1
|
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
| |
Collapse
|
2
|
Picquet J, Paumier A, Maugin E, Papon X, Enon B, Abraham P. The Role of the Deep Femoral Artery in the Treatment of Thigh Claudication in Case of Hypogastric Occlusion. Ann Vasc Surg 2013; 27:474-9. [DOI: 10.1016/j.avsg.2011.11.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 09/22/2011] [Accepted: 11/13/2011] [Indexed: 11/17/2022]
|
3
|
Impaired somatosensation in patients with isolated proximal-without-distal exercise-related lower-limb ischemia. Clin J Pain 2012; 28:404-9. [PMID: 22395334 DOI: 10.1097/ajp.0b013e3182340c01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Isolated proximal-without-distal (buttock but not calf) exercise-related lower-limb ischemia (IPI) might develop in the presence of arterial lesions impairing the blood flow supply toward the hypogastric vascular bed. In IPI, lower-limb sensory nerve dysfunction might occur from the sacral nerve plexus becoming ischemic during exercise. The purpose of this study was to compare patients with IPI with healthy controls for the presence of sensory nerve dysfunction, as assessed using somatosensory testing (SST). METHODS Seventeen nondiabetic patients with IPI and 17 age-matched and sex-matched healthy controls underwent SST of both the upper and lower limbs. RESULTS The upper-limb SST data did not differ between groups (P>0.05). In contrast, lower-limb testing showed that patients with IPI had impaired warm (43.4±2.7 vs. 40.5±4.9°C) and vibration (5.0±2.3 vs. 6.4±1.4 arbitrary units) detection thresholds compared with healthy controls (P≤0.05). Furthermore, lower-limb mechanical detection threshold and Neuropathy Symptom and Disability Scores tended to be higher in the patients (P≤0.10). DISCUSSION The SST data suggest that patients with IPI have abnormal functioning of Aβ-fiber and C-fiber inputs in their affected limb(s). These sensory abnormalities might contribute to the exercise-induced ischemic symptoms experienced by these patients.
Collapse
|
4
|
Maugin E, Abraham P, Paumier A, Mahé G, Enon B, Papon X, Picquet J. Patency of Direct Revascularisation of the Hypogastric Arteries in Patients with Aortoiliac Occlusive Disease. Eur J Vasc Endovasc Surg 2011; 42:78-82. [DOI: 10.1016/j.ejvs.2011.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Accepted: 03/20/2011] [Indexed: 11/26/2022]
|
5
|
Wang YC, Chiu YS, Yeh CH. Leriche's syndrome presenting as sciatica. Ann Vasc Surg 2010; 24:694.e1-3. [PMID: 20488654 DOI: 10.1016/j.avsg.2009.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 10/23/2009] [Indexed: 10/19/2022]
Abstract
Sciatica is a common cause of lower back pain and claudication; the true etiology is often misunderstood. We report a case of a 53-year-old man who presented with sciatica. Clinically, there was evidence of aortoiliac obstruction with the absence of femoral pulses and a vascular index of 0.4 at the ankle. An aortogram revealed a very tight irregular stenosis of the aortic bifurcation and bilateral proximal common iliac arteries. After resection of diseased aorta, an aortoiliac graft was inserted. The symptoms subsided. This case highlights the importance of performing a complete vascular evaluation in patients diagnosed with sciatica.
Collapse
Affiliation(s)
- Yao-Chang Wang
- Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan.
