1
|
Trihan JE, Croquette M, Hersant J, Prigent R, Fontaine C, Henni S, Lanéelle D. Accuracy of maximal acceleration time of pedal arteries to diagnose critical limb-threatening ischemia. Vasc Med 2024; 29:153-162. [PMID: 38469710 DOI: 10.1177/1358863x231226216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Maximal acceleration time of distal arteries of the foot (ATmax) is correlated to ankle-brachial index (ABI) and toe-brachial index (TBI), and seems very promising in diagnosing severe peripheral artery disease (PAD) and especially critical limb-threatening ischemia (CLTI). Our goal was to confirm the cut-off value of 215 ms to predict a toe pressure (TP) ⩽ 30 mmHg. METHODS A 4-month retrospective study was conducted on patients addressed for suspicion of PAD. Demographic data, ABI, TBI, and Doppler ultrasound scanning parameters of the dorsal pedis and lateral plantar arteries (DPA and LPA) were recorded. RESULTS A total of 137 patients with 258 lower limbs were included. ATmax was highly correlated to TBI (r = -0.89, p < 0.001). With the cut-off value of 215 ms, ATmax was effective to diagnose TP ⩽ 30 mmHg with a sensitivity of 93% [95% CI 77-99], a specificity of 96% [95% CI 92-98], a positive predictive value of 73% [95% CI 56-86], a negative predictive value of 99% [95% CI 97-100], and an area under the receiver operating characteristics curve of 0.99 [95% CI 0.98-1.00]. ATmax also showed promising results to rule out PAD in healthy patients. CONCLUSION ATmax is a reliable diagnostic tool to diagnose low TP and could be a new easily performed hemodynamic criterion for diagnosis of CLTI.
Collapse
Affiliation(s)
- Jean-Eudes Trihan
- Vascular Medicine Unit, Hospital of Cholet, Cholet, Pays de la Loire, France
- Vascular Medicine Department, University Hospital Angers, Angers, Pays de la Loire, France
| | - Magali Croquette
- Vascular Medicine Unit, University Hospital Centre Poitiers, Poitiers, Nouvelle-Aquitaine, France
| | - Jeanne Hersant
- Vascular Medicine Department, University Hospital Angers, Angers, Pays de la Loire, France
- UMR CNRS 1083, INSERM 6015, LUNAM University, Angers, France
| | - Romain Prigent
- Vascular Medicine Unit, Hospital of Cholet, Cholet, Pays de la Loire, France
| | - Cedric Fontaine
- Vascular Medicine Unit, Hospital of Cholet, Cholet, Pays de la Loire, France
| | - Samir Henni
- Vascular Medicine Department, University Hospital Angers, Angers, Pays de la Loire, France
- UMR CNRS 1083, INSERM 6015, LUNAM University, Angers, France
| | - Damien Lanéelle
- Vascular Medicine Unit, University Hospital Côte de Nacre, Caen, Normandie, France
- UNICAEN, INSERM 1075, COMETE, Caen, Normandie, France
| |
Collapse
|
2
|
Mellinger A, Hersant J, Bourreau C, Lecoq S, Deveze E, Clere N, Henni S. Caliper, contrast enhanced-ultrasound or laser speckle contrast imaging: Techniques to follow mice melanoma growth. J Biophotonics 2024; 17:e202300439. [PMID: 38302735 DOI: 10.1002/jbio.202300439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/17/2024] [Accepted: 01/17/2024] [Indexed: 02/03/2024]
Abstract
Due to morphological characteristics, metastatic melanoma is a cancer for which vascularization is not a diagnostic criterion. Laser speckle contrast imaging (LSCI) and contrast enhanced ultrasound (CEUS) are two imaging techniques that will be explored in this study, which aims to confirm these two techniques for monitoring tumor vascularization. B16F10 cells were xenografted to C57BL/6 mice treated with anti-PD1 or 0.9% NaCl. Tumor volume was measured daily while CEUS and LSCI were performed weekly. LSCI and CEUS analyses showed a decrease in tumor perfusion in both groups of mice. Although both CEUS and LSCI are useful for measuring tumor volume, LSCI appears to be more robust and effective for monitoring tumor microcirculation. Non-invasive investigations are needed to better predict tumor vascularization: CEUS and LSCI have a good applicability in a mice model.
Collapse
Affiliation(s)
| | | | - Clara Bourreau
- Univ Angers, Inserm, CNRS, MINT, SFR ICAT, Angers, France
| | - Simon Lecoq
- Vascular Medicine, University Hospital, Angers, France
| | - Eva Deveze
- Vascular Surgery, University Hospital, Angers, France
| | - Nicolas Clere
- Univ Angers, Inserm, CNRS, MINT, SFR ICAT, Angers, France
| | - Samir Henni
- Vascular Medicine, University Hospital, Angers, France
| |
Collapse
|
3
|
Abrard S, Streichenberger A, Riou J, Hersant J, Rineau E, Jacquet-Lagrèze M, Fouquet O, Henni S, Rimmelé T. Preoperative endothelial dysfunction for the prediction of acute kidney injury after cardiac surgery using cardiopulmonary bypass: a pilot study based on a second analysis of the MONS study. Perioper Med (Lond) 2024; 13:12. [PMID: 38424616 PMCID: PMC10903056 DOI: 10.1186/s13741-024-00364-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 02/13/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Up to 42% of patients develop acute kidney injury (AKI) after cardiac surgery. The aim of this study was to describe the relationship between preoperative microcirculatory function and postoperative AKI after cardiac surgery using cardiopulmonary bypass (CPB). METHODS The prospective observational cohort MONS enrolled 60 patients scheduled for valvular (n = 30, 50%) or coronary (n = 30, 50%) surgery using CPB. Preoperative microcirculation was assessed during preoperative consultation from January 2019 to April 2019 at the University Hospital of Angers, France, using endothelium-dependent and endothelium-independent reactivity tests on the forearm (iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP), respectively). Skin blood flow was measured by laser speckle contrast imaging. The primary endpoint was the occurrence of AKI according to the KDIGO classification during the hospital stay. RESULTS Forty-three (71.7%) patients developed AKI during the in-hospital follow-up, and 15 (25%) were classified as KDIGO stage 1, 20 (33%) KDIGO stage 2, and 8 (13%) KDIGO stage 3. Regarding preoperative microcirculation, a higher peak amplitude of vasodilation in response to iontophoresis of ACh was found in patients with postoperative occurrence of AKI (35 [20-49] vs 23 [9-44] LSPU, p = 0.04). Iontophoresis of SNP was not significantly different according to AKI occurrence (34 [22-49] vs 36 [20-50] LSPU, p = 0.95). In a multivariable model, the preoperative peak amplitude at iontophoresis of ACh was independently associated with postoperative AKI (OR 1.045 [1.001-1.092], p = 0.045). CONCLUSIONS The preoperative peak amplitude of endothelium-dependent vasodilation is independently associated with the postoperative occurrence of AKI. TRIAL REGISTRATION Clinical-Trials.gov, NCT03631797. Registered 15 August 2018, https://clinicaltrials.gov/ct2/show/NCT03631797.
Collapse
Affiliation(s)
- Stanislas Abrard
- Department of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, 5 Pl d'Arsonval, Lyon, 69437, France.
- MitoVasc Institut, UMR INSERM 1083 ‑ CNRS 6015, University of Angers, 3 Rue Roger Amsler, Angers, 49100, France.
- Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, Cedex 08, Lyon, 69373, France.
| | - Antoine Streichenberger
- Department of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, 5 Pl d'Arsonval, Lyon, 69437, France
| | - Jérémie Riou
- Department of Methodology and Biostatistics Delegation to Clinical Research and Innovation, Angers University Hospital, 4 Rue Larrey, 49933, Angers, France
- Micro Et Nanomedecines Translationnelles, MINT, UMR INSERM 1066 - CNRS 6021, University of Angers, 3 Rue Roger Amsler, Angers, 49100, France
| | - Jeanne Hersant
- MitoVasc Institut, UMR INSERM 1083 ‑ CNRS 6015, University of Angers, 3 Rue Roger Amsler, Angers, 49100, France
- Department of Vascular Medicine, University Hospital of Angers, 4 Rue Larrey, 49933, Angers, France
| | - Emmanuel Rineau
- MitoVasc Institut, UMR INSERM 1083 ‑ CNRS 6015, University of Angers, 3 Rue Roger Amsler, Angers, 49100, France
- Department of Anesthesiology and Intensive Care, University Hospital of Angers, 4 Rue Larrey, 49933, Angers, France
| | - Matthias Jacquet-Lagrèze
- Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, Cedex 08, Lyon, 69373, France
- CarMeN Laboratory, UMR INSERM 1060, Université Claude Bernard Lyon 1, 59 Bd Pinel, Bron, 69500, France
- Department of Anesthesiology and Intensive Care Medicine, Hospices Civils de Lyon, University Hospital Louis Pradel, 59 Bd Pinel, Bron, 69500, France
| | - Olivier Fouquet
- MitoVasc Institut, UMR INSERM 1083 ‑ CNRS 6015, University of Angers, 3 Rue Roger Amsler, Angers, 49100, France
- Department of Cardiac Surgery, University Hospital of Angers, 4 Rue Larrey, 49933, Angers, France
| | - Samir Henni
- MitoVasc Institut, UMR INSERM 1083 ‑ CNRS 6015, University of Angers, 3 Rue Roger Amsler, Angers, 49100, France
- Department of Vascular Medicine, University Hospital of Angers, 4 Rue Larrey, 49933, Angers, France
| | - Thomas Rimmelé
- Department of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, 5 Pl d'Arsonval, Lyon, 69437, France
- Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, Cedex 08, Lyon, 69373, France
- Pathophysiology of Injury-Induced Immunosuppression, EA7426, Hospices Civils de Lyon - BioMérieux - University Claude Bernard Lyon 1, 5 Pl d'Arsonval, Lyon, 69437, France
| |
Collapse
|
4
|
Abraham P, Lecoq S, Mechenin M, Deveze E, Hersant J, Henni S. Role of Lifestyle in Thoracic Outlet Syndrome: A Narrative Review. J Clin Med 2024; 13:417. [PMID: 38256551 PMCID: PMC10816325 DOI: 10.3390/jcm13020417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/20/2023] [Accepted: 01/07/2024] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION The presence of a positional compression of the neurovascular bundle in the outlet between the thorax and the upper limb during arm movements (mainly abduction) is common but remains asymptomatic in most adults. Nevertheless, a certain number of subjects with thoracic outlet positional compression will develop incapacitating symptoms or clinical complications as a result of this condition. Symptomatic forms of positional neurovascular bundle compression are referred to as "thoracic outlet syndrome" (TOS). MATERIALS AND METHODS This paper aims to review the literature and discuss the interactions between aspects of patients' lifestyles in TOS. The manuscript will be organized to report (1) the historical importance of lifestyle evolution on TOS; (2) the evaluation of lifestyle in the clinical routine of TOS-suspected patients, with a description of both the methods for lifestyle evaluation in the clinical routine and the role of lifestyle in the occurrence and characteristics of TOS; and (3) the influence of lifestyle on the treatment options of TOS, with a description of both the treatment of TOS through lifestyle changes and the influence of lifestyle on the invasive treatment options of TOS. RESULTS We report that in patients with TOS, lifestyle (1) is closely related to anatomical changes with human evolution; (2) is poorly evaluated by questionnaires and is one of the factors that may induce symptoms; (3) influences the sex ratio in symptomatic athletes and likely explains why so many people with positional compression remain asymptomatic; and (4) can sometimes be modified to improve symptoms and potentially alter the range of interventional treatment options available. CONCLUSIONS Detailed descriptions of the lifestyles of patients with suspected TOS should be carefully analysed and reported.
Collapse
Affiliation(s)
- Pierre Abraham
- Service of Sports Medicine, University Hospital, 49100 Angers, France;
- Service of Vascular Medicine, University Hospital, 49100 Angers, France (J.H.)
- INSERM, CNRS, MITOVASC, Equipe CarMe, SFR ICAT, University Angers, 49100 Angers, France
| | - Simon Lecoq
- Service of Sports Medicine, University Hospital, 49100 Angers, France;
- Service of Vascular Medicine, University Hospital, 49100 Angers, France (J.H.)
| | - Muriel Mechenin
- Service of Vascular Medicine, University Hospital, 49100 Angers, France (J.H.)
| | - Eva Deveze
- Service of Thoracic and Vascular Surgery, University Hospital, 49100 Angers, France
| | - Jeanne Hersant
- Service of Vascular Medicine, University Hospital, 49100 Angers, France (J.H.)
| | - Samir Henni
- Service of Vascular Medicine, University Hospital, 49100 Angers, France (J.H.)
- INSERM, CNRS, MITOVASC, Equipe CarMe, SFR ICAT, University Angers, 49100 Angers, France
| |
Collapse
|
5
|
Deveze E, Ammi M, Hersant J, Papon X, Henni S, Abraham P, Picquet J. Ten-year Experience of Surgical Management of Paget-Schroetter Syndrome. Ann Vasc Surg 2023; 96:328-334. [PMID: 37023925 DOI: 10.1016/j.avsg.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 03/03/2023] [Accepted: 03/12/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Paget-Schroetter syndrome (PSS) or effort-induced thrombosis is an acute (<14 days) venous thrombosis of the axillosubclavian vein. Early catheter-directed thrombolysis (CDT) is required to improve patency rate and avoid postthrombotic syndrome. This study aimed to report the management of PSS in our center across 10 years and compare it to the established guidelines. METHODS Some of the selected patients were treated with CDT if the diagnosis of acute vein thrombosis was established 6 weeks after the appearance of the first symptoms and if a vascular surgeon was involved in the care and management of the patient. Patients underwent first rib removal 6 weeks after the CDT. Some patients with primary upper limb venous thrombosis were not immediately referred to a vascular surgeon after the initial diagnosis. They were instead discharged home with the prescription of oral anticoagulation therapy (OAT) alone for at least 3 months. RESULTS Between 2010 and 2020, 426 first rib removal procedures were performed for 338 patients with thoracic outlet syndrome (TOS) at our center. Among them, 18 (4.2%) patients with PSS were identified. 5 (27.8%) patients underwent CDT. The median duration between first symptoms and thrombolysis was 10 days (range, 1-32). Thirteen (72.2%) patients were discharged home with OAT alone and referred to a vascular surgeon with a median time of 365 days (range, 8-6,422) for TOS diagnosis. Postthrombotic syndrome was noticed in 5 (38%) patients in the OAT group and 1 (20%) patient in the CDT group. CONCLUSIONS Despite the guidelines being in favor of early CDT in PSS, most patients are discharged home with OAT alone. The study findings demonstrate that better information about this specific complication must be provided to the concerned practitioners who are likely to encounter such patients.
