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Tehan PE, Rounsley R, Sebastian M, Chuter VH. Diagnostic accuracy of postexercise toe-brachial index for identifying peripheral artery disease (PAD): A pilot study. Vasc Med 2021; 26:657-659. [PMID: 34488499 DOI: 10.1177/1358863x211039548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Peta Ellen Tehan
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia
| | | | - Mathew Sebastian
- Department of Surgery, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Vivienne Helaine Chuter
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia
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Fejfarová V, Matuška J, Jude E, Piťhová P, Flekač M, Roztočil K, Wosková V, Dubský M, Jirkovská A, Bém R, Husáková J, Lánská V. Stimulation TcPO2 Testing Improves Diagnosis of Peripheral Arterial Disease in Patients With Diabetic Foot. Front Endocrinol (Lausanne) 2021; 12:744195. [PMID: 34956078 PMCID: PMC8704582 DOI: 10.3389/fendo.2021.744195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/15/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND All diagnostic procedures of peripheral arterial disease (PAD) in diabetic foot (DF) are complicated due to diabetes mellitus and its late complications.The aim of our study is to enhance diagnosis of PAD using a novel transcutaneous oximetry (TcPO2) stimulation test. METHODS The study comprised patients with mild-to-moderate PAD(WIfI-I 1 or 2) and baseline TcPO2 values of 30-50 mmHg.TcPO2 was measured across 107 different angiosomes. Stimulation examination involved a modification of the Ratschow test. All patients underwent PAD assessment (systolic blood pressures (SBP), toe pressures (TP), the ankle-brachial indexes (ABI) and toe-brachial indexes (TBI), duplex ultrasound of circulation). Angiosomes were divided into two groups based on ultrasound findings: group M(n=60) with monophasic flow; group T(n=47) with triphasic flow. Large vessel parameters and TcPO2 at rest and after exercise (minimal TcPO2, changes in TcPO2 from baseline (Δ,%), TcPO2 recovery time) measured during the stimulation test were compared between study groups. RESULTS During the TcPO2 stimulation exercise test, group M exhibited significantly lower minimal TcPO2 (26.2 ± 11.1 vs. 31.4 ± 9.4 mmHg; p<0.01), greater Δ and percentage decreases from resting TcPO2 (p=0.014 and p=0.007, respectively) and longer TcPO2 recovery times (446 ± 134 vs. 370 ± 81ms;p=0.0005) compared to group T. SBPs, TPs and indexes were significantly lower in group M compared to group T. Sensitivity and specificity of TcPO2 stimulation parameters during PAD detection increased significantly to the level of SBP, ABI, TP and TBI. CONCLUSION Compared to resting TcPO2, TcPO2 measured during stimulation improves detection of latent forms of PAD and restenosis/obliterations of previously treated arteries in diabetic foot patients. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov [https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009V7W&selectaction=Edit&uid=U0005381&ts=2&cx=3j24u2], identifier NCT04404699.
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Affiliation(s)
- Vladimíra Fejfarová
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
- *Correspondence: Vladimíra Fejfarová,
| | - Jiří Matuška
- MATMED, Vascular Outpatient Clinic, Hodonín, Czechia
| | - Edward Jude
- Tameside Hospital NHS Foundation Trust, Ashton-under-Lyne, United Kingdom
| | - Pavlína Piťhová
- Diabetes Centre, Second Faculty of Medicine, Motol Teaching Hospital, Prague, Czechia
| | - Milan Flekač
- First Faculty of Medicine, Charles University, Prague, Czechia
| | - Karel Roztočil
- Department of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Veronika Wosková
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Michal Dubský
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Alexandra Jirkovská
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Robert Bém
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Jitka Husáková
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Věra Lánská
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