| | | | | |
Collapse
|
6
|
Paumier A, Abraham P, Mahé G, Maugin E, Enon B, Leftheriotis G, Picquet J. Functional outcome of hypogastric revascularisation for prevention of buttock claudication in patients with peripheral artery occlusive disease. Eur J Vasc Endovasc Surg 2009; 39:323-9. [PMID: 19910224 DOI: 10.1016/j.ejvs.2009.10.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 10/08/2009] [Indexed: 11/16/2022]
Abstract
We have defined proximal lower limb ischaemia as a decrease in Exercise-transcutaneous oxygen pressure (TcPO(2)) lower than minus 15mmHg at the buttock level in patients with peripheral artery occlusive disease. The purpose of this study was to objectively evaluate the benefits of direct versus indirect revascularisation of internal iliac arteries (IIAs) for prevention of buttock claudication in this population. We retrospectively reviewed the charts of proximal ischaemia patients who underwent revascularisation and both preoperative and postoperative stress TcPO(2) testing. Revascularisation procedures were classified as either direct revascularisation, including percutaneous transluminal angioplasty and internal iliac artery bypass, resulting in a direct inflow in a patent IIA (group 1) or indirect revascularisation, including aortobifemoral bypass and recanalisation of the femoral junction on the ischaemic side, resulting in indirect inflow from collateral arteries in the hypogastric territory (group 2). Patency was checked 3 months after revascularisation in all cases. Treadmill exercise stress tests were performed before and after revascularisation using the same protocol designed to assess pain, determine maximum walking distance (MWD) and measure TcPO(2) during exercise. In addition, ankle-brachial indices (ABIs) were calculated. Between May 2001 and March 2008, a total of 93 patients with objectively documented proximal ischaemia underwent 145 proximal revascularisation procedures using conventional open techniques in 109 cases and endovascular techniques in 36. Direct revascularisation was performed on 50 limbs (35%) (group 1) and indirect revascularisation on 95 limbs (65%) (group 2). The mean interval between revascularisation and stress testing was 60+/-74 days preoperatively and 149+/-142 days postoperatively. No postoperative thrombosis was observed. Buttock claudication following revascularisation was more common in group 2 (p<0.001). No difference was observed between the two groups with regard to improvement in MWD (365 / 294 m) and ABI (0.20/0.22). Disappearance of proximal ischaemia was more common after direct revascularisation (p<0.01). The extent of lesions graded according to the TASC II classification appeared not to be predictive of improvement in assessment criteria following revascularisation. Conversely, patency of the superficial femoral artery was correlated with improvement (p<0.01). This study indicates that direct revascularisation, if feasible, provides the best functional outcome for prevention of buttock claudication.
Collapse
Affiliation(s)
- A Paumier
- Department of Vascular and Thoracic Surgery, University Hospital, Angers, France
| | | | | | | | | | | | | |
Collapse
|
7
|
Naguib NN, Nour-Eldin NEA, Hammerstingl RM, Lehnert T, Floeter J, Zangos S, Vogl TJ. Three-dimensional Reconstructed Contrast–enhanced MR Angiography for Internal Iliac Artery Branch Visualization before Uterine Artery Embolization. J Vasc Interv Radiol 2008; 19:1569-75. [DOI: 10.1016/j.jvir.2008.08.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Revised: 08/08/2008] [Accepted: 08/08/2008] [Indexed: 11/15/2022] Open
|
8
|
Jaquinandi V, Picquet J, Bouyé P, Saumet JL, Leftheriotis G, Abraham P. High prevalence of proximal claudication among patients with patent aortobifemoral bypasses. J Vasc Surg 2007; 45:312-8. [PMID: 17264010 DOI: 10.1016/j.jvs.2006.09.050] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2006] [Accepted: 09/20/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Proximal (ie, buttock, hip) claudication can result from impaired perfusion in the hypogastric area after aortobifemoral bypass (ABF) despite normal femorodistal blood flow provided by the patent bypass. The proportion of patients that experience proximal claudication after ABF is unknown, and arguments for the vascular origin of symptoms specifically at the proximal level have never been reported. METHODS This was a prospective study set in an institutional practice of ambulatory patients referred for a systematic survey of their previous ABF bypass. Among the 131 eligible patients, 10 refused to participate and 16 were unable to walk on a treadmill. The 105 studied patients (94 men, 11 women) were a mean age of 63 +/- 10 years, and the median delay from surgery was 2 years (range, 4 months to 26 years). We used a modified version of the San Diego Claudication Questionnaire administered both at rest before the treadmill study and again after the treadmill test. Transcutaneous oxygen pressure (TcPO2) at the buttock level was used to evaluate blood flow impairment during exercise at the proximal level, with blood flow impairment defined as buttock minus chest TcPO2 decrease in excess of -15 mm Hg. RESULTS Thirty patients reported proximal exercise-related pain consistent with vascular criteria by history before exercise. However, 59 patients (56%) reported symptoms compatible with proximal claudication, and TcPO2 values were abnormal on one or both sides in 52. The persistence of at least one (prograde or retrograde) pathway to the hypogastric circulation, determined by review of operative details from the aortobifemoral bypass and angiography, did not significantly decrease the proportion of patients reporting proximal claudication by history (26%) or on treadmill (55%) compared with those with bilateral hypogastric occlusion (33% by history, P = .51 compared with at least one prograde hypogastric pathway and 61% based on treadmill test, P = .65 compared with at least one prograde hypogastric pathway). CONCLUSION The present study shows that (1) the proportion of ABF patients with a median bypass age of 2 years that report proximal claudication is high (28%), (2) this proportion is significantly higher when claudication is detected by treadmill exercise tests, (3) a vascular origin (or at least contribution) is likely 88% of the proximal symptoms observed on treadmill, (4) the presence of proximal claudication with associated abnormal TcPO(2) results increases the risk of walking impairment in affected patients, and (5) preservation of at least one internal iliac artery to allow prograde or retrograde flow to the hypogastric vascular bed does not decrease the risk of proximal claudication after ABF surgery. A vascular origin of (or at least contribution to) most of the proximal exercise-related symptoms should always be discussed in patients with patent ABF bypass.
Collapse
Affiliation(s)
- Vincent Jaquinandi
- Department of Vascular Investigations, University Hospital of Angers, Angers, France
| | | | | | | | | | | |
Collapse
|
9
|
Abstract
Proximal arterial stenosis (bifurcation of the aortic, common iliac and especially hypogastric or hip arteries) can cause misleading 'hip' or buttock pain (two thirds of these cases involve the area of the trochanter, groin, or thigh). Their essential characteristic is that they cause patients to stop walking, improve in a minute or two and reappear when the patient starts walking again. Neither articular complications nor periarthritis of the hip fit this pattern, and physical examination and imaging exclude them. Neurogenic intermittent claudication is more difficult to rule out: it is 'often accompanied by paresthesia and anteflexion of the trunk to relieve the pain. A radiologic image of lumbar canal stenosis alone does not indicate that it is responsible for the pain: the stenosis may be asymptomatic and only fortuitously associated with the pain. The usual reduction in femoral pulse or ankle pressure index is absent if the stenosis is located on the hypogastric or gluteal artery and there is not substantial damage to the aorta-iliac axis. Arterial stenosis is confirmed by Doppler ultrasound. Arteriography is an examination performed during treatment, to guide angioplasty. It is indicated when medical treatment fails, as it frequently does.
Collapse
|
10
|
Chaer RA, Faries PL, Lin S, Dayal R, McKinsey JF, Kent KC. Successful percutaneous treatment of gluteal claudication secondary to isolated bilateral hypogastric stenoses. J Vasc Surg 2006; 43:165-8. [PMID: 16414405 DOI: 10.1016/j.jvs.2005.09.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2005] [Accepted: 09/07/2005] [Indexed: 11/16/2022]
Abstract
We report an unusual case of bilateral buttock claudication at ambulation of less than two blocks in a 57-year-old man with normal lower-extremity segmental pressure on noninvasive exercise testing. He was found to have bilateral high-grade internal iliac artery stenoses on arteriography. Both sides were successfully treated in a staged fashion via a contralateral approach with percutaneous transluminal angioplasty and a balloon-expandable stent, with complete symptom resolution. A clinical vascular examination with normal findings of the common iliac, external iliac, and common and superficial femoral arteries eliminates significant vascular obstruction as a cause of claudication. However, internal iliac occlusive disease may be suspected when symptoms are limited to the gluteal musculature and other causes are eliminated. Percutaneous interventions can be of diagnostic and therapeutic value.