Collapse
Affiliation(s)
- Eva Deveze
- Vascular and Thoracic Surgery, University Hospital, Angers, France.
| | - Myriam Ammi
- Vascular and Thoracic Surgery, University Hospital, Angers, France
| | | | - Xavier Papon
- Vascular and Thoracic Surgery, University Hospital, Angers, France
| | - Samir Henni
- Vascular Medicine, University Hospital, Angers, France
| | - Pierre Abraham
- Vascular Medicine, University Hospital, Angers, France; UMR CNRS6015-INSERM-1083, Mitovasc Institute, University of Angers, Angers, France
| | - Jean Picquet
- Vascular and Thoracic Surgery, University Hospital, Angers, France
| |
Collapse
|
6
|
Espitia O, Douane F, Hersant J, Abbadie F, Sobocinski J, Heautot JF, Miossec A, Lapébie FX, Hartung O. Predictive Factors of Stent Patency in Iliofemoral Venous Diseases in a Multicentre Cohort Study. Eur J Vasc Endovasc Surg 2023; 65:564-572. [PMID: 36642400 DOI: 10.1016/j.ejvs.2023.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 12/13/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE This study assessed primary stent patency predictive factors in three groups of patients with history of lower limb (LL) vein thrombosis: non-thrombotic iliac vein lesion (NIVL), acute deep vein thrombosis (aDVT), and post-thrombotic syndrome (PTS). METHODS Consecutive patients from January 2014 to December 2020 with history of LL vein stenting from seven hospitals were included. All patients received an iliac or common femoral venous stent and had at least a six month follow up available with stent imaging. Anticoagulant and antiplatelet therapy strategies employed after venous stenting are reported and compared between groups. RESULTS This study included 377 patients: 134 NIVL, 55 aDVT, and 188 PTS. Primary patency was statistically significantly higher in the NIVL group (99.3%) compared with the PTS group (68.6%) (p < .001) and the aDVT group (83.6%) (p = .002). PTS patients received a statistically significantly greater number of stents (p < .001) and had more stents below the inguinal ligament (p < .001). Median follow up was 28.8 months (IQR 16, 47). Discontinuation of antiplatelet therapy at the last assessment was 83.6% for NIVL, 100% for aDVT, and 95.7% for the PTS group (p < .001). Discontinuation of anticoagulation therapy at the last assessment was 93.2% for NIVL, 25.0% for aDVT, and 70.3% for the PTS group (p < .001). The only predictor of worse primary patency in the aDVT group was long term anticoagulation before stenting. CONCLUSION Patients with NIVL have better primary patency after venous stenting than patients with venous thrombotic disorders. Long term anticoagulation before stenting was the only factor associated with poorer primary patency in patients with aDVT.
Collapse
Affiliation(s)
- Olivier Espitia
- Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, Nantes, France.
| | - Frédéric Douane
- Nantes Université, CHU Nantes, Department of Radiology, Nantes, France
| | | | | | | | | | - Annaïg Miossec
- Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, Nantes, France
| | | | | |
Collapse
|
7
|
Espitia O, Robin O, Hersant J, Roncato C, Théry A, Vibet MA, Gautier G, Raimbeau A, Lapébie FX. Inter and intra-observer agreement of arterial wall contrast-enhanced ultrasonography in giant cell arteritis. Front Med (Lausanne) 2022; 9:1042366. [DOI: 10.3389/fmed.2022.1042366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022] Open
Abstract
ObjectiveThe aim of this study was to analyze inter- and intra-observer agreement for contrast-enhanced ultrasonography (CEUS) for monitoring disease activity in Giant Cell Arteritis (GCA) in the wall of axillary arteries, and common carotid arteries.MethodsGiant cell arteritis patients have CEUS of axillary arteries and common carotid. These images were rated by seven vascular medicine physicians from four hospitals who were experienced in duplex ultrasonography of GCA patients. Two weeks later, observers again rated the same images. GCA patients were recruited in from December 2019 to February 2021. An analysis of the contrast of the ultrasound images with a gradation in three classes (grade 0, 1, and 2) was performed. Grade 0 corresponds to no contrast, grade 1 to moderate wall contrast and grade 2 to intense contrast. A new analysis in 2 classes: positive or negative wall contrast; was then performed on new series of images.ResultsSixty arterial segments were evaluated in 30 patients. For the three-class scale, intra-rater agreement was substantial: κ 0.70; inter-rater agreement was fair: κ from 0.22 to 0.27. Thirty-four videos had a wall thickness of less than 2 mm and 26 videos had a wall thickness greater than 2 mm. For walls with a thickness lower than 2 mm: intra-rater agreement was substantial: κ 0.69; inter-rater agreement was fair: κ 0.35. For walls with a thickness of 2 mm or more: intra-rater agreement was substantial: κ 0.53; inter-rater agreement was fair: κ 0.25. For analysis of parietal contrast uptake in two classes: inter-rater agreement was fair to moderate: κ from 0.35 to 0.41; and for walls with a thickness of 2 mm or more: inter-rater agreement was fair to substantial κ from 0.22 to 0.63.ConclusionThe visual analysis of contrast uptake in the wall of the axillary and common carotid arteries showed good intra-rater agreement in GCA patients. The inter-rater agreement was low, especially when contrast was analyzed in three classes. The inter-rater agreement for the analysis in two classes was also low. The inter-rater agreement was higher in two-class analysis for walls of 2 mm thickness or more.
Collapse
|
8
|
Hersant J, Lecoq S, Ramondou P, Feuilloy M, Abraham P, Henni S. Upper arm versus forearm transcutaneous oximetry during upper limb abduction in patients with suspected thoracic outlet syndrome. Front Physiol 2022; 13:1033137. [DOI: 10.3389/fphys.2022.1033137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/26/2022] [Indexed: 11/10/2022] Open
Abstract
Context: Thoracic outlet syndrome (TOS) is common among athletes and should be considered as being of arterial origin only if patients have “clinical symptoms due to documented symptomatic ischemia.” We previously reported that upper limb ischemia can be documented with DROPm (minimal value of limb changes minus chest changes) from transcutaneous oximetry (TcpO2) in TOS.Purpose: We aimed to test the hypothesised that forearm (F-) DROPm would better detect symptoms associated with arterial compression during abduction than upper arm (U-) DROPm, and that the thresholds would differ.Methods: We studied 175 patients (retrospective analysis of a cross-sectional acquired database) with simultaneous F-TcpO2 and U-TcpO2 recordings on both upper limbs, and considered tests to be positive (CS+) when upper limb symptoms were associated with ipsilateral arterial compression on either ultrasound or angiography. We determined the threshold and diagnostic performance with a receiver operating characteristic (ROC) curve analysis and calculation of the area under the ROC curve (AUROC) for absolute resting TcpO2 and DROPm values to detect CS+. For all tests, a two-tailed p < 0.05 was considered indicative of statistical significance.Results: In the 350 upper-limbs, while resting U-TcpO2 and resting F-TcpO2 were not predictive of CS + results, the AUROCs were 0.68 ± 0.03 vs. 0.69 ± 0.03 (both p < 0.01), with the thresholds being −7.5 vs. −14.5 mmHg for the detection of CS + results for U-DROPm vs. F-DROPm respectively.Conclusion: In patients with suspected TOS, TcpO2 can be used for detecting upper limb arterial compression and/or symptoms during arm abduction, provided that different thresholds are used for U-DROPm and F-DROPm.Clinical Trial Registration:ClinicalTrials.gov, identifier NCT04376177.
Collapse
|
9
|
Hersant J, Ramondou P, Josse C, Lecoq S, Henni S, Abraham P. Quantitative analysis of venous outflow with photo-plethysmography in patients with suspected thoracic outlet syndrome. Front Cardiovasc Med 2022; 9:803919. [DOI: 10.3389/fcvm.2022.803919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundVenous compression is the second most frequent form of thoracic outlet syndrome (TOS). Although venous photo-plethysmography (PPG) has been largely used to estimate the consequences of chronic thromboses (Paget Schroetter syndrome), systematic direct quantitative recording of hemodynamic consequences of positional venous outflow impairment in patients with suspected TOS has never been reported.ObjectiveWe hypothesized that moving the arms forward (prayer: “Pra” position) while keeping the hands elevated after a surrender/candlestick position (Ca) would allow quantification of 100% upper limb venous emptying (PPGmax) and quantitative evaluation of the emptying observed at the end of the preceding abduction period (End-Ca-PPG), expressed in %PPGmax.Materials and methodsWe measured V-PPG in 424 patients referred for suspected TOS (age 40.9 years old, 68.3% females) and retrieved the results of ultrasound investigation at the venous level. We used receiver operating characteristics curves (ROC) to determine the optimal V-PPG values to be used to predict the presence of a venous compression on ultrasound imaging. Results are reported as a median (25/75 centiles). Statistical significance was based on a two-tailed p < 0.05.ResultsAn End-Ca-PPG value of 87% PPGmax at the end of the “Ca” period is the optimal point to detect an ultrasound-confirmed positional venous compression (area under ROC: 0.589 ± 0.024; p < 0.001). This threshold results in 60.9% sensitivity, 47.6% specificity, 27.3% positive predictive value, 79.0% negative predictive value, and 50.8% overall accuracy.ConclusionV-PPG is not aimed at detecting the presence of a venous compression due to collateral veins potentially normalizing outflow despite subclavicular vein compression during abduction, but we believe that it could be used to strengthen the responsibility of venous compression in upper limb symptoms in TOS-suspected patients, with the possibility of non-invasive, bilateral, recordable measurements of forearm volume that become quantitative with the Ca-Pra maneuver.Clinical trial registration[ClinicalTrials.gov], identifier [NCT04376177].
Collapse
|
10
|
Semporé WY, Hersant J, Ramondou P, Hamel JF, Abraham P, Henni S. Exercise Oximetry Correlates Better With Exercise-Induced Lactate Increase, than Ankle Brachial Index or Walking Time, in Vascular Claudicants. Angiology 2022; 74:526-535. [PMID: 35816616 DOI: 10.1177/00033197221112132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In claudication, the correlation between walking-induced biomarkers and indices of clinical severity (e.g., walking distance or ankle brachial index (ABI)), is fair. We hypothesized that a correlation would be observed between the clinical estimation of ischemia severity with exercise transcutaneous oximetry (Ex-TcpO2) and lactate increase. A prospective study was performed among 377 patients with arterial claudication. We recorded age, sex, ABI, body mass index (BMI), systolic arterial blood pressure (SBP), and glycemia. Capillary blood lactate was measured at rest and 3 min after a constant load treadmill test. We recorded maximum walking time (MWT), heart rate (HRmax), the sum of minimal decrease from oxygen values for buttocks, thighs and calves Ex-TcpO2 (DROPmin), as well as the amplitude of chest-TcpO2 decrease. A multilinear regression model was used to assess the variables associated with lactate increase. BMI, SBP, HRmax, the amplitude of decrease in chest-TcpO2 and DROPmin, but not age, sex, ABI, MWT, diabetes mellitus nor glycemia, were significantly associated to lactate increase in the model. Because it accounts for the severity and diffusion of lower-limb exercise-induced ischemia and detects exercise induced hypoxemia, TcpO2 may be preferable to ABI or MWT to estimate the metabolic consequences of walking in claudicants.
Collapse
Affiliation(s)
- Wendsèndaté Yves Semporé
- 307960Centre MURAZ, National Institute of Public Health, Bobo Dioulasso, Burkina Faso.,MitoVasc Institute UMR CNRS 6015 / INSERM 1083, Angers, France
| | - Jeanne Hersant
- MitoVasc Institute UMR CNRS 6015 / INSERM 1083, Angers, France.,Vascular Medicine, 551564University Hospital of Angers, Pays de la Loire, France
| | - Pierre Ramondou
- MitoVasc Institute UMR CNRS 6015 / INSERM 1083, Angers, France.,Vascular Medicine, 551564University Hospital of Angers, Pays de la Loire, France
| | - Jean François Hamel
- Department of Biostatistics, 26966University Hospital of Angers, Pays de la Loire, France
| | - Pierre Abraham
- MitoVasc Institute UMR CNRS 6015 / INSERM 1083, Angers, France.,Vascular Medicine, 551564University Hospital of Angers, Pays de la Loire, France.,Sports Medicine, 26966University Hospital of Angers, Pays de la Loire, France
| | - Samir Henni
- Vascular Medicine, 551564University Hospital of Angers, Pays de la Loire, France
| |
Collapse
|
11
|
Deveze E, Bruneau A, Hersant J, Ammi M, Abraham P, Picquet J. Popliteal entrapment syndrome: diagnostic, surgical management and short-term results of a ten-year experience. Ann Vasc Surg 2022; 88:139-144. [PMID: 35810946 DOI: 10.1016/j.avsg.2022.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/16/2022] [Accepted: 06/22/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Popliteal artery entrapment syndrome (PAES) is a rare cause of lower limb claudication in young sportsperson without cardiovascular risk factor. We reported our diagnostic approach, surgical management and short term outcomes of this syndrome, over a 10-year period. MATERIAL AND METHOD Sportsperson with intermittent claudication systematically received color duplex ultrasonography with dynamic maneuvers in the sport medicine department. In case of PAES suspicion, diagnosis was confirmed by dynamic computed tomography or dynamic magnetic resonance angiography. Each patient was then evaluated by a vascular surgeon and surgery was performed. We retrospectively screened patients who underwent PAES surgery between 2010 and 2020 in the department of surgery in Angers university hospital. RESULTS Between January 2010 and December 2020, 38 patients with 67 symptomatic legs underwent surgery for PAES. Twenty three (60.5%) were men. The mean age at the time of surgery was 24.7 +/- 9 years. Clinical presentation was bilateral in 30 patients (81.1%). Duplex ultrasound demonstrated severe stenosis or occlusion in 45 legs (77%). When performed, CT-scan demonstrated popliteal artery compression in all cases (100%). According to Whelan and Rich classification, 36 patients (94.7%) had type 6 PAES. There was no mortality or severe complication after surgery. Morbidity included 4 post-operative hematoma (6%) and 8 prolonged healing (13%). The mean time of follow-up was 2.3 months +/- 1.2 months. After surgery, D-scan showed no signs of remaining popliteal artery compression in 92.5% of the case. Twelve patients (33.3%) were able to resume sport, 18 (50%) partially and 6 (16.6%) did not resume sport yet. CONCLUSION We report a cohort of 38 patients who underwent surgery for popliteal artery entrapment syndrome. Among them, 36 (94.7%) were functional PAES. Morbidity included 13% of prolonged healing. Two months follow-up demonstrated good results at dynamic D-scan without signs of remaining popliteal artery compression in 92.5% of the cases. These short-term results showed that one third of patients able to resume sport activity at initial level.
Collapse
Affiliation(s)
- Eva Deveze
- Department of Vascular Surgery, University Hospital of Angers, Angers, France.
| | - Antoine Bruneau
- Department of Sport Medicine, University Hospital of Angers, Angers, France
| | - Jeanne Hersant
- Department of Vascular Medicine, University Hospital of Angers, Angers, France
| | - Myriam Ammi
- Department of Vascular Surgery, University Hospital of Angers, Angers, France
| | - Pierre Abraham
- Department of Sport Medicine, University Hospital of Angers, Angers, France; Department of Vascular Medicine, University Hospital of Angers, Angers, France
| | - Jean Picquet
- Department of Vascular Surgery, University Hospital of Angers, Angers, France
| |
Collapse
|
12
|
Hersant J, Ramondou P, Douillet D, Abrard S, Vandeputte P, Lapébie FX, Abraham P, Henni S. Comparison between conventional duplex ultrasonography and the dual-gate Doppler mode for hemodynamic measurements of the carotid arteries. Ultrasonography 2022; 41:373-381. [PMID: 34974673 PMCID: PMC8942739 DOI: 10.14366/usg.21175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/09/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose This study investigated the correlations of hemodynamic parameters measured to quantify stenosis between the gold-standard duplex ultrasonography and the dual-gate Doppler mode. Methods Patients examined due to suspicion of carotid artery stenosis or for surveillance of known stenosis were invited to participate in this prospective single-center study. Upon acceptance, the hemodynamic characteristics of the carotid arteries were determined successively in standard duplex and dual-gate Doppler modes. The correlations between the two modes were analyzed by computing Pearson coefficients (r2) and Lin concordance coefficients (ρc). The degree of agreement between the two methods was visualized using Bland-Altman graphical representations. Results The correlation between internal carotid artery peak systolic velocity measured by standard duplex ultrasonography and dual-gate Doppler mode was good (r2=0.642). The same high level of correlation was observed for the carotid ratio (r2=0.544). However, the Bland-Altman graphical representation and the Lin concordance coefficients (ρc=0.75 and ρc=0.74 for the internal carotid artery peak systolic velocity and carotid ratio, respectively) showed that a lack of precision generated some discrepancies between the two measurement methods. Conclusion Although some discrepancies were observed, the hemodynamic measurements were closely correlated between the two ultrasonography modes. Therefore, the dual-gate Doppler mode may have obvious advantages over conventional ultrasonography, offering interesting development possibilities.
Collapse
Affiliation(s)
- Jeanne Hersant
- Vascular Medicine, University Hospital Center, Angers, France
| | - Pierre Ramondou
- Vascular Medicine, University Hospital Center, Angers, France
| | | | | | | | | | - Pierre Abraham
- Sports Medicine, University Hospital Center, Angers, France.,MitoVasc Institute UMR CNRS 6015/INSERM 1083, Faculty of Medicine, Angers University, Angers, France
| | - Samir Henni
- Vascular Medicine, University Hospital Center, Angers, France.,MitoVasc Institute UMR CNRS 6015/INSERM 1083, Faculty of Medicine, Angers University, Angers, France
| |
Collapse
|
13
|
Ammi M, Hersant J, Henni S, Daligault M, Papon X, Abraham P, Picquet J. Evaluation Of Quality Of Life After Surgical Treatment Of Thoracic Outlet Syndrome. Ann Vasc Surg 2022; 85:276-283. [PMID: 35339598 DOI: 10.1016/j.avsg.2022.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND To evaluate the quality of life of surgically treated patients for TOS. METHODS A prospective observational study including patients treated surgically for TOS, on 2018. Two standardized questionnaires: Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and the Short-Form 12 (SF-12) were used. The SF-12 consists of a physical and mental component (PCS-SF-12 and MCS-SF-12). The questionnaires were completed during the preoperative and postoperative consultations and at 3, 6, and 12 months. RESULTS We performed 53 interventions. The population was mostly female (n = 35, 66.0%) of 40.1±10.0 years. The preoperative DASH score was 46.3±19.7. It was 40.9±21.7 at 6 weeks, 33.5±22.7 at 3 months, 28.9±22.6 at 6 months, and 21.1±20 at 9 to 12 months. The improvement of DASH becomes statistically significant at 3 months (p = 0.036), 6 months (p = 0.002), and 12 months (p = 0.001). The preoperative MCS-SF-12 was 36.6±9.4. It was 41.6±10.9 at 6 weeks, 43.8±11.1 at 3 months, 46.2±11.8 at 6 months, and 51.4±8 at 8 to 12 months. The improvement of MCS-SF-12 became significant at 3 months (p=0.009), 6 months (p=0.001), and 12 months (p=0.001). The preoperative PCS-SF-12 was 35.5±6.4. It was 37.1±8.7 at 6 weeks, 39.9±8.7 at 3 months, 41.6±8.4 at 6 months, and 46.1±8.1 to 12 months. The improvement of PCS-SF-12 became significant at 6 months (p=0.005) and 12 months (p=0.001). CONCLUSION The surgical management of TOS allows an improvement of quality of life in short and medium term.
Collapse
Affiliation(s)
- Myriam Ammi
- Department of Vascular and Thoracic Surgery, University Hospital, 49933 Angers, France.
| | - Jeanne Hersant
- Department of Vascular and Sport Investigations, University Hospital, 49933 Angers, France
| | - Samir Henni
- Department of Vascular and Thoracic Surgery, University Hospital, 49933 Angers, France
| | - Mickael Daligault
- Department of Vascular and Thoracic Surgery, University Hospital, 49933 Angers, France
| | - Xavier Papon
- Department of Vascular and Thoracic Surgery, University Hospital, 49933 Angers, France
| | - Pierre Abraham
- Department of Vascular and Sport Investigations, University Hospital, 49933 Angers, France
| | - Jean Picquet
- Department of Vascular and Thoracic Surgery, University Hospital, 49933 Angers, France
| |
Collapse
|
14
|
Abstract
Background Behçet’s disease (BD) is a rare form of systemic vasculitis that affects small to large vessels. It is characterized by mucocutaneous, pulmonary, cardiovascular, gastrointestinal, and neurological manifestations. Large vessel involvement may occur in a third of cases. Veins are usually more affected than arteries. Furthermore aneurysms are the most frequent arterial complication. Case presentation A 41-year-old man presented with multiple arterial aneurysms. He had previous medical history of a right popliteal aneurysm treated with a reversed femoro-popliteal venous bypass, long-term steroids and immunosuppressive treatment. On admission, diagnostic computed tomography angiography revealed multiple aneurysms, including an 87 mm aneurysm of the femoro-popliteal bypass and an abdominal aortic and left common iliac artery aneurysm. He received an intensification of medical treatment with methylprednisolone and infliximab intravenous infusion. Aorto iliac artery aneurysms were treated by infrarenal bifurcated stent graft implantation. The aneurysm of the venous femoro-popliteal bypass was treated by explantation and prosthetic repair. One month later, he presented with acute right limb ischemia related to occlusion of the right limb of the stent graft despite anticoagulation which was treated by mechanical thrombectomy. Conclusions Vascular BD can worsen the vascular outcome after surgery. Except in an urgent context, BD must be controlled before surgery. This case report illustrates the importance of combined medical and surgical management, with first BD activity control with corticosteroids and immunosuppressive treatment, then surgical or endovascular treatment.
Collapse
Affiliation(s)
- Jeanne Hersant
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | | | - Olivier Espitia
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| |
Collapse
|
15
|
Hersant J, Lecoq S, Ramondou P, Papon X, Feuilloy M, Abraham P, Henni S. Relationship Between Inflow Impairment and Skin Oxygen Availability to the Upper Limb During Standardized Arm Abduction in Patients With Suspected Thoracic Outlet Syndrome. Front Physiol 2022; 13:726315. [PMID: 35222068 PMCID: PMC8874319 DOI: 10.3389/fphys.2022.726315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Thoracic outlet syndrome (TOS) should be considered of arterial origin only if patients have clinical symptoms that are the result of documented symptomatic ischemia. Simultaneous recording of inflow impairment and forearm ischemia in patients with suspected TOS has never been reported to date. We hypothesized that ischemia would occur in cases of severely impaired inflow, resulting in a non-linear relationship between changes in pulse amplitude (PA) and the estimation of ischemia during provocative attitudinal upper limb positioning. Design Prospective single center interventional study. Material Fifty-five patients with suspected thoracic outlet syndrome. Methods We measured the minimal decrease from rest of transcutaneous oximetry pressure (DROPm) as an estimation of oxygen deficit and arterial pulse photo-plethysmography to measure pulse amplitude changes from rest (PA-change) on both arms during the candlestick phase of a “Ca + Pra” maneuver. “Ca + Pra” is a modified Roos test allowing the estimation of maximal PA-change during the “Pra” phase. We compared the DROPm values between deciles of PA-changes with ANOVA. We then analyzed the relationship between mean PA-change and mean DROPm of each decile with linear and second-degree polynomial (non-linear) models. Results are reported as median [25/75 centiles]. Statistical significance was p < 0.05. Results DROPm values ranged −11.5 [−22.9/−7.2] and − 12.3 [−23.3/−7.4] mmHg and PA-change ranged 36.4 [4.6/63.8]% and 38.4 [−2.0/62.1]% in the right and left forearms, respectively. The coefficient of determination between median DROPm and median PA-change was r2 = 0.922 with a second-degree polynomial fitting, but only r2 = 0.847 with a linear approach. Conclusion Oxygen availability was decreased in cases of severe but not moderate attitudinal inflow impairments. Undertaking simultaneous A-PPG and forearm oximetry during the “Ca + Pra” maneuver is an interesting approach for providing objective proof of ischemia in patients with symptoms of TOS suspected of arterial origin.
Collapse
Affiliation(s)
| | - Simon Lecoq
- Vascular Medicine, University Hospital, Angers, France
| | - Pierre Ramondou
- Vascular Medicine, University Hospital, Angers, France
- UMR CNRS 1083 INSERM 6015, LUNAM University, Angers, France
| | - Xavier Papon
- Service of Thoracic and Vascular Surgery, University Hospital, Angers, France
| | - Mathieu Feuilloy
- School of Electronics (ESEO), Angers, France
- UMR CNRS 6613 LAUM, Le Mans, France
| | - Pierre Abraham
- Vascular Medicine, University Hospital, Angers, France
- UMR CNRS 1083 INSERM 6015, LUNAM University, Angers, France
- Sports and Exercise Medicine, University Hospital, Angers, France
- *Correspondence: Pierre Abraham,
| | - Samir Henni
- Vascular Medicine, University Hospital, Angers, France
- UMR CNRS 1083 INSERM 6015, LUNAM University, Angers, France
| |
Collapse
|
16
|
Quéneau A, Pistorius MA, Connault J, Raimbeau A, Gautier G, Bergère G, Artifoni M, Durant C, Bénichou A, Hersant J, Espitia O. Case–Control Study on Exercise-Induced Vasculitis in Hikers. Angiology 2022; 73:643-648. [DOI: 10.1177/00033197211065792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to identify clinical factors associated with exercise-induced vasculitis (EIV). This study included EIV cases and controls matched for age. Cases included were all members of a hiking club and participated in extended hiking trips. Exercise-induced vasculitis was diagnosed based on clinical signs occurring only after prolonged walks. Chronic venous disease was defined using the Clinical Etiological Anatomical Pathophysiologic classification. This study included 162 hikers: 32 EIV cases and 130 matched controls. Mean age at EIV diagnosis was 47.1 years and 24 (75.0%) of EIV cases were women. Chronic venous disease was present in 19 (57.6%) of EIV cases vs 39 (30.0%) in controls ( P = .001); those with EIV had significantly more saphenous vein insufficiency and C3 venous insufficiency than controls, 85.0 vs 52.6% and 8 (25.0%) vs 13 (10.0%) ( P = .02), respectively. For EIV cases, mean walking distance per hike was significantly higher than for controls ( P = .002). Exercise-induced vasculitis symptoms were typical with rash and/or purpura on the leg in warm conditions. Lesions spontaneously disappear in <10 days. In this study, EIV cases had more chronic venous disease and longer mean walking distances than controls.
Collapse
Affiliation(s)
- Alexandre Quéneau
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | | | - Jérôme Connault
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Alizée Raimbeau
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Giovanni Gautier
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Guillaume Bergère
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Mathieu Artifoni
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Cécile Durant
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Antoine Bénichou
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Jeanne Hersant
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Olivier Espitia
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
- Nantes Université, Nantes, France
| |
Collapse
|
17
|
Abraham P, Lecoq S, Hersant J, Henni S. Arterial claudication. Vasc Invest Ther 2022. [DOI: 10.4103/2589-9686.360872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
18
|
Hersant J, Ramondou P, Durand S, Feuilloy M, Daligault M, Abraham P, Henni S. Thoracic Outlet Syndrome: Fingertip Cannot Replace Forearm Photoplethysmography in the Evaluation of Positional Venous Outflow Impairments. Front Physiol 2021; 12:765174. [PMID: 34887775 PMCID: PMC8650580 DOI: 10.3389/fphys.2021.765174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/22/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Fingertip photoplethysmography (PPG) resulting from high-pass filtered raw PPG signal is often used to record arterial pulse changes in patients with suspected thoracic outlet syndrome (TOS). Results from venous (low-pass filtered raw signal) forearm PPG (V-PPG) during the Candlestick-Prayer (Ca + Pra) maneuver were recently classified into four different patterns in patients with suspected TOS, two of which are suggestive of the presence of outflow impairment. We aimed to test the effect of probe position (fingertip vs. forearm) and of red (R) vs. infrared (IR) light wavelength on V-PPG classification and compared pattern classifications with the results of ultrasound (US). Methods: In patients with suspected TOS, we routinely performed US imaging (US + being the presence of a positional compression) and Ca + Pra tests with forearm V-PPGIR. We recruited patients for a Ca + Pra maneuver with the simultaneous fingertip and forearm V-PPGR. The correlation of each V-PPG recording to each of the published pattern profiles was calculated. Each record was classified according to the patterns for which the coefficient of correlation was the highest. Cohen’s kappa test was used to determine the reliability of classification among forearm V-PPGIR, fingertip V-PPGR, and forearm V-PPGR. Results: We obtained 40 measurements from 20 patients (40.2 ± 11.3 years old, 11 males). We found 13 limbs with US + results, while V-PPG suggested the presence of venous outflow impairment in 27 and 20 limbs with forearm V-PPGIR and forearm V-PPGR, respectively. Fingertip V-PPGR provided no patterns suggesting outflow impairment. Conclusion: We found more V-PPG patterns suggesting venous outflow impairment than US + results. Probe position is essential if aiming to perform upper-limb V-PPG during the Ca + Pra maneuver in patients with suspected TOS. V-PPG during the Ca + Pra maneuver is of low cost and easy and provides reliable, recordable, and objective evidence of forearm swelling. It should be performed on the forearm (close to the elbow) with either PPGR or PPGIR but not at the fingertip level.