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Ishii T, Takabe S, Yanagawa Y, Ohshima Y, Kagawa Y, Shibata A, Oyama K. Laser Doppler blood flowmeter as a useful instrument for the early detection of lower extremity peripheral arterial disease in hemodialysis patients: an observational study. BMC Nephrol 2019; 20:470. [PMID: 31852449 PMCID: PMC6921472 DOI: 10.1186/s12882-019-1653-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 12/01/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A simpler method for detecting atherosclerosis obliterans is required in the clinical setting. Laser Doppler flowmetry (LDF) is easy to perform and can accurately detect deterioration in skin perfusion. We performed LDF for hemodialysis patients to determine the correlations between blood flow in the lower limbs and peripheral arterial disease (PAD). METHODS This retrospective study included 128 hemodialysis patients. Patients were categorized into the non-PAD group (n = 106) and PAD group (n = 22), 14 early stage PAD patients were included in the PAD group. We conducted LDF for the plantar area and dorsal area of the foot and examined skin perfusion pressure (SPP) during dialysis. RESULTS SPP-Dorsal Area values were 82.1 ± 22.0 mmHg in the non-PAD, and 59.1 ± 20.3 mmHg in PAD group, respectively (p < 0.05). The LDF-Plantar blood flow (Qb) values were 32.7 ± 15.5 mL/min in non-PAD group and 21.5 ± 11.3 mL/min in PAD group (p < 0.001). A total of 21 non-PAD patients underwent LDF before and during dialysis. The LDF-Plantar-Qb values were 36.5 ± 17.6 mL/min before dialysis and 29.6 ± 17.7 mL/min after dialysis (p < 0.05). We adjusted SPP and LDF for PAD using logistic regression, SPP-Dorsal-Area and LDF-P were significantly correlated with PAD (p < 0.05). The receiver-operating characteristic curve analysis indicated cut-off values of 20.0 mL/min for LDF-Plantar-Qb during dialysis. CONCLUSION LDF is a simple technique for sensitive detection of early-stage PAD. This assessment will help physicians identify early-stage PAD, including Fontaine stage II in clinical practice, thereby allowing prompt treatment.
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Affiliation(s)
- Takeo Ishii
- Zenjinkai Yokohama Daiichi Hospital, Internal Medicine, 2-5-15 Takashima, Nishi-ku, Yokohama, Kanagawa, 220-0011, Japan. .,Department of Medical Science and Cardiorenal Medicine, Yokohama City University, Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Shizuka Takabe
- Zenjinkai Yokohama Daiichi Hospital, Internal Medicine, 2-5-15 Takashima, Nishi-ku, Yokohama, Kanagawa, 220-0011, Japan
| | - Yuki Yanagawa
- Zenjinkai Yokohama Daiichi Hospital, Internal Medicine, 2-5-15 Takashima, Nishi-ku, Yokohama, Kanagawa, 220-0011, Japan
| | - Yuko Ohshima
- Zenjinkai Yokohama Daiichi Hospital, Internal Medicine, 2-5-15 Takashima, Nishi-ku, Yokohama, Kanagawa, 220-0011, Japan
| | - Yasuhiro Kagawa
- Zenjinkai Yokohama Daiichi Hospital, Internal Medicine, 2-5-15 Takashima, Nishi-ku, Yokohama, Kanagawa, 220-0011, Japan
| | - Atsuko Shibata
- Zenjinkai Yokohama Daiichi Hospital, Internal Medicine, 2-5-15 Takashima, Nishi-ku, Yokohama, Kanagawa, 220-0011, Japan
| | - Kunio Oyama
- Zenjinkai Yokohama Daiichi Hospital, Internal Medicine, 2-5-15 Takashima, Nishi-ku, Yokohama, Kanagawa, 220-0011, Japan
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Ma KF, Kleiss SF, Schuurmann RCL, Bokkers RPH, Ünlü Ç, De Vries JPPM. A systematic review of diagnostic techniques to determine tissue perfusion in patients with peripheral arterial disease. Expert Rev Med Devices 2019; 16:697-710. [PMID: 31340684 DOI: 10.1080/17434440.2019.1644166] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Peripheral arterial disease (PAD) may cause symptoms due to impaired tissue perfusion of the lower extremity. So far, assessment of PAD is mainly performed by determination of stenosis or occlusion in the large arteries and does not focus on microcirculation. Several diagnostic techniques have been recently introduced that may enable tissue perfusion measurements in the lower limb; however, most have not yet been implemented in clinical daily practice. This systematic review provides an overview of these diagnostic techniques and their ability to accurately detect PAD by peripheral tissue perfusion. Areas covered: A literature search was performed for articles that described a diagnostic technique to determine tissue perfusion in patients with known PAD compared with healthy controls. Expert opinion: So far, transcutaneous oxygen measurements are most often used to measure tissue oxygenation in PAD patients, but evidence seems too low to define this technique as a gold standard, and implementing this technique for home monitoring is difficult. New potentially suitable diagnostic tests should be non-invasive, contact-free, and quick. Further research is needed for all of these techniques before broad implementation in clinical use is justified, in hospital, and for home monitoring.