Collapse
Affiliation(s)
- Rabih A Chaer
- Division of Vascular Surgery, New York Presbyterian Hospital, Cornell University, New York, NY, USA
| | | | | | | | | | | |
Collapse
|
11
|
Picquet J, Jaquinandi V, Saumet JL, Leftheriotis G, Enon B, Abraham P. Systematic diagnostic approach to proximal-without-distal claudication in a vascular population. Eur J Intern Med 2005; 16:575-9. [PMID: 16314239 DOI: 10.1016/j.ejim.2005.06.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2005] [Revised: 05/26/2005] [Accepted: 06/23/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Very few observations of proximal-without-distal claudication have been reported in the literature. This is likely due to the use of questionnaires limiting vascular claudication to the calves and to the problems encountered in attributing unexplained "buttock" claudication to a vascular origin. METHODS During a 2 1/2-year period, we searched for proximal-without-distal exercise-related pain with the San Diego claudication questionnaire among some 2000 patients referred for lower limb arterial investigations. Of these patients, 97 presented no contraindication to treadmill testing and were investigated with exercise transcutaneous oxygen pressure (tcpO2). We used buttock tcpO2 (DROP index<-15 mm hg) to argue for the presence of ischemia on the corresponding side. RESULTS Ischemia consistent with symptoms was found in 61 patients, whereas pain on one or both sides without underlying ischemia was found in 36 patients, suggesting a non-arterial origin of the symptoms. More than half of the patients with proximal-without-distal claudication and underlying exercise-related ischemia had been suffering for more than 2 years before they were referred to the laboratory. Eleven of the patients were treated. The treatment was successful in all but one of them. CONCLUSIONS An important delay before diagnosis is frequently observed in proximal-without-distal claudication. TcpO2 is useful in attributing proximal exercise-related pain to a vascular origin. Given the number of detected and successfully treated patients in this small monocentric study, it is surprising that so few observations have been published to date, suggesting that proximal-without-distal arterial claudication is most likely an underestimated diagnosis.
Collapse
Affiliation(s)
- J Picquet
- Department of Vascular Surgery, University Hospital, Angers, France
| | | | | | | | | | | |
Collapse
|
12
|
Bouyé P, Jacquinandi V, Picquet J, Thouveny F, Liagre J, Leftheriotis G, Saumet JL, Abraham P. Near-infrared spectroscopy and transcutaneous oxygen pressure during exercise to detect arterial ischemia at the buttock level: Comparison with arteriography. J Vasc Surg 2005; 41:994-9. [PMID: 15944599 DOI: 10.1016/j.jvs.2005.03.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Noninvasive tests are required to detect (in both male and female subjects and side by side) arteries toward the hypogastric circulation that are likely to present significant lesions as a cause of buttock claudication. METHODS We compared the accuracy of near-infrared spectroscopy (NIRS) and transcutaneous oxygen pressure (TCP o 2 ) on both buttocks during walking tests to detect lesions on the arteries toward the hypogastric circulation. NIRS was considered abnormal if recovery time to pre-exercise values was greater than 240 seconds for tissue oxygen saturation (absent data being coded 0), and TCP o 2 was coded abnormal if the minimal value of buttock changes minus chest changes was lower than -15 mm Hg. The study was conducted in a university hospital; there were 30 ambulatory patients with stage 2 claudication of the Fontaine classification. RESULTS Angiography showed 36 abnormal (stenosis > 75%) and 24 normal arterial axes toward the buttocks circulation. NIRS and TCP o 2 provided respectively 55% (range, 41.6% to 67.9%) and 82% (range, 69.6% to 90.5%) accuracy (95% confidence interval) to predict the presence of arteriographically proven lesions; P < .05. CONCLUSIONS Using available cut-off points proposed in the literature, NIRS showed a lower diagnostic accuracy than TCP o 2 for the prediction of lesions on the arterial tree to the hypogastric circulation. NIRS is a recent technique as compared with TCP o 2 , and its diagnostic accuracy might improve in the future. Currently, one should carefully weigh the advantages and limits of NIRS and TCP o 2 when a choice is to be made between them to monitor exercise-induced changes resulting from lower limb arterial disease at the proximal level.
Collapse
Affiliation(s)
- Philippe Bouyé
- Laboratoire d'Explorations Vasculaires, Centre Hospitalier Universitaire, Angers, France
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Coruh A, Akcali Y, Ozcan N, Ekmekcioglu O. Modified pudendal thigh flap for perineoscrotal reconstruction: A case of Leriche syndrome with rapidly progressing Fournier’s gangrene. Urology 2004; 64:1030. [PMID: 15533507 DOI: 10.1016/j.urology.2004.05.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2004] [Accepted: 05/26/2004] [Indexed: 10/26/2022]
Abstract
We present the first report of Leriche syndrome associated with Fournier's gangrene. We used a modified pudendal thigh flap in the treatment of an extensive perineoscrotal soft-tissue defect successfully. We propose this new robust flap as an addition to the existing reconstructive armamentarium and draw attention to the coexistence of Leriche syndrome and Fournier's gangrene.
Collapse
Affiliation(s)
- Atilla Coruh
- Department of Plastic and Reconstructive Surgery, Erciyes University Medical Faculty, Kayseri, Turkey
| | | | | | | |
Collapse
|
14
|
Abraham P, Picquet J, Vielle B, Sigaudo-Roussel D, Paisant-Thouveny F, Enon B, Saumet JL. Transcutaneous oxygen pressure measurements on the buttocks during exercise to detect proximal arterial ischemia: comparison with arteriography. Circulation 2003; 107:1896-900. [PMID: 12668524 DOI: 10.1161/01.cir.0000060500.60646.e0] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We sought to identify whether transcutaneous oxygen tension (tcPo2) measurements could be used to noninvasively detect lesions in the arterial network supplying blood flow to the hypogastric circulation. METHODS AND RESULTS A study was undertaken in vascular patients with suspected (PC, n=43) and not with suspected (NPC, n=34) proximal ischemia. TcPo2 was measured on both buttocks and with a chest reference electrode. Arteriography on the right or left side was positive for stenoses (> or =75%) or occlusion of one or more of the following arteries: the aorta, the common iliac arteries, or the internal iliac arteries. The arteriography was compared with the resting tcPo2 values (REST) and with the minimal value (MIN) and maximal change from rest normalized to eventual chest changes (DROP) recorded during or after a treadmill test. REST, MIN, and DROP were, respectively, as follows in positive versus negative arteriograms (mean+/-SD; in mm Hg): 80.2+/-10.9 versus 78.6+/-11.5 (P>0.05), 55.2+/-20.0 versus 69.9+/-15.8 (P<0.001), and -31.8+/-17.6 versus -9.5+/-6.4 (P<0.0001) in PC and 78.9+/-14.0 versus 80.5+/-14.3 (P>0.05), 64.4+/-21.0 versus 75.1+/-14.6 (P<0.02), and -24.1+/-13.5 versus -8.7+/-4.8 (P<0.0001) in NPC. In PC and NPC respectively, with a cutoff point of -16 and -15 mm Hg, DROP showed, respectively, 83%/82% and 79%/86% sensitivity/specificity in the diagnosis of positive arteriograms. CONCLUSIONS Proximal ischemia is a frequent finding in vascular patients. TcPo2 measurement on the buttocks during exercise is a sensitive and specific indicator for lesions in the arterial tree toward the hypogastric circulation. Potentially it could objectively assess the response to endovascular or surgical approaches to iliac lesions.
Collapse
Affiliation(s)
- Pierre Abraham
- Department of Vascular Studies, University Hospital of Angers, France.
| | | | | | | | | | | | | |
Collapse
|