Collapse
Affiliation(s)
- Jeanne Hersant
- Vascular Medicine, University Hospital, Angers, France.,UMR CNRS 1083 INSERM 6214, LUNAM University, Angers, France
| | - Pierre Ramondou
- Vascular Medicine, University Hospital, Angers, France.,UMR CNRS 1083 INSERM 6214, LUNAM University, Angers, France.,Sports and Exercise Medicine, University Hospital, Angers, France
| | - Sylvain Durand
- EA 4334 Motricité Interaction Performance, Le Mans University, Le Mans, France
| | - Mathieu Feuilloy
- UMR CNRS 6613 LAUM, Le Mans, France.,School of Electronics (ESEO), Angers, France
| | - Mickael Daligault
- Department of Thoracic and Vascular Surgery, University Hospital, Angers, France
| | - Pierre Abraham
- Vascular Medicine, University Hospital, Angers, France.,UMR CNRS 1083 INSERM 6214, LUNAM University, Angers, France.,Sports and Exercise Medicine, University Hospital, Angers, France
| | - Samir Henni
- Vascular Medicine, University Hospital, Angers, France.,UMR CNRS 1083 INSERM 6214, LUNAM University, Angers, France
| |
Collapse
|
19
|
Semporé WY, Chao De La Barca JM, Hersant J, Ouédraogo N, Yaméogo TM, Henni S, Reynier P, Abraham P. Exercise-Induced Plasma Metabolomic Profiles in Patients With Peripheral Arterial Disease. Front Physiol 2021; 12:758085. [PMID: 34867463 PMCID: PMC8637284 DOI: 10.3389/fphys.2021.758085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022] Open
Abstract
Aim: A better knowledge of the biological consequences in the blood of these exercise-induced ischemic events in lower extremity artery disease (LEAD) may improve the prospects of disease management. We explored the preminus postexercise metabolomic difference in 39 patients with LEAD referred for a treadmill oximetry test [transcutaneous oximetry (TcPO2)]. Methods: Ischemia was estimated through the sum of decrease from rest of oxygen pressure (DROPs) (limb TcPO2 changes minus chest TcPO2 changes) at buttocks, thighs, and calves regions. Targeted metabolomic analyses measuring 188 metabolites were performed on a few microliters blood samples taken at the earlobe at rest and 3 min after exercise. Results: Maximum walking distance (MWD) was 290 m (120–652 m) and ankle brachial index (ABI) was 0.67 ± 0.17. Supervised paired partial least squares discriminant analysis based on 23,345 models showed good predictive performance for test sets with a median area under the receiver operating characteristic (AUROC) curve value of 0.99 and a p-value of 0.00049. The best discriminant metabolites contributing to the model included a subset of 71 (47%) of the 150 accurately measured metabolites in the plasma, comprising 3 acylcarnitines, 3 amino acids, 5 biogenic amines, 9 sphingomyelin, 7 lysophosphatidylcholines, and 44 phosphatidylcholines. In addition, 16 of these metabolites were found to correlate with one or more severity scores of the LEAD. Conclusion: Our results provide new insights into the biological changes that accompany exercise in LEAD and contribute to a better understanding of walking impairment pathophysiology in LEAD, highlighting new candidate biomarkers.
Collapse
Affiliation(s)
- Wendsèndaté Yves Semporé
- Centre MURAZ, National Institute of Public Health, Bobo Dioulasso, Burkina Faso.,Sports Medicine Department, University Hospital of Angers, Angers, France.,MitoVasc Research Unit, CNRS 6015, INSERM U-1083, University of Angers, Angers, France
| | - Juan Manuel Chao De La Barca
- MitoVasc Research Unit, CNRS 6015, INSERM U-1083, University of Angers, Angers, France.,Biochemistry and Molecular Biology Laboratory, University Hospital of Angers, Angers, France
| | - Jeanne Hersant
- Vascular Medicine Department, University Hospital of Angers, Angers, France
| | - Nafi Ouédraogo
- Physiology, Nazi Boni University, Bobo Dioulasso, Burkina Faso
| | | | - Samir Henni
- MitoVasc Research Unit, CNRS 6015, INSERM U-1083, University of Angers, Angers, France.,Vascular Medicine Department, University Hospital of Angers, Angers, France
| | - Pascal Reynier
- MitoVasc Research Unit, CNRS 6015, INSERM U-1083, University of Angers, Angers, France.,Biochemistry and Molecular Biology Laboratory, University Hospital of Angers, Angers, France
| | - Pierre Abraham
- Sports Medicine Department, University Hospital of Angers, Angers, France.,MitoVasc Research Unit, CNRS 6015, INSERM U-1083, University of Angers, Angers, France.,Vascular Medicine Department, University Hospital of Angers, Angers, France
| |
Collapse
|
20
|
Ramondou P, Hersant J, Bernardeau E, Moumneh T, Feuilloy M, Henni S, Abraham P. Kneeling-induced calf ischemia: a pilot study in apparently healthy European young subjects. Eur J Appl Physiol 2021; 121:3031-3040. [PMID: 34254181 DOI: 10.1007/s00421-021-04764-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 07/02/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Many tasks, sports or leisure activities require maximal knee flexion. We hypothesized that this position could result in reduced calf perfusion, in young European subjects. METHODS We quantified calf ischemia resulting from the knee flexion with transcutaneous oxygen pressure (TcpO2) sensors by assessing the decrease from rest of TcpO2 (DROP) defined as limb changes minus chest changes. A minimal DROP (DROPm) <-15 mmHg defines the presence of ischemia. From the crawling position, participants kneeled for 3 min while bending as in prostration/prayer position (P). Thirty-five participants repeated this maneuver a second time, while 7 participants were also required to sit on their heels with the torso in the vertical position to attain knee flexion without significant groin flexion (S). RESULT In 41 healthy young volunteers (30 males), 25 [20-31] years old, 37 patients showed a DROPm < -15 mmHg from "R" to "P" in one (n = 4) or both (n = 33) calves (90.2%; 95% CI 76.9-97.3). After backward regression of the DROPm, there was no significant association with side, body weight of systolic blood pressure. However, age was strongly associated with DROPm (OR 5.34 [2.45-8.69]) so that DROPm was significantly higher in older, with a correlation ρ = 0.31 (p = 0.003). CONCLUSION Kneeling dramatically reduces calf perfusion, likely through popliteal artery kinking, possibly through muscle crushing. Eastern lifestyle includes routine flexed position since childhood. Whether or not such a chronic training reduces the risk of kneeling-induced ischemia in adults is unknown to date.
Collapse
Affiliation(s)
- Pierre Ramondou
- Vascular Medicine, University Hospital, Angers, France.,Institut MITOVASC, UMR CNRS 6015 UMR INSERM 1083, Université d'Angers, Angers, France
| | | | - Elise Bernardeau
- Sports and Exercise Medicine and Vascular Medicine, University Hospital, Angers, France
| | - Thomas Moumneh
- Vascular Medicine, University Hospital, Angers, France.,Institut MITOVASC, UMR CNRS 6015 UMR INSERM 1083, Université d'Angers, Angers, France.,Département de Médecine d'Urgence, CHU d'Angers, Angers, France
| | - Mathieu Feuilloy
- School of Electronics (ESEO), Angers, France.,UMR CNRS 6613 LAUM, Le Mans, France
| | - Samir Henni
- Vascular Medicine, University Hospital, Angers, France.,Institut MITOVASC, UMR CNRS 6015 UMR INSERM 1083, Université d'Angers, Angers, France
| | - Pierre Abraham
- Vascular Medicine, University Hospital, Angers, France. .,Institut MITOVASC, UMR CNRS 6015 UMR INSERM 1083, Université d'Angers, Angers, France. .,Sports and Exercise Medicine and Vascular Medicine, University Hospital, Angers, France.
| |
Collapse
|
21
|
Hersant J, Ramondou P, Thouveny F, Daligault M, Feuilloy M, Saulnier P, Abraham P, Henni S. Arterial Digital Pulse Photoplethysmography in Patients with Suspected Thoracic Outlet Syndrome: A Study of the "Ca+Pra" Maneuver. Diagnostics (Basel) 2021; 11:diagnostics11061128. [PMID: 34205560 PMCID: PMC8234081 DOI: 10.3390/diagnostics11061128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/15/2021] [Indexed: 11/24/2022] Open
Abstract
The level of pulse amplitude (PA) change in arterial digital pulse plethysmography (A-PPG) that should be used to diagnose thoracic outlet syndrome (TOS) is debated. We hypothesized that a modification of the Roos test (by moving the arms forward, mimicking a prayer position (“Pra”)) releasing an eventual compression that occurs in the surrender/candlestick position (“Ca”) would facilitate interpretation of A-PPG results. In 52 subjects, we determined the optimal PA change from rest to predict compression at imaging (ultrasonography +/− angiography) with receiver operating characteristics (ROC). “Pra”-PA was set as 100%, and PA was expressed in normalized amplitude (NA) units. Imaging found arterial compression in 23 upper limbs. The area under ROC was 0.765 ± 0.065 (p < 0.0001), resulting in a 91.4% sensitivity and a 60.9% specificity for an increase of fewer than 3 NA from rest during “Ca”, while results were 17.4% and 98.8%, respectively, for the 75% PA decrease previously proposed in the literature. A-PPG during a “Ca+Pra” test provides demonstrable proof of inflow impairment and increases the sensitivity of A-PPG for the detection of arterial compression as determined by imaging. The absence of an increase in PA during the “Ca” phase of the “Ca+Pra” maneuver should be considered indicative of arterial inflow impairment.
Collapse
Affiliation(s)
- Jeanne Hersant
- Vascular Medicine Department, University Hospital in Angers, 49100 Angers, France; (J.H.); (P.R.); (S.H.)
- University Angers, UMR CNRS 6015-INSERM 1083, MITOVASC, SFR ICAT, 49045 Angers, France;
| | - Pierre Ramondou
- Vascular Medicine Department, University Hospital in Angers, 49100 Angers, France; (J.H.); (P.R.); (S.H.)
- University Angers, UMR CNRS 6015-INSERM 1083, MITOVASC, SFR ICAT, 49045 Angers, France;
| | - Francine Thouveny
- Radiology Department, University Hospital in Angers, 49100 Angers, France;
| | - Mickael Daligault
- University Angers, UMR CNRS 6015-INSERM 1083, MITOVASC, SFR ICAT, 49045 Angers, France;
- Thoracic and Vascular Surgery Department, University Hospital in Angers, 49100 Angers, France
| | - Mathieu Feuilloy
- School of Electronics (ESEO), Universite catholique de l’ouest, 49100 Angers, France;
- University Le Mans, LAUM CNR S6613, 72000 Le Mans, France
| | - Patrick Saulnier
- University Angers, Inserm, 1066 CNRS 6021, MINT, SFR ICAT, F-49045 Angers, France;
- Biostatistics Department, University Hospital in Angers, 49100 Angers, France
| | - Pierre Abraham
- University Angers, UMR CNRS 6015-INSERM 1083, MITOVASC, SFR ICAT, 49045 Angers, France;
- Sports and Exercise Medicine Department, University Hospital in Angers, 49100 Angers, France
- Correspondence: ; Tel.: +33-(0)2-41-35-40-93
| | - Samir Henni
- Vascular Medicine Department, University Hospital in Angers, 49100 Angers, France; (J.H.); (P.R.); (S.H.)
- University Angers, UMR CNRS 6015-INSERM 1083, MITOVASC, SFR ICAT, 49045 Angers, France;
| |
Collapse
|
22
|
Ploton G, Brebion N, Guyomarch B, Pistorius MA, Connault J, Hersant J, Raimbeau A, Bergère G, Artifoni M, Durant C, Gautier G, Dumont R, Kubina JM, Toquet C, Espitia O. Predictive factors of venous recanalization in upper-extremity vein thrombosis. PLoS One 2021; 16:e0251269. [PMID: 33983979 PMCID: PMC8118536 DOI: 10.1371/journal.pone.0251269] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/22/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Upper extremity venous thrombosis (UEVT) represents about 10% of venous thrombo-embolic disease. This is mainly explained by the increasing use of central venous line, for oncologic or nutritional care. The factors associated with venous recanalization are not known. OBJECTIVE The aim of this study was to investigate prognosis factor associated with venous recanalization after UEVT. METHODS This study included patients with UEVT diagnosed with duplex ultra-sonography (DUS) from January 2015 to December 2017 with DUS evaluations during follow-up. A multivariate Cox proportional-hazards-model analysis was performed to identify predictive factors of UEVT complete recanalization. RESULTS This study included 494 UEVT, 304 proximal UEVT and 190 distal UEVT. The median age was 58 years, 39.5% were women. Clinical context was: hematological malignancy (40.7%), solid cancer (14.2%), infectious or inflammatory context (49.9%) and presence of venous catheters or pacemaker leads in 86.4%. The rate of recanalization without sequelae of UEVT was 38%. For all UEVT, in multivariate analysis, factors associated with complete vein recanalization were: thrombosis associated with central venous catheter (CVC) (HR:2.40, [1.45;3.95], p<0.001), UEVT limited to a venous segment (HR:1.94, [1.26;3.00], p = 0.003), occlusive thrombosis (HR:0.48 [0.34;0.67], p<0.0001), the presence of a PICC Line (HR:2.29, [1.48;3.52], p<0.001), a thrombosis of deep and distal topography (HR:1.70, [1.10;2.63], p = 0.02) or superficial thrombosis of the forearm (HR:2.79, [1.52;5.12], p<0.001). For deep and proximal UEVT, non-occlusive UEVT (HR:2.23, [1.49;3.33], p<0.0001), thrombosis associated with CVC (HR:1.58, [1.01;2.47], p = 0.04) and infectious or inflammatory context (HR:1.63, [1.10;2.41], p = 0.01) were factors associated with complete vein recanalization. CONCLUSION In this study, factors associated with UEVT recanalization were UEVT limited to a venous segment, thrombosis associated with CVC, a thrombosis of deep and distal thrombosis topography and superficial thrombosis of the forearm. Occlusive thrombosis was associated with the absence of UEVT recanalization.