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Affiliation(s)
- Kirsten F Ma
- a Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Simone F Kleiss
- a Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Richte C L Schuurmann
- a Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Reinoud P H Bokkers
- b Department of Vascular Surgery, Noordwest Hospital Group , Alkmaar , The Netherlands
| | - Çagdas Ünlü
- c Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Jean-Paul P M De Vries
- a Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
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Tehan PE, Sadler SG, Lanting SM, Chuter VH. How does a short period of exercise effect toe pressures and toe-brachial indices? A cross-sectional exploratory study. J Foot Ankle Res 2018; 11:63. [PMID: 30498520 PMCID: PMC6258309 DOI: 10.1186/s13047-018-0309-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whilst post exercise ankle-brachial indices (ABI) are commonly used to help identify peripheral arterial disease (PAD), the role of post exercise toe pressures (TP) or toe-brachial indices (TBI) is unclear. The aim of this study was to determine, in a population without clinical signs of PAD, the effect that 30 s of weight-bearing heel raises has on TP and TBI values. Additionally, the ability of resting TP and TBI values to predict change in post-exercise values using the heel raise method was investigated. METHODS Participants over the age of 18 with a resting TBI of ≥0.60 and ABI between 0.90 and 1.40, without diabetes, history of cardiovascular disease and not currently smoking were included. Following ten minutes of supine rest, right TP and bilateral brachial pressures were performed in a randomized order using automated devices. Participants then performed 30 s of weight-bearing heel raises, immediately after which supine vascular measures were repeated. Data were assessed for normality using the Shapiro-Wilk test. For change in TP and TBI values the Wilcoxon Signed-Rank Test was performed. For correlations between resting and change in post exercise values, the Spearman Rank Order Correlations were performed, and where significant correlation identified, a linear regression undertaken. RESULTS Forty-eight participants were included. A statistically significant decrease was seen in the median TP from resting 103.00 mmHg (IQR: 89.00 to 124.75) to post exercise 98.50 mmHg (IQR: 82.00 to 119.50), z = - 2.03, p = 0.04. This difference of 4.50 mmHg represents a 4.37% change and is considered a small effect size (r = 0.21). The median TBI also demonstrated a statistically significant decrease from resting 0.79 (IQR: 0.68 to 0.94) to post exercise 0.72 (IQR: 0.60 to 0.87), z = - 2.86, p = < 0.01. This difference of 0.07 represents an 8.86% change and is considered a small effect size (r = 0.29). Linear regression demonstrated that resting TBI predicted 22.4% of the variance in post exercise TBI, p = < 0.01, coefficients beta - 0.49. CONCLUSIONS Thirty seconds of weight-bearing heel raises resulted in a similar decrease in TBI values seen in longer periods of exercise. TP values also showed a decrease post exercise; however this was contrary to previous studies.
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Affiliation(s)
- Peta Ellen Tehan
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Ourimbah, NSW 2258 Australia
- Priority Research Centre for Physical Activity and Nutrition, Univeristy of Newcastle, Callaghan, 2308 NSW Australia
| | - Sean George Sadler
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Ourimbah, NSW 2258 Australia
| | - Sean Michael Lanting
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Ourimbah, NSW 2258 Australia
| | - Vivienne Helaine Chuter
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Ourimbah, NSW 2258 Australia
- Priority Research Centre for Physical Activity and Nutrition, Univeristy of Newcastle, Callaghan, 2308 NSW Australia
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Kovacs D, Biro K, Koltai K, Endrei D, Toth K, Kesmarky G. Reply to: "Exercise oximetry in patients with arterial claudication". Atherosclerosis 2018; 272:245-246. [PMID: 29576226 DOI: 10.1016/j.atherosclerosis.2018.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
Affiliation(s)
- David Kovacs
- First Department of Medicine, Medical School, University of Pecs, Ifjusag utja 13, Pecs 7624, Hungary
| | - Katalin Biro
- First Department of Medicine, Medical School, University of Pecs, Ifjusag utja 13, Pecs 7624, Hungary
| | - Katalin Koltai
- First Department of Medicine, Medical School, University of Pecs, Ifjusag utja 13, Pecs 7624, Hungary
| | - Dora Endrei
- First Department of Medicine, Medical School, University of Pecs, Ifjusag utja 13, Pecs 7624, Hungary
| | - Kalman Toth
- First Department of Medicine, Medical School, University of Pecs, Ifjusag utja 13, Pecs 7624, Hungary
| | - Gabor Kesmarky
- First Department of Medicine, Medical School, University of Pecs, Ifjusag utja 13, Pecs 7624, Hungary.
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