Discordance of peripheral artery disease diagnosis using exercise transcutaneous oxygen pressure measurement and post-exercise ankle-brachial index

Catillon, Floriane; Tollenaere, Quentin; Jéhannin, Pierre; Guilcher, Antoine; Pabic, Estelle Le; Lesager, G.; Omarjee, Loukman; Faucheur, Alexis Le

doi:10.1038/s41598-020-64276-x

Cited by 5 publications

(3 citation statements)

References 37 publications

(81 reference statements)

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“…There was no marked difference between the pre- and postoperative rest ABI. If the exercise ABI had been measured, it might have explained the reason behind the occurrence of lower-limb claudication [ 25 , 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Prospective clinical study for claudication after endovascular aneurysm repair involving hypogastric artery embolization

et al. 2022

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Purpose This prospective study aimed to assess the prognosis of claudication after endovascular aneurysm repair (EVAR) involving hypogastric artery (HGA) embolization. Methods Patients who were scheduled to undergo EVAR involving bilateral or unilateral HGA embolization (BHE or UHE, respectively) between May 2017 and January 2019 were included in this study. Patients underwent the walk test preoperatively, one week postoperatively, and monthly thereafter for six months. The presence of claudication and the maximum walking distance (MWD) were recorded. A near-infrared spectroscopy monitor was placed on the buttocks, and the recovery time (RT) was determined. A walking impairment questionnaire (WIQ) was completed to determine subjective symptoms. Results Of the 13 patients who completed the protocol, 12 experienced claudication in the 6-min walk test. The MWD was significantly lower at one week postoperatively than preoperatively. The claudication prevalence was significantly higher at five and six months postoperatively after BHE than after UHE. BHE was associated with longer RTs and lower WIQ scores than UHE. Conclusions We noted a trend in adverse effects on the gluteal circulation and subjective symptoms ameliorating within six months postoperatively, with more effects being associated with BHE than with UHE. These findings should be used to make decisions concerning management strategies for HGA reconstruction.

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Section: Discussionmentioning

confidence: 99%

Prospective clinical study for claudication after endovascular aneurysm repair involving hypogastric artery embolization

et al. 2022

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“…AUCs for post-exercise ABI decrease ≥18.5% and DROP ≤-15 mmHg were 0.67[0.53-0.78] and 0.67[0.53-0.78] respectively (7). We and others have previously demonstrated that discrepancies for the diagnosis of LEPAD exist between exercise criteria (Ankle pressure, post-exercise ABI and exercise-TcPO2) (8)(9)(10). Indeed, using a criterion patient can be considered as a LEPAD patient whereas using another criterion the same patient can be considered as a patient without LEPAD.…”

Section: Introductionmentioning

confidence: 95%

Combination of Exercise Testing Criteria to Diagnose Lower Extremity Peripheral Artery Disease

Stivalet

Pathil

Belabbas

et al. 2021

Front. Cardiovasc. Med.

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Objectives: Nothing is known about the interest of the combination of exercise tests to diagnose Lower-extremity Peripheral Artery Disease (LEPAD). The aim of this study was to assess if combining exercise testing criteria [post-exercise Ankle-Brachial Index (ABI) + exercise-oximetry (exercise-TcPO2)] improves the detection of lower limbs arterial stenoses as compared with post-exercise ABI using American Heart Association (AHA) criteria, or exercise-TcPO2 alone.Material and Methods: In a prospective monocentric study, consecutive patients with exertional-limb pain and normal resting-ABI referred to our vascular center (Rennes, France) were assessed from May 2016 to February 2018. All included patients had a computed tomography angiography (CTA), a resting-ABI, a post-exercise ABI and an exercise-TcPO2. AHA post-exercise criteria, new validated post-exercise criteria (post-exercise ABI decrease ≥18.5%, post-exercise ABI decrease <0.90), and Delta from Rest of Oxygen Pressure (Total-DROP) ≤-15mmHg (criterion for exercise-TcPO2) were used to diagnose arterial stenoses ≥50%. For the different combinations of exercise testing criteria, sensitivity or specificity or accuracies were compared with McNemar's test.Results: Fifty-six patients (mean age 62 ± 11 years old and 84% men) were included. The sensitivity of the combination of exercise testing criteria (post-exercise ABI decrease ≥18.5%, or post-exercise ABI decrease <0.90 or a Total-DROP ≤-15mