterial stenosis assessed by computed tomography angiography. Medicine (Baltimore) 2016; 95:e4522. [PMID: 27603342 PMCID: PMC5023864 DOI: 10.1097/md.0000000000004522] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Peripheral artery disease (PAD) is a highly prevalent disease diagnosed by the use of ankle-brachial index (ABI) at rest. In some clinical conditions (diabetes, renal insufficiency, advanced age), ABI can be falsely normal and other tests are required for the PAD diagnosis (American Heart Association statement). This study was conducted to determine the accuracy of exercise transcutaneous oxygen pressure measurement (exercise-TcPo2) in detection of arterial stenosis ≥50% using computed tomography angiography (CTA) as the gold standard.We retrospectively analyzed consecutive patients referred to our vascular unit (University Hospital, Rennes, France) for exercise-TcPo2 testing from 2014 to 2015. All included patients had a CTA performed within 3 months of the exercise-TcPo2 test. Exercise-TcPo2 was performed on treadmill (10% slope; 2 mph speed). We calculated the Delta from Resting Oxygen Pressure (DROP) index (expressed in mm Hg) at the proximal and distal levels. Two blinded physicians performed stenosis quantification on CTA. The receiver operating characteristic (ROC) curve was used to define a cutoff point to detect arterial stenosis ≥50%, stenosis ≥60%, and stenosis ≥70%.A total of 34 patients (mean age 64 ± 2 years old; 74% men) were analyzed. The highest areas under the curve (AUC) were found for 60% stenosis at both proximal and distal levels. For stenosis ≥50%, sensitivity and specificity of proximal minimal DROP were 80.9% [67.1-89.7], 81.0% [59.3-92.7] respectively. For stenosis ≥50%, sensitivity and specificity of distal minimal DROP were 73.2% [60.3-83.1], 83.3% [53.8-96.2], respectively. For stenosis ≥60%, sensitivity and specificity of proximal minimal DROP were 82.5% [67.6-91.5] and 85.7% [67.7-94.8] respectively. For stenosis ≥60%, sensitivity and specificity of distal minimal DROP were 80.4% [67.3-89.1] and 88.2% [64.2-97.7], respectively. For stenosis ≥70%, sensitivity and specificity of proximal minimal DROP were 85.7% [67.7-94.8] and 75.0% [59.6-85.9] respectively. For stenosis ≥70%, sensitivity and specificity of distal minimal DROP were 86.0% [72.2-93.7] and 76.0% [56.1-88.7], respectively.Exercise-TcPo2 using a proximal minimal DROP value ≤-15 mm Hg or a distal minimal DROP value ≤-16 mm Hg is accurate to diagnose arterial stenosis especially stenosis ≥60% on the lower limbs. Exercise-TcPo2 is safe and noninvasive test that might be used in second line for PAD diagnosis.
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Affiliation(s)
| | | | - Ségolène Chaudru
- CHU Rennes, Imagerie Cœur-Vaisseaux
- INSERM, Centre d’investigation clinique 1414
| | - Alexis Le Faucheur
- INSERM, Centre d’investigation clinique 1414
- Movement, Sport and Health Laboratory, EA 1274, UFR APS, University of Rennes, Rennes
- Department of Sport Sciences and Physical Education, ENS Rennes, Bruz
| | - Vincent Jaquinandi
- CHU Rennes, Imagerie Cœur-Vaisseaux
- INSERM, Centre d’investigation clinique 1414
| | - Guillaume Mahé
- CHU Rennes, Imagerie Cœur-Vaisseaux
- INSERM, Centre d’investigation clinique 1414
- Université de Rennes 1, Rennes, France
- Correspondence: Guillaume Mahe, Pôle Imagerie Médicale et Explorations Fonctionnelles, Hôpital Pontchaillou, 2 rue Henri Le Guilloux, Rennes, F-35033, France (e-mail: )
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Cotard S, Nouni A, Jaquinandi V, Gladu G, Kaladji A, Mahé G. [Peripheral artery disease in patients younger than 50 years old: Which etiology?]. Ann Cardiol Angeiol (Paris) 2016; 65:275-285. [PMID: 27319272 DOI: 10.1016/j.ancard.2016.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 04/29/2016] [Indexed: 06/06/2023]
Abstract
Peripheral arterial disease (PAD) encompasses disease of all arteries of the body except the coronary arteries. The main etiology whatever the patient's age is atherosclerosis. Different etiologies can induce PAD especially when patients are younger than 50 years old and have no cardiovascular risk factors (smoking, hypertension, diabetes…). PAD that appears before 50 years old can be named juvenile PAD (JPAD) although there is no consensus about the definition. The aim of this work is to present the different etiologies of JPAD according to their hereditary, acquired or mixed origins. The following hereditary causes are addressed: Marfan syndrome, Ehlers-Danlos syndrome, homocystinuria, pseudoxanthoma elasticum, osteogenesis imperfecta "mid-aortic" syndrome. Among the acquired etiologies, inflammatory JPADs without extravascular signs such as atherosclerosis and Buerger's disease, inflammatory JPADs with extravascular signs as Takayasu's disease, Behçet's disease and Cogan's syndrome, JPADs like aortitis, embolic JPADs, iatrogenic JPADs, and mechanical or traumatic JPADs are described. Finally, mixed origins as thrombotic disease and fibromuscular dysplasia are presented. This work will assist clinicians in the diagnosis of JPAD.
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Affiliation(s)
- S Cotard
- Imagerie cœur-vaisseaux, centre hospitalier universitaire, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - A Nouni
- Centre hospitalier centre Bretagne, Kério, 56306 Pontivy, France
| | - V Jaquinandi
- Imagerie cœur-vaisseaux, centre hospitalier universitaire, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes, France; Université de Rennes 1, Inserm, centre d'investigation clinique CIC 1414, 35033 Rennes, France
| | - G Gladu
- Clinique du Ter, 56270 Plœmeur, France
| | - A Kaladji
- Service de chirurgie vasculaire, centre hospitalier universitaire, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes, France
| | - G Mahé
- Imagerie cœur-vaisseaux, centre hospitalier universitaire, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes, France; Université de Rennes 1, Inserm, centre d'investigation clinique CIC 1414, 35033 Rennes, France.
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Signolet I, Henni S, Colas-Ribas C, Feuilloy M, Picquet J, Abraham P. Prevalence and Causes of Normal Exercise Oximetry in the Calf in Patients with Peripheral Artery Disease and Limiting Calf Claudication. Eur J Vasc Endovasc Surg 2016; 51:572-8. [DOI: 10.1016/j.ejvs.2015.12.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/22/2015] [Indexed: 11/26/2022]
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Mahé G, Kaladji A, Le Faucheur A, Jaquinandi V. Internal Iliac Artery Stenosis: Diagnosis and How to Manage it in 2015. Front Cardiovasc Med 2015; 2:33. [PMID: 26664904 PMCID: PMC4671337 DOI: 10.3389/fcvm.2015.00033] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 08/18/2015] [Indexed: 01/13/2023] Open
Abstract
Lower extremity arterial disease (LEAD) is a highly prevalent disease affecting 202 million people worldwide. Internal iliac artery stenosis (IIAS) is one of the localization of LEAD. This diagnosis is often neglected when a patient has a proximal walking pain since most physicians evoke a pseudoclaudication. Surprisingly, IIAS management is reported neither in the Trans-Atlantic Inter-Society Consensus II nor in the report of the American College Foundation/American Heart Association guidelines. The aims of this review are to present the current knowledge about the disease, how should it be managed in 2015 and what are the future research trends.
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Affiliation(s)
- Guillaume Mahé
- Pôle Imagerie et Explorations Fonctionnelles , Rennes , France ; INSERM, Clinical Investigation Center (CIC 14 14) , Rennes , France
| | - Adrien Kaladji
- Vascular Surgery, University Hospital , Rennes , France ; INSERM Laboratoire Traitement du Signal et de l'Image (LTSI), UMR 1099 , Rennes , France
| | - Alexis Le Faucheur
- INSERM, Clinical Investigation Center (CIC 14 14) , Rennes , France ; École normale supérieure de Rennes , Rennes , France
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Jaquinandi V, Kaladji A, Lederlin M, Mahe G. Re: "diagnostic value of peripheral fractional flow reserve in isolated iliac artery stenosis: a comparison with the post-exercise ankle-brachial index". J Endovasc Ther 2015; 22:272-4. [PMID: 25809375 DOI: 10.1177/1526602815576093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Adrien Kaladji
- CHU Rennes; INSERM Signal and Image Processing Laboratory, Rennes, France
| | | | - Guillaume Mahe
- University Hospital, CHU Rennes; INSERM Clinical Investigation Center CIC1414, Rennes, France
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