Collapse
Affiliation(s)
- Gaëtan Ploton
- Department of Internal Medicine and Vascular Medicine, CHU de Nantes, Nantes, France
| | - Nicolas Brebion
- Department of Vascular Medicine, CHD La Roche-sur-Yon, La Roche-sur-Yon, France
| | - Béatrice Guyomarch
- Direction de la recherche, Plateforme de Méthodologie et Biostatistique, CHU de Nantes, Nantes, France
| | - Marc-Antoine Pistorius
- Department of Internal Medicine and Vascular Medicine, CHU de Nantes, Nantes, France
- UNAV, Nantes Vascular Access Unit, CHU de Nantes, Nantes, France
| | - Jérôme Connault
- Department of Internal Medicine and Vascular Medicine, CHU de Nantes, Nantes, France
- UNAV, Nantes Vascular Access Unit, CHU de Nantes, Nantes, France
| | - Jeanne Hersant
- Department of Internal Medicine and Vascular Medicine, CHU de Nantes, Nantes, France
| | - Alizée Raimbeau
- Department of Internal Medicine and Vascular Medicine, CHU de Nantes, Nantes, France
- UNAV, Nantes Vascular Access Unit, CHU de Nantes, Nantes, France
| | - Guillaume Bergère
- Department of Internal Medicine and Vascular Medicine, CHU de Nantes, Nantes, France
- UNAV, Nantes Vascular Access Unit, CHU de Nantes, Nantes, France
| | - Mathieu Artifoni
- Department of Internal Medicine and Vascular Medicine, CHU de Nantes, Nantes, France
- UNAV, Nantes Vascular Access Unit, CHU de Nantes, Nantes, France
| | - Cécile Durant
- Department of Internal Medicine and Vascular Medicine, CHU de Nantes, Nantes, France
- UNAV, Nantes Vascular Access Unit, CHU de Nantes, Nantes, France
| | - Giovanni Gautier
- Department of Internal Medicine and Vascular Medicine, CHU de Nantes, Nantes, France
- UNAV, Nantes Vascular Access Unit, CHU de Nantes, Nantes, France
| | - Romain Dumont
- UNAV, Nantes Vascular Access Unit, CHU de Nantes, Nantes, France
- Department of Anesthesia and Critical Care, CHU de Nantes, Nantes, France
| | - Jean-Manuel Kubina
- Department of Vascular Medicine, CHD La Roche-sur-Yon, La Roche-sur-Yon, France
| | - Claire Toquet
- Department of Pathology, CHU de Nantes, Nantes, France
- Université de Nantes, CHU de Nantes, Nantes, France
| | - Olivier Espitia
- Department of Internal Medicine and Vascular Medicine, CHU de Nantes, Nantes, France
- UNAV, Nantes Vascular Access Unit, CHU de Nantes, Nantes, France
- Université de Nantes, CHU de Nantes, Nantes, France
| |
Collapse
|
23
|
Hervé H, Toquet C, Ploton G, Connault J, Gautier G, Raimbeau A, Bergère G, Hersant J, Durant C, Artifoni M, Brebion N, Kubina JM, Pistorius MA, Espitia O. Prevalence of post-thrombotic syndrome in a cohort of upper extremity vein thrombosis. J Vasc Surg Venous Lymphat Disord 2021; 10:111-117.e3. [PMID: 33894342 DOI: 10.1016/j.jvsv.2021.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/01/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Post-thrombotic syndrome (PTS) is one of the main complications that occurs after venous thrombosis. There are few data on the proportion of patients that will develop upper extremity PTS (UE-PTS) after upper extremity venous thrombosis (UEVT). The main objective of the study was to assess the prevalence of PTS in a UEVT cohort and to identify predictive factors of UE-PTS. METHODS This study included patients with a history of proximal or arm UEVT, diagnosed on duplex ultrasound examination, between January 1, 2015, and December 31, 2017, in a university hospital. After UEVT, each patient was evaluated by a prospective standardized recording of clinical manifestations and duplex ultrasound examination in case of upper limb symptoms. UE-PTS was defined as a modified Villalta score of 4 or higher. RESULTS Ninety-two patients were included; 68 (73.9%) had deep vein thrombosis (DVT) and 24 (19.2%) arm superficial vein thrombosis. Thirteen patients had PTS (14.1%), 12 (17.6%) in the DVT group and 1 (4.2%) in the superficial vein thrombosis group. There was a history of DVT in 92.3% of the cases of PTS. PTS was more frequent in patients with strokes with limb movement reduction (P = .01). On multivariate Cox analysis, a history of stroke (hazard ratio, 5.4; 95% confidence interval, 1.46-20.22; P = .01) was predictive of UE-PTS. CONCLUSIONS UE-PTS occurred in 14.1% of cases after UEVT. Stroke with a decrease in limb movement was a predictor of developing PTS. Diagnostic criteria should be established for UE-PTS and prospective studies are needed to improve the description and management of UE-PTS.
Collapse
Affiliation(s)
- Henri Hervé
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; Department of Vascular Medicine, CHD Vendée, La Roche sur Yon, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | | | - Gaëtan Ploton
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Jérôme Connault
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | - Giovanni Gautier
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | - Alizée Raimbeau
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | - Guillaume Bergère
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | - Jeanne Hersant
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | - Cécile Durant
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | - Mathieu Artifoni
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | - Nicolas Brebion
- Department of Vascular Medicine, CHD Vendée, La Roche sur Yon, France
| | | | - Marc-Antoine Pistorius
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France
| | - Olivier Espitia
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France; UNAV, Nantes Vascular Access Unit, CHU Nantes, Nantes, France.
| |
Collapse
|
24
|
Hersant J, Ramondou P, Chavignier V, Chavanon A, Feuilloy M, Picquet J, Henni S, Abraham P. Forearm Volume Changes Estimated by Photo-Plethysmography During an Original Candlestick/Prayer Maneuver in Patients With Suspected Thoracic Outlet Syndrome. Front Physiol 2021; 12:652456. [PMID: 33927642 PMCID: PMC8076800 DOI: 10.3389/fphys.2021.652456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/08/2021] [Indexed: 11/28/2022] Open
Abstract
Objective: Hemodynamic investigations in thoracic outlet syndrome (TOS) remain difficult, even in trained hands. Results are generally reported as either presence or absence of venous compression. In fact, in patients with suspected TOS but without chronic venous occlusion, the forearm volume changes may result from various combinations of forearm position from heart level, arterial inflow, and/or venous outflow positional impairment. Design: Cross sectional, retrospective, single center study, accessible on Clinicaltrial.gov under reference NCT04376177. Material: We used venous photo-plethysmography (V-PPG) in 151 patients with suspected TOS. The subjects elevated their arms to the “candlestick” (Ca) position for 30 s and then kept their arm elevated in front of the body for an additional 15 s (“prayer” position; Pra). This CA–Pra procedure was repeated three times by each patient with recording of both arms. Method: We classified V-PPG recordings using an automatic clustering method. Result: The blinded clustering classification of 893 V-PPG recordings (13 missing files) resulted in four out of seven clusters, allowing the classification of more than 99% of the available recordings. Each cluster included 65.73, 6.16, 17.13, and 10.8% of the recordings, respectively. Conclusion: Venous hemodynamic profiles in TOS are not only either normal or abnormal. With V-PPG, four clusters were observed to be consistent with, and assumed to result from, the four possible associations of presence/absence of arterial inflow/venous outflow positional impairment: (1) normal response (maximal emptying in Ca and Pra), (2) isolated inflow impairment (emptying in Ca and filling in Pra due to post-ischemic vasodilation), (3) isolated venous outflow impairment (emptying then filling in Ca due to arterial inflow and emptying in Pra), and (4) simultaneous inflow/outflow impairment (emptying in Ca but no filling due to concomitant inflow impairment and further emptying in Pra).
Collapse
Affiliation(s)
- Jeanne Hersant
- Vascular Medicine, University Hospital, Angers, France.,UMR CNRS 1083 INSERM 6214, LUNAM University, Angers, France
| | - Pierre Ramondou
- Vascular Medicine, University Hospital, Angers, France.,UMR CNRS 1083 INSERM 6214, LUNAM University, Angers, France
| | | | | | - Mathieu Feuilloy
- School of Electronics (ESEO), Angers, France.,UMR CNRS 6613 LAUM, Le Mans, France
| | - Jean Picquet
- UMR CNRS 1083 INSERM 6214, LUNAM University, Angers, France.,Service of Thoracic and Vascular Surgery, University Hospital, Angers, France
| | - Samir Henni
- Vascular Medicine, University Hospital, Angers, France.,UMR CNRS 1083 INSERM 6214, LUNAM University, Angers, France
| | - Pierre Abraham
- Vascular Medicine, University Hospital, Angers, France.,UMR CNRS 1083 INSERM 6214, LUNAM University, Angers, France.,Sports and Exercise Medicine, University Hospital, Angers, France
| |
Collapse
|
25
|
Bergère G, Toquet C, Hoffmann C, Bressollette L, Raimbeau A, Durant C, Artifoni M, Gautier G, Hersant J, Connault J, Pistorius MA, Espitia O. Effect of cannabis consumption on characteristics and evolution of thromboangitis obliterans. VASA 2021; 50:301-305. [PMID: 33739143 DOI: 10.1024/0301-1526/a000948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Thromboangiitis obliterans (TAO) is a distal non atherosclerotic thrombotic vasculitis affecting tobacco smokers. The role of cannabis co-exposure remains controversial. The study aims to assess how cannabis consumption influences clinical presentation and outcome of TAO in tobacco smokers. Patients and methods: TAO patients, according to Papa's criteria, were included in a retrospective bicentric study between the 1st January 2003 and the 1st march 2020. Clinical characteristics, arterial involvement at TAO diagnosis, vascular event and amputations during follow-up were analyzed according to cannabis consumption. Results: Seventy-three patients with TAO patients were included. Forty-five patients were in Tobacco group (T) and 28 in Tobacco and cannabis group (T&C). Tobacco exposure was less important in T&C group than in T group (19.4±11.3 vs 31.6±16.6 pack-years) (p=0.005) and patients in T&C group were younger at TAO diagnosis than in T group (p=0.008). Patients in T&C group presented more claudication (33.3% vs 8.9%, p=0.01) and less upper limbs resting ischemia (25.9% vs 51.1%, p=0.04) than patients in the T group. No differences were found between groups with regard to arterial distribution. Amputation rate for patients who had at least one major or minor amputation did not differ between T and T&C group (25% vs 14.8%, p=0.38). Conclusions: Cannabis consumption was associated with a younger age of TAO onset. However, it does not affect amputation-free survival, Tobacco exposure is less important in T&C patients; data of this bicentric study suggest that cannabis could be a cofactor of tobacco which accelerates TAO onset.
Collapse
Affiliation(s)
- Guillaume Bergère
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
| | | | - Clément Hoffmann
- Department of vascular medicine, EA 3878 GETBO, CHU de Brest, France
| | - Luc Bressollette
- Department of vascular medicine, EA 3878 GETBO, CHU de Brest, France
| | - Alizée Raimbeau
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
| | - Cécile Durant
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
| | - Mathieu Artifoni
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
| | - Giovanni Gautier
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
| | - Jeanne Hersant
- Department of internal and vascular medicine, CHU de Nantes, France
| | - Jérôme Connault
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
| | - Marc-Antoine Pistorius
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
| | - Olivier Espitia
- Department of internal and vascular medicine, CHU de Nantes, France.,UNAV, Nantes vascular access unit, CHU de Nantes, France
| |
Collapse
|
26
|
Abraham P, Ramondou P, Hersant J, Henni S. Muscle blood flow, oxygen pressure, and hemoglobin/myoglobin saturation: The infernal triad. Magn Reson Med 2021; 86:13-14. [PMID: 33683719 DOI: 10.1002/mrm.28640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Pierre Abraham
- Sports Medicine, University Hospital, Angers, France.,Vascular Medicine, University Hospital, Angers, France.,Mitovasc Institute, UMR CNRS6015, INSERM 1083 University of Angers, Angers, France
| | - Pierre Ramondou
- Vascular Medicine, University Hospital, Angers, France.,Mitovasc Institute, UMR CNRS6015, INSERM 1083 University of Angers, Angers, France
| | | | - Samir Henni
- Vascular Medicine, University Hospital, Angers, France.,Mitovasc Institute, UMR CNRS6015, INSERM 1083 University of Angers, Angers, France
| |
Collapse
|
27
|
Hersant J, Ramondou P, Picquet J, Feuilloy M, Abraham P, Henni S. Calf and non-calf hemodynamic recovery in patients with arterial claudication: Implication for exercise training. Microvasc Res 2021; 135:104143. [PMID: 33515566 DOI: 10.1016/j.mvr.2021.104143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Previous studies in patients with arterial claudication have focused on calf hemodynamic recovery. We hypothesized that the duration of hemodynamic recovery with TcpO2 at calf and non-calf levels would be shorter than 10 min. We analyzed the factors that influence the recovery time. METHODS We monitored limb changes minus chest changes from rest (DROP) of transcutaneous oximetry on buttocks, thighs and calves, during and following a treadmill test (3.2 km/h; 10% grade). We calculated the time required to reach 50% (50%RT) and 10% (90%RT) of minimal DROP value (DROPm) from walking cessation. Regression analyses were used to determine the factors associated to 50%RT and 90%RT. RESULTS Of the 132 patients studied, 18.2% reported isolated non-calf pain by history. Of the 792 recovery time values, only 3 (0.4%) and 23 (2.9%) were in excess of 10 min for 50%RT and for 90%RT, respectively. A weak correlation was found between each of the 792 DROPm and 50%RT (r = -0.270, p < 0.001) as well as for 90%RT (r = -0.311 p < 0.001). Lowest DROPm and BMI (but not age, sex, the use of beta-blockers, the duration of the walking period) were associated to both 50%RT and 90%RT. CONCLUSION Although recovery duration correlates significantly with the severity of ischemia of the same location, a wide discrepancy exists and the longest recovery time does not always correlate to the localization of the most severe ischemia. Non-calf ischemia should be measured when one aims at objectifying the biological effects of exercise or the effects of treatments on recovery from exercise.
Collapse
Affiliation(s)
| | | | - Jean Picquet
- MitoVasc Institute UMR CNRS 6015/INSERM 1083, Faculty of Medicine, Angers University, France; Thoracic and Vascular Surgery, University Hospital, Angers, France
| | | | - Pierre Abraham
- MitoVasc Institute UMR CNRS 6015/INSERM 1083, Faculty of Medicine, Angers University, France; Sports Medicine, University Hospital Center, Angers, France.
| | - Samir Henni
- Vascular Medicine, University Hospital, Angers, France; MitoVasc Institute UMR CNRS 6015/INSERM 1083, Faculty of Medicine, Angers University, France
| |
Collapse
|
28
|
Ramondou P, Hersant J, Fouquet O, Sempore WY, Abraham P, Henni S. Current-Induced Vasodilation Specifically Detects, and Correlates With the Time Since, Last Aspirin Intake: An Interventional Study of 830 Patients. J Cardiovasc Pharmacol Ther 2020; 26:269-278. [PMID: 33161777 DOI: 10.1177/1074248420971165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Galvanic current-induced vasodilation (CIV) is impaired in patients under low-dose aspirin (ASA; ≤ 500 mg/day), but potential covariates and the impact of the time since the last ASA intake are unknown. OBJECTIVES We used tissue viability imaging (TiVi) in patients at risk of cardiovascular disease and examined its association with self-reported treatments. PATIENTS/METHODS We recorded the age, gender, height, weight, smoking status, and use of 14 different drug categories in 822 patients either with known peripheral artery disease or at risk thereof. The difference between TiVi arbitrary units (TAUs) where stimulation was applied and an adjacent skin area was recorded, as well as the time since the last ASA intake. Step-by-step regression analysis was used to determine the factors that affect CIV amplitude. RESULTS AND CONCLUSIONS CIV was 28.2 ± 22.9 vs. 14.6 ± 18.0 TAUs (P < 0.001) in patients treated with ASA (n = 287) and not treated with ASA (n = 535), respectively. The main determinants of CIV amplitude, by order of importance, were: aspirin intake, diabetes mellitus, age, and male sex. In ASA-treated patients, the main determinants were diabetes mellitus, time since the last ASA intake, male gender, and age. Non-invasive determination of the physiological effects of low-dose ASA is feasible in routine clinical practice. It could be a clinical approach to provide objective evidence of ASA intake, and potentially could be used to test adherence to treatment in ASA-treated patients.
Collapse
Affiliation(s)
- Pierre Ramondou
- Vascular Medicine, Angers University Hospital, Angers, France
| | - Jeanne Hersant
- Vascular Medicine, Angers University Hospital, Angers, France
| | | | - Wendsendate Yves Sempore
- 551563Sports and Exercise Medicine, Angers University Hospital, Angers, France.,UMR CNRS 1083 INSERM 6015, LUNAM University, Angers, France.,Université Nazi Boni, Bobo Dioulasso, Burkina Faso
| | - Pierre Abraham
- 551563Sports and Exercise Medicine, Angers University Hospital, Angers, France.,UMR CNRS 1083 INSERM 6015, LUNAM University, Angers, France
| | - Samir Henni
- Vascular Medicine, Angers University Hospital, Angers, France.,UMR CNRS 1083 INSERM 6015, LUNAM University, Angers, France
| |
Collapse
|
29
|
Hersant J, Bigou Y, Abraham P, Henni S. We all dream of simple things. Prim Care Diabetes 2020; 14:569. [PMID: 31126744 DOI: 10.1016/j.pcd.2019.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/05/2019] [Indexed: 11/25/2022]
Affiliation(s)
| | - Yannick Bigou
- Vascular Medicine, University Hospital, Angers, France
| | - Pierre Abraham
- Vascular Medicine, University Hospital, Angers, France; Exercise and Sports Medicine, University Hospital, Angers, France; UMR CNRS6015-INSERM-1083, Mitovasc Institute, University of Angers, France
| | - Samir Henni
- Vascular Medicine, University Hospital, Angers, France; UMR CNRS6015-INSERM-1083, Mitovasc Institute, University of Angers, France
| |
Collapse
|
30
|
Abraham P, Hersant J, Ramondou P, Thouveny F, Feuilloy M, Picquet J, Henni S. Comparison of transcutaneous oximetry with symptoms and arteriography in thoracic outlet syndrome. Clin Hemorheol Microcirc 2020; 75:107-119. [PMID: 31929152 DOI: 10.3233/ch-190751] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Non-invasive tests are still required to improve the holistic diagnostic approach of thoracic outlet syndrome (TOS). OBJECTIVES We aimed to analyze the diagnostic accuracy of the decrease from rest oxygen pressure (DROP) index of transcutaneous oximetry (TcpO2) in TOS. METHODS Seventy-six patients and 40 asymptomatic volunteers (Controls) were enrolled. In TOS-suspected patients, the arteriograms were investigated for the presence of≥75% stenosis. The area under receiver operating characteristics curve (AUC) analysis tested the ability of forearm TcpO2 during provocative maneuvers to discriminate patients from controls and, to predict a positive arteriographic findings in the 44 TOS-suspected patients that had an arteriography. RESULTS The media [25/75° centile] DROP values of controls and patients were -14 [-8/-22] mmHg and -22 [-12/-42] mmHg, respectively (p for Mann-Whitney<0.02). AUC analysis showed a significant ability of TcpO2 to predict the presence of subclavian arterial compression on arteriography (AUC, 0.694). CONCLUSIONS Although time consuming, tcpO2 is independent of the observer expertise and could be useful in TOS-suspected patients to select the patients that should undergo arteriography.
Collapse
Affiliation(s)
- Pierre Abraham
- Exercise investigation and Sports Medicine, University Hospital, Angers, France.,UMR CNRS 6015, INSERM 1228, Medical School, University of Angers, France
| | | | | | | | | | - Jean Picquet
- UMR CNRS 6015, INSERM 1228, Medical School, University of Angers, France.,Thoracic and Vascular Surgery, University Hospital, Angers, France
| | - Samir Henni
- UMR CNRS 6015, INSERM 1228, Medical School, University of Angers, France.,Vascular Radiology, University Hospital, Angers, France
| |
Collapse
|
31
|
Gahier M, Hersant J, Hamel JF, Sempore Y, Bruneau A, Henni S, Abraham P. A Simple Scale for Screening Lower-Extremity Arterial Disease as a Possible Cause of Low Back Pain: a Cross-sectional Study Among 542 Subjects. J Gen Intern Med 2020; 35:1963-1970. [PMID: 32367389 PMCID: PMC7351938 DOI: 10.1007/s11606-020-05670-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/13/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Epidemiological, imaging, and anatomical studies suggest an association between proximal arterial atherosclerosis and development of low back pain (LBP). OBJECTIVES We aimed to define (1) the frequency and (2) factors associated with exercise-induced proximal ischemia (EIPI) in individuals with LBP and (3) develop a clinical screening scale. DESIGN Monocentric cross-sectional study. PARTICIPANTS All patients with history of ongoing LBP referred to our exercise investigation laboratory for exercise transcutaneous oximetry (ex-tcPO2) between January 2011 and December 2017 (n = 542; mean age, 65.4 ± 10.9; 83.9% men). MAIN MEASURES EIPI was defined as a decrease from rest of oxygen pressure (DROP) below - 15 mmHg on the lumbar and/or buttock probes. Ex-tcPO2 is a reliable validated tool for diagnosing EIPI in comparison with arteriography and computed tomography angiography. Ex-tcPO2 was performed on a treadmill until symptom manifestation or exhaustion. Clinical data were collected using interview questionnaires, medical file review, and clinical examination. KEY RESULTS EIPI was diagnosed in 282 patients (52%). Age ≤ 70 years (OR, 2.22; 95% CI, 1.35-3.57; p = 0.002), a history of proximal revascularization (OR, 2.64; 95% CI, 1.50-4.65; p = 0.001), use of antiplatelet medication (OR, 1.71; 95% CI, 0.96-3.06; p = 0.069), a relationship between exercise and LBP (OR, 2.61; 95% CI, 1.49-4.57; p = 0.001), and an abnormal ankle to brachial index (OR, 2.87; 95% CI, 1.77-4.66; p < 0.0001) were identified as EIPI predictors. Using these items, we developed a screening scale that showed an area under the receiver operating characteristics curve of .756. At a score of ≥ 3, the sensitivity, specificity, and accuracy for EIPI were 84%, 55%, and 71%, respectively. CONCLUSIONS EIPI was common among our patients with LBP undergoing ex-TcPO2. Our screening scale could help better select the patients who require angiography.
Collapse
Affiliation(s)
- M Gahier
- Sports Medicine and Exercise Investigations, University Hospital, Angers, France.
| | - J Hersant
- Vascular Medicine, University Hospital, Angers, France
| | - J F Hamel
- Methodology and Biostatistics Department, Angers University Hospital, Angers, France
| | - Y Sempore
- Sports Medicine and Exercise Investigations, University Hospital, Angers, France
| | - A Bruneau
- Sports Medicine and Exercise Investigations, University Hospital, Angers, France
| | - S Henni
- Vascular Medicine, University Hospital, Angers, France
- UMR INSERM 1083 - CNRS 6015, Angers University Hospital, Angers, France
| | - P Abraham
- Sports Medicine and Exercise Investigations, University Hospital, Angers, France
- Vascular Medicine, University Hospital, Angers, France
- UMR INSERM 1083 - CNRS 6015, Angers University Hospital, Angers, France
| |
Collapse
|
32
|
Sempore WY, Ramondou P, Hersant J, Feuilloy M, Guilleron C, Henni S, Abraham P. Specific slow tests are not mandatory in patients with extremely short standard (3.2 km/hr 10% slope) test durations during exercise oximetry. Clin Physiol Funct Imaging 2020; 40:232-237. [DOI: 10.1111/cpf.12626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/10/2019] [Accepted: 02/23/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Wendsèndaté Yves Sempore
- Department of Vascular Medicine University Hospital Angers Angers France
- Centre Muraz National Institut of Public Health Bobo dioulaso Burkina Faso
| | - Pierre Ramondou
- Department of Vascular Medicine University Hospital Angers Angers France
| | - Jeanne Hersant
- Department of Vascular Medicine University Hospital Angers Angers France
| | | | - Celine Guilleron
- Department of Sports medicine University Hospital Angers Angers France
- Department of Sports Sciences University Le mans Le mans France
| | - Samir Henni
- Department of Vascular Medicine University Hospital Angers Angers France
- UMR Mitovasc CNRS6015‐INSERM 1083 University of Angers Angers France
| | - Pierre Abraham
- Department of Vascular Medicine University Hospital Angers Angers France
- Department of Sports medicine University Hospital Angers Angers France
- UMR Mitovasc CNRS6015‐INSERM 1083 University of Angers Angers France
| |
Collapse
|
33
|
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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/19/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
Transcutaneous oxygen pressure (TcpO2) measurement has been used for years at rest in patients with lower extremity artery disease. It was proposed for exercise testing (Ex-TcpO2) in the 80ies to evaluate regional blood flow impairment (RBFI) at the proximal and distal levels simultaneously and on both sides, in case of claudication. It was suggested that the use of a chest electrode was mandatory to show that decreases in TcpO2 at the limb level result from limb RBFI and not from a systemic pO2 decrease of cardiopulmonary origin (exercise-induced hypoxemia). Unfortunately, a major pitfall of Ex-TcpO2 was the low absolute reliability of the regional perfusion index (RPI: ratio of limb to chest values) and the technique was almost abandoned until 2003, when the DROP index (Decrease from rest of oxygen pressure: limb changes minus chest changes from rest) was proposed. The DROP mathematical formula makes Tcpo2 results independent from the absolute pO2 starting values, improving reliability of Ex-TcpO2 as compared to the RPI. Since then, Ex-TcpO2 has been of renewed interest. The present paper addresses the physiology of Ex-TcpO2, interpretation of its results, and common misunderstandings about its use.
Collapse
Affiliation(s)
- Pierre Abraham
- Department of Sports Medicine, University Hospital, Angers, France; Department of Vascular Medicine, University Hospital, Angers, France; Department of Physiology, UMR Mitovasc CNRS6015-INSERM 1083, Faculty of Medicine, University of Angers and LUNAM University, Angers, France.
| | - Pierre Ramondou
- Department of Vascular Medicine, University Hospital, Angers, France
| | - Jeanne Hersant
- Department of Vascular Medicine, University Hospital, Angers, France
| | - Wendsèndaté Yves Sempore
- Department of Sports Medicine, University Hospital, Angers, France; Department of Physiology, UMR Mitovasc CNRS6015-INSERM 1083, Faculty of Medicine, University of Angers and LUNAM University, Angers, France; Centre Muraz, National Institute of Public Health, Burkina Faso
| | | | - Samir Henni
- Department of Vascular Medicine, University Hospital, Angers, France; Department of Physiology, UMR Mitovasc CNRS6015-INSERM 1083, Faculty of Medicine, University of Angers and LUNAM University, Angers, France
| |
Collapse
|
34
|
Haupert G, Ammi M, Hersant J, Daligault M, Tesson P, Papon X, Picquet J. Treatment of Carotid Restenoses after Endarterectomy: A Retrospective Monocentric Study. Ann Vasc Surg 2020; 64:43-53. [PMID: 31923595 DOI: 10.1016/j.avsg.2019.10.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/13/2019] [Accepted: 10/16/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND To compare the different techniques for the treatment of carotid restenosis after carotid artery endarterectomy (CAE). METHODS Among 1,218 carotid surgeries carried out in our center between January 2010 and November 2017, 45 procedures were performed for carotid restenosis after CAE, including 11 by iterative conventional surgery and 34 with endovascular techniques (7 transluminal angioplasties alone [TLA], 9 carotid artery stenting [CAS], and 18 angioplasties with active balloons [drug-coated balloon {DCB}]). Perioperative data (cumulated rate of morbimortality [CRMM], duration of hospitalization) and postoperative results (survival, symptomatic restenoses > 50% or asymptomatic stenoses > 70% on ultrasound, reinterventions) were collected retrospectively and analyzed with Fisher's exact test. The long-term results were estimated according to the Kaplan-Meier estimator and were compared with the log rank test (P < 0.05 was regarded as significant). RESULTS There was one secondary death due to a massive postoperative stroke in the endovascular (ENDO) group. No significant difference regarding CRMM (2.9%, P = 0.756) between the iterative conventional surgery (open surgery; OS) and the ENDO groups of was observed. Three hematomas were found in the OS group versus one in the ENDO group (P = 0.04). The length of hospital stay was shorter in the ENDO group (P < 0.001). No difference was found between the ENDO group and the OS group regarding the two-year survival or the survival without recurrent restenosis (86 vs. 100%, log rank = 0.804, and log rank = 0.114). There were 5 restenoses >70% and two reinterventions in the ENDO group (P > 0.05). The comparison of the different endovascular techniques did not show significant differences regarding the CRMM, the one-year overall survival, the survival without recurrent restenosis, or the survival without reintervention (89% in the DCB and CAS groups vs. 100% in the percutaneous transluminal angioplasty [PTA] group, log rank = 0.286; 87% in the DCB group vs. 100% in the PTA and CAS groups, log rank = 0.137; and 94% in the DCB group vs. 100% in the PTA and CAS groups, log rank = 0.585, respectively). CONCLUSIONS In our experience, endovascular procedures are equivalent to iterative conventional surgery for the treatment of carotid restenoses in terms of major complications, news restenoses, or survival with less hematoma and a shorter duration of hospitalization. We however could not identify the best endovascular strategy in this indication, and a controlled study comparing the various endovascular strategies is proposed.
Collapse
Affiliation(s)
- Gautier Haupert
- Service de chirurgie vasculaire, Centre Hospitalier Universitaire d'Angers, Angers, France.
| | - Myriam Ammi
- Service de chirurgie vasculaire, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Jeanne Hersant
- Service de chirurgie vasculaire, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Mickael Daligault
- Service de chirurgie vasculaire, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Pierre Tesson
- Service de chirurgie vasculaire, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Xavier Papon
- Service de chirurgie vasculaire, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Jean Picquet
- Service de chirurgie vasculaire, Centre Hospitalier Universitaire d'Angers, Angers, France
| |
Collapse
|
35
|
Abraham P, Hersant J, Ramondou P, Picquet J, Feuilloy M, Henni S. Comparison of exercise oximetry and ankle pressure measurements for patients with intermittent claudication: an observational study of 433 patients. Pflugers Arch 2020; 472:293-301. [DOI: 10.1007/s00424-019-02340-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/21/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022]
|
36
|
Abraham P, Zegar G, Hersant J, Rouvière O, Bruneau A, Ramondou P, Feugier P. Ankle and arm pressure recordings for the diagnosis of exercise-induced arterial endofibrosis. Vasc Invest Ther 2020. [DOI: 10.4103/vit.vit_13_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
37
|
Hersant J, Ramondou P, Guilleron C, Picquet J, Henni S, Abraham P. A pilot study of forearm microvascular impairment and pain while using a telephone. Microvasc Res 2019; 129:103963. [PMID: 31790665 DOI: 10.1016/j.mvr.2019.103963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine if using a telephone can induce forearm pain and ischemia. DESIGN Prospective case-control trial. SETTING Vascular laboratory in the university hospital in Angers between September 2018 and March 2019. PARTICIPANTS Fifteen apparently healthy subjects (controls) and 32 patients with suspected thoracic outlet syndrome (TOS) of vascular or non-vascular origin. INTERVENTION Hand-holding a cellular phone to answer a call from investigators. MAIN OUTCOME MEASURES Presence of forearm fatigue or pain (primary outcome), ability to hold the phone with each hand for 1 min (secondary outcome 1) and decrease in forearm transcutaneous oxygen pressure DROP index indicating forearm ischemia (secondary outcome 2). A DROP < -15 mm Hg defined ischemia. RESULTS Answering a phone call resulted in 25(78%) patients with forearm fatigue or pain and in 18 (56%) cases in the inability to hold the phone for 1 min, on one or both arms in patients with suspected TOS, but never occurred in healthy volunteers (p < .05 and p < .001). The presence of ischemia was observed in one or both arms in 10 (31%) patients with proved TOS and was always associated to phone-induced pain. Three (20%) of the controls had phone-induced ischemia. All had asymptomatic TOS and remained asymptomatic during the phone test (p = .42 from suspected-TOS patients). CONCLUSION The phone conversation resulted in pain in many patients with suspected TOS. Transcutaneous oximetry can document the underlying ischemia. Forearm phone-call-induced pain may be indicative of TOS provided that no earplug or headset is used. Trial registrationClinicalTrials.govNCT03355274.
Collapse
Affiliation(s)
- Jeanne Hersant
- Vascular Medicine, University Hospital Center, Angers, France
| | - Pierre Ramondou
- Vascular Medicine, University Hospital Center, Angers, France; Sports Medicine, University Hospital Center, Angers, France
| | - Celine Guilleron
- Sports Medicine, University Hospital Center, Angers, France; Laboratory Movement Interactions performance; MIP EA4334, F-72000 Le Mans, France
| | - Jean Picquet
- Vascular and thoracic surgery, University Hospital Center, Angers, France; UMR INSERM 1083-CNRS 6015, Mitovasc Institute, Angers, France
| | - Samir Henni
- Vascular Medicine, University Hospital Center, Angers, France; UMR INSERM 1083-CNRS 6015, Mitovasc Institute, Angers, France
| | - Pierre Abraham
- Vascular Medicine, University Hospital Center, Angers, France; Sports Medicine, University Hospital Center, Angers, France; UMR INSERM 1083-CNRS 6015, Mitovasc Institute, Angers, France.
| |
Collapse
|
38
|
Sempore WY, Ilboudo A, Henni S, Hersant J, Ammi M, Yameogo AA, Ouedraogo N, Yameogo TM, Abraham P. The walking estimated limitation stated by history (WELSH): a visual tool to self-reported walking impairment in a predominantly illiterate population. Cardiovasc J Afr 2019; 30:341-346. [PMID: 31469386 PMCID: PMC8802349 DOI: 10.5830/cvja-2019-032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/20/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The prevalence of cardiovascular diseases is increasing in low-income countries. Various questionnaires to estimate walking capacity in patients are available in multiple languages but they are not suitable for illiterate patients. OBJECTIVE The walking estimated limitation stated by history (WELSH) tool aims at rating individual walking disability using only drawings and four items. METHODS A six-month prospective study was performed on new patients referred to the Department of Cardiology at the Centre Hospitalier Universitaire Sourô Sanou in Bobo-Dioulasso, Burkina Faso. We administered the WELSH tool after a short oral presentation in the patient's language or dialect. Thereafter, patients performed a six-minute walking test in the hospital corridor under the supervision of a nurse who was blinded to the results of the WELSH score. We performed a step-by-step multilinear regression analysis to determine the factors predicting maximal walking distance (MWD). RESULTS There were 40 female and 10 male patients in this study. Their ages ranged from 54.8 ± 10.7 years. Only 32% of the patients had attended primary school. Most patients were classified as stage I to III of the New York Heart Association (NYHA) classification. The objective measurement of MWD during a six-minute walking test showed no association with the subjects' educational level, body mass index, NYHA stage or gender, but a significant correlation with the WELSH scores. The Spearman r-value for the WELSH score-to-MWD relationship was 0.605 (p < 0.001). CONCLUSIONS The WELSH tool is feasible and correlated with measured MWD in a population of predominantly illiterate patients.
Collapse
Affiliation(s)
- Wendsàndaté Yves Sempore
- Centre Muraz, Bobo-Dioulasso, Burkina Faso; Vascular Medicine, University Hospital Centre of Angers, Angers Cedex Angers, France
| | - Alassane Ilboudo
- Internal Medicine, Centre Hospitalier Universitaire Sourô Sanou, Bobo Dioulasso, Burkina Faso
| | - Samir Henni
- Vascular Medicine, University Hospital Centre of Angers, Angers Cedex Angers, France
| | - Jeanne Hersant
- Vascular Medicine, University Hospital Centre of Angers, Angers Cedex Angers, France
| | - Myriam Ammi
- Vascular Surgery, University Hospital Centre of Angers, Angers, France
| | - Aimé Arsàne Yameogo
- Cardiology, Centre Hospitalier Universitaire Sourô Sanou, Bobo Dioulasso, Burkina Faso
| | - Nafi Ouedraogo
- Physiology, Centre Hospitalier Universitaire Sourô Sanou, Bobo Dioulasso, Burkina Faso
| | - Téné Marcéline Yameogo
- Internal Medicine, Centre Hospitalier Universitaire Sourô Sanou, Bobo Dioulasso, Burkina Faso
| | - Pierre Abraham
- Vascular Medicine, University Hospital Centre of Angers, Angers Cedex Angers, France; UMR CNRS 6214, INSERM 1083, Mitovasc Institute, Angers, France.
| |
Collapse
|
39
|
Henni S, Ammi M, Semporé Y, Hersant J, Zegar G, Gourdier AS, Picquet J, Abraham P. Treadmill Measured vs. Questionnaire Estimated Changes in Walking Ability in Patients With Peripheral Artery Disease. Eur J Vasc Endovasc Surg 2019; 57:676-684. [PMID: 30982731 DOI: 10.1016/j.ejvs.2018.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/22/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Determining the maximum walking time (MWT) using the treadmill test is the gold standard method for evaluating walking capacity and treatment effect in patients with peripheral arterial disease (PAD). However, self reported functional disability is important when assessing quality of life. Changes in the Walking Estimated Limitation Calculated by History (WELCH) questionnaire scores were compared with the MWT. METHODS A cross sectional study was performed in patients with intermittent claudication. The treadmill test (3.2 km/h; 10% gradient) and WELCH questionnaire were administered to all patients for objective evaluation of walking capacity. Given the log normal distribution of these parameters in patients with PAD, a log transformation was applied to the WELCH score (LnW) and maximum walking time (LnT). The responsiveness of the WELCH score was determined using mean changes and correlation coefficients of LnW and LnT changes. The effect of time on the "estimated minus real" (E - R) changes (LnW - change minus LnT - change) was assessed after categorisation of patients into various test-retest intervals. Patients who underwent lower limb revascularisation between the two tests and those who underwent medical treatment only were analysed. RESULTS Correlation coefficients between LnW and LnT for tests 1 and 2 were r = 0.514 and r = 0.503, respectively (p < .001, for both). Correlation for LnW change vs. LnT change was 0.384 (p < .001). E - R was positive only early after surgery. E - R was negative for all test-retest intervals >1 year in revascularised and non-revascularised patients. CONCLUSION Changes in WELCH scores correlated with changes observed on the treadmill in patients with intermittent claudication. For long test-retest intervals, WELCH changes tended to overestimate the worsening of walking impairment as compared with the measured difference observed in both revascularised and non-revascularised patients. A shortlived "honeymoon" (overestimation of the benefit for the shortest test-retest interval) was observed only in revascularised patients.
Collapse
Affiliation(s)
- Samir Henni
- Vascular Medicine Department, University Hospital Centre of Angers, Angers, France
| | - Myriam Ammi
- Vascular Surgery Department, University Hospital Centre of Angers, Angers, France
| | - Yves Semporé
- Laboratoire de Physiologie, Institut Supérieur des Sciences de la Santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | - Jeanne Hersant
- Vascular Medicine Department, University Hospital Centre of Angers, Angers, France
| | - Geoffrey Zegar
- Vascular Medicine Department, University Hospital Centre of Angers, Angers, France
| | - Anne-Sophie Gourdier
- Vascular Medicine Department, University Hospital Centre of Angers, Angers, France
| | - Jean Picquet
- Vascular Surgery Department, University Hospital Centre of Angers, Angers, France; UMR CNRS 6015, INSERM U1083, Mitovasc Institute, Angers, France
| | - Pierre Abraham
- Vascular Surgery Department, University Hospital Centre of Angers, Angers, France; UMR CNRS 6015, INSERM U1083, Mitovasc Institute, Angers, France.
| |
Collapse
|
40
|
Henni S, Bauer P, Le Meliner T, Hersant J, Papon X, Daligault M, Chretien JM, Ammi M, Picquet J, Abraham P. High prevalence of exercise-induced ischemia in the asymptomatic limb of patients with apparently strictly unilateral symptoms and unilateral peripheral artery disease. Ther Adv Cardiovasc Dis 2019; 13:1753944718819063. [PMID: 30803404 PMCID: PMC6348574 DOI: 10.1177/1753944718819063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND: The prevalence of exercise-induced ischemia in the asymptomatic limb of patients with unilateral claudication based on history and treadmill evaluation, and with unilateral ipsilateral peripheral artery disease (i.e ankle-to-brachial systolic pressure index <0.90) is unknown. METHODS: We detected exercise-induced ischemia in the asymptomatic limb of patients with apparently unilateral claudication. Among 6059 exercise-oximetry tests performed in 3407 nondiabetic and 961 diabetic patients. We estimated the intensity of ischemia in the both limb (buttocks and calves) using the lowest minimum value of the decrease from rest of oxygen pressure (DROP; limb changes minus chest changes from rest), with significant ischemia defined as DROP lower than -15 mmHg. RESULTS: We found 152 tests performed in 142 nondiabetic patients and 40 tests performed in 38 diabetic patients. The asymptomatic limb showed significant ischemia in 46.7% and 37.5% of the tests. Strictly unilateral exercise-induced claudication with apparently unilateral peripheral artery disease was rare (<4% of all tests). However, among these highly selected tests, significant ischemia was found in the asymptomatic limb in more than one-third of cases. CONCLUSION: The asymptomatic limb of patients with peripheral artery disease should not be considered a normal limb.
Collapse
Affiliation(s)
- Samir Henni
- Department of Vascular Investigation, University of Angers Hospital, France.,UMR Mitovasc CNRS6015-INSERM 1083, University of Angers, France
| | - Pascal Bauer
- Cardiology and Angiology, University Hospital Giessen, Germany
| | - Tanguy Le Meliner
- Department of Vascular Investigation, University of Angers Hospital, France
| | - Jeanne Hersant
- Department of Vascular Investigation, University of Angers Hospital, France
| | - Xavier Papon
- Department of Vascular and thoracic Surgery, University of Angers Hospital, France
| | - Mickael Daligault
- Department of Vascular and thoracic Surgery, University of Angers Hospital, France
| | - Jean-Marie Chretien
- Department of Biostatistics and Data Management, University of Angers Hospital, France
| | - Myriam Ammi
- Department of Vascular and thoracic Surgery, University of Angers Hospital, France
| | - Jean Picquet
- Department of Vascular and thoracic Surgery, University of Angers Hospital, France.,UMR Mitovasc CNRS6015-INSERM 1083, University of Angers, France
| | - Pierre Abraham
- Laboratoire d'Explorations Vasculaires; Centre Hospitalier Universitaire, 49033 Angers Cedex 01, France
| |
Collapse
|
41
|
Henni S, Hersant J, Ammi M, Mortaki FE, Picquet J, Feuilloy M, Abraham P. Microvascular Response to the Roos Test Has Excellent Feasibility and Good Reliability in Patients With Suspected Thoracic Outlet Syndrome. Front Physiol 2019; 10:136. [PMID: 30846945 PMCID: PMC6393400 DOI: 10.3389/fphys.2019.00136] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/06/2019] [Indexed: 12/03/2022] Open
Abstract
Background: Exercise oximetry allows operator-independent recordings of microvascular blood flow impairments during exercise and can be used during upper arm provocative maneuvers. Objective: To study the test-retest reliability of upper-limb oximetry during the Roos test in patients with suspected thoracic outlet syndrome (TOS). Materials and Methods: Forty-two patients (28 men, 14 women; mean age: 40.8 years) were examined via transcutaneous oxygen pressure (TcpO2) recordings during two consecutive Roos tests in the standing position. The minimal decrease from rest of oxygen pressure (DROPmin) value was recorded after each maneuver was performed on both arms. The area under the receiver operating characteristic (ROC) curve defined the DROPmin diagnostic performance in the presence of symptoms during the tests. The Mann–Whitney U-test was used to compare the DROPmin in the symptomatic vs. asymptomatic arms. The test-retest reliability was analyzed with Bland-Altman representations. The results are presented as means ± standard deviations (SD) or medians [25–75 percentiles]. Results: The symptoms by history were different from the symptoms expressed during the Roos maneuvers in one-third of the patients. The DROPmin measurements were −19 [−36; −7] mmHg and −8 [−16; −5] mmHg in the symptomatic (n = 108) and asymptomatic (n = 60) arms, respectively. When TOS observed on ultrasound imaging was the endpoint, the area under the ROC curve (AUC) was 0.725 ± 0.058, with an optimal cutoff point of −15 mmHg. This value provided 67% sensitivity and 78% specificity for the presence TOS via ultrasound. When symptoms occurring during the test represented the endpoint, the AUC was 0.698 ± 0.04, with a cutoff point of −10 mmHg. This provided 62% sensitivity and 66% specificity for the presence of pain in the ipsilateral arm during the test. The test-retest reliability of DROPmin proved to be good but not perfect, partly because of unreliability of the provocation maneuvers. Conclusion: To the best of our knowledge, this study is the first to investigate microvascular responses during the Roos maneuver in patients with suspected TOS. The presence of symptoms was significantly associated with ischemia. TcpO2 facilitated the recording of both macrovascular and microvascular responses to the Roos test. The Roos maneuver should probably be performed at least twice in patients with suspected TOS.
Collapse
Affiliation(s)
- Samir Henni
- Vascular Medicine, University Hospital Center, Angers, France.,UMR INSERM 1083 - CNRS 6015, Mitovasc Institute, Angers, France
| | - Jeanne Hersant
- Vascular Medicine, University Hospital Center, Angers, France
| | - Myriam Ammi
- Department of Cardiovascular and Thoracic Surgery, University Hospital Center, Angers, France
| | | | - Jean Picquet
- UMR INSERM 1083 - CNRS 6015, Mitovasc Institute, Angers, France.,Department of Cardiovascular and Thoracic Surgery, University Hospital Center, Angers, France
| | | | - Pierre Abraham
- UMR INSERM 1083 - CNRS 6015, Mitovasc Institute, Angers, France.,Sports Medicine, University Hospital Center, Angers, France
| |
Collapse
|
42
|
Henni S, Hersant J, Gourdier AS, Ammi M, Abraham P. A new electron paramagnetic resonance device to measure transcutaneous oxygen in humans. Magn Reson Med 2019; 81:2835-2836. [DOI: 10.1002/mrm.27618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 11/06/2018] [Accepted: 11/06/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Samir Henni
- Vascular Medicine Department; University Hospital Center of Angers; Angers France
| | - Jeanne Hersant
- Vascular Medicine Department; University Hospital Center of Angers; Angers France
| | - Anne Sophie Gourdier
- Vascular Medicine Department; University Hospital Center of Angers; Angers France
| | - Myriam Ammi
- Thoracic and Vascular Surgery; University Hospital Center of Angers; Angers France
| | - Pierre Abraham
- Sports Medicine; University Hospital Center of Angers; Angers France
- UMR INSERM 1083- CNRS 6015; Mitovasc Institute; 49045 Angers France
| |
Collapse
|
43
|
Hersant J, Bigou Y, Ammi M, Henni S, Abraham P. Screening for peripheral artery disease in people with diabetes. Diabet Med 2019; 36:256-257. [PMID: 30198580 DOI: 10.1111/dme.13812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J Hersant
- Vascular Medicine, University Hospital Angers, Angers, France
| | - Y Bigou
- Vascular Medicine, University Hospital Angers, Angers, France
| | - M Ammi
- Vascular Surgery, University Hospital Angers, Angers, France
| | - S Henni
- Vascular Medicine, University Hospital Angers, Angers, France
| | - P Abraham
- Vascular Medicine, University Hospital Angers, Angers, France
- Mitovasc, University of Angers, Angers, France
| |
Collapse
|
44
|
Henni S, Hersant J, Loufrani L, Duval G, Humeau-Heurtier A, Riou J, Abraham P. Painless local pressure application to test microvascular reactivity to ischemia. Microvasc Res 2018; 122:13-21. [PMID: 30399363 DOI: 10.1016/j.mvr.2018.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Forearm cutaneous blood flux (CBF) measurement with post-occlusive reactive hyperemia (PORH) is uncomfortable and may not be devoid of risks. We aimed to investigate post-compression reactive hyperemia (PCRH) with a custom-made indenter that was designed to be easily used routinely by inexperienced observers. METHODS Medical students evaluated PCRH with 1- to 4-min pressure applications of 16 to 34 kPa and PORH with 3-min forearm cuff occlusion using laser speckle contrast imaging in 15 healthy volunteers. Participants were asked to quantify their discomfort with a visual analogue scale (VAS) of 10 cm. Total ischemia (ISCH) was quantified by the product of CBF during ischemia and ischemia duration (min). We subtracted the CBF changes in the skin from a reference ipsilateral (PCRH) or contralateral (PORH) non-stimulated area. RESULTS The average VAS was 1.0 for PCRH vs. 6.0 for PORH (p < 0.001). A strong linear relationship between ISCH and peak PCRH (r2 = 0.915, p < 0.001) was noted. Peak PORH values (63.9 laser perfusion units (LPU)) were significantly lower than all values of the 3-min PCRH (72.6 LPU), including the one obtained with 16 kPa. CONCLUSION Inexperienced observers could test microvascular reactivity with PCRH without inducing the discomfort that is typically experienced with PORH. Further, PCRH elicits a higher peak response to ischemia compared with PORH. This extremely simple method could influence a broad spectrum of routine cutaneous microcirculation investigations, especially when a painful approach is particularly inadequate or if the patient is fragile. CLINICAL TRIAL REGISTRATION NCT02861924.
Collapse
Affiliation(s)
- Samir Henni
- Vascular Medicine, University Hospital of Angers, France; MitoVasc Institute, UMR CNRS 6015 - INSERM U 1083, Faculté de Médecine, Angers, France
| | - Jeanne Hersant
- Vascular Medicine, University Hospital of Angers, France; MitoVasc Institute, UMR CNRS 6015 - INSERM U 1083, Faculté de Médecine, Angers, France
| | - Laurent Loufrani
- MitoVasc Institute, UMR CNRS 6015 - INSERM U 1083, Faculté de Médecine, Angers, France
| | - Guillaume Duval
- Department of Gerontology, University Hospital of Angers, France
| | - Anne Humeau-Heurtier
- Université Angers, LARIS - Laboratoire Angevin de Recherche en Ingénierie des Systèmes, Angers, France
| | -
- Vascular Medicine, University Hospital of Angers, France
| | - Jeremie Riou
- UMR Inserm 1066 - CNRS 6021, Faculté de Médecine, Angers, France
| | - Pierre Abraham
- MitoVasc Institute, UMR CNRS 6015 - INSERM U 1083, Faculté de Médecine, Angers, France; Sports Medicine, University Hospital of Angers, France.
| | | |
Collapse
|
45
|
Abraham P, Hersant J, Bigou Y, Ammi M, Henni S. Gravity changes in transcutaneous oxygen pressure and cutaneous blood flow. Clin Biomech (Bristol, Avon) 2018; 59:207-209. [PMID: 30266322 DOI: 10.1016/j.clinbiomech.2018.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/12/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Pierre Abraham
- Vascular medicine, University Hospital, Angers, France; Mitovasc, UMR CNRS 6015/INSERM 1083, University of Angers, Angers, France.
| | | | - Yannick Bigou
- Vascular medicine, University Hospital, Angers, France
| | - Myriam Ammi
- Vascular surgery, University Hospital, Angers, France
| | - Samir Henni
- Vascular medicine, University Hospital, Angers, France
| |
Collapse
|
46
|
Abraham P, Julienne T, Ammi M, Hersant J, Henni S. Near-infrared spectroscopy of the thigh fails to discriminate cyclists with arterial endofibrosis from normal asymptomatic athletes. Vasc Invest Ther 2018. [DOI: 10.4103/vit.vit_1_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
47
|
Truchaud A, Glikmanas G, Gourmelin Y, Hersant J, Trepo D, Foray G, Collombel C. Liquid-phase reactions started by rehydrating lyophilized reagents in a centrifugal analyzer. Clin Chem 1985. [DOI: 10.1093/clinchem/31.9.1506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
In the disposable rotor of the SAM microcentrifugal analyzer, various lyophilized reagents are predistributed in 24 33-microL cuvets, for determination of multiple analytes in one specimen (e.g., for patient profiles). We evaluated a prototype of this system, which can be used at 25, 30, or 37 degrees C; absorbance readings at 340, 405, and 500 nm varied linearly up to 2.0 A. Starting the reactions by rehydrating the reagents with diluted serum is adequate because absorbance readings do not begin until 180 s after initiating the rehydration. Analytical performances of kinetic determinations at 30 degrees C showed good accuracy and correlation with other methods for creatine kinase, amylase, aspartate aminotransferase, and gamma-glutamyltransferase. Kinetic determinations for urea, and equilibrium determinations with blank corrections for glucose, cholesterol, and triglycerides gave excellent results for glucose and correct results for the other analytes. This compact analyzer combines the analytical performances of a centrifugal analyzer with the practicability of instruments having predistributed reagents.
Collapse
|
48
|
Truchaud A, Glikmanas G, Gourmelin Y, Hersant J, Trepo D, Foray G, Collombel C. Liquid-phase reactions started by rehydrating lyophilized reagents in a centrifugal analyzer. Clin Chem 1985; 31:1506-8. [PMID: 4028400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In the disposable rotor of the SAM microcentrifugal analyzer, various lyophilized reagents are predistributed in 24 33-microL cuvets, for determination of multiple analytes in one specimen (e.g., for patient profiles). We evaluated a prototype of this system, which can be used at 25, 30, or 37 degrees C; absorbance readings at 340, 405, and 500 nm varied linearly up to 2.0 A. Starting the reactions by rehydrating the reagents with diluted serum is adequate because absorbance readings do not begin until 180 s after initiating the rehydration. Analytical performances of kinetic determinations at 30 degrees C showed good accuracy and correlation with other methods for creatine kinase, amylase, aspartate aminotransferase, and gamma-glutamyltransferase. Kinetic determinations for urea, and equilibrium determinations with blank corrections for glucose, cholesterol, and triglycerides gave excellent results for glucose and correct results for the other analytes. This compact analyzer combines the analytical performances of a centrifugal analyzer with the practicability of instruments having predistributed reagents.
Collapse
|
49
|
Truchaud A, Hersant J, Glikmanas G, Fievet P, Dubois O. Parallel evaluation of Astra 8 and Astra 4 multichannel analyzers in two hospital laboratories. Clin Chem 1980; 26:139-41. [PMID: 7356549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
We evaluated the new Beckman multichannel analyzers Astra 8 and Astra 4. Both instruments performed the following tests: Na, K, Cl, CO2, urea, glucose, and creatinine in plasma and Na, K, Cl, and creatinine determinations in urine. We tested precision, accuracy, and linearity at the usual concentrations in plasma and urine. We compared the Astra 8 and Astra 4 with continuous-flow (SMA 6) and discrete analyzers such as IL 243, Beckman KLiNa Flame, Beckman System 1, Corning 920 M Chloride Meter, and the Corning Blood-Gas Analyzer 175. Special tests were performed on plasma-to-plasma and urine-to-plasma carryover. Both analyzers are easy to operate and suitable for both emergency and routine use.
Collapse
|
50
|
Truchaud A, Hersant J, Glikmanas G, Fievet P, Dubois O. Parallel evaluation of Astra 8 and Astra 4 multichannel analyzers in two hospital laboratories. Clin Chem 1980. [DOI: 10.1093/clinchem/26.1.139] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
We evaluated the new Beckman multichannel analyzers Astra 8 and Astra 4. Both instruments performed the following tests: Na, K, Cl, CO2, urea, glucose, and creatinine in plasma and Na, K, Cl, and creatinine determinations in urine. We tested precision, accuracy, and linearity at the usual concentrations in plasma and urine. We compared the Astra 8 and Astra 4 with continuous-flow (SMA 6) and discrete analyzers such as IL 243, Beckman KLiNa Flame, Beckman System 1, Corning 920 M Chloride Meter, and the Corning Blood-Gas Analyzer 175. Special tests were performed on plasma-to-plasma and urine-to-plasma carryover. Both analyzers are easy to operate and suitable for both emergency and routine use.
Collapse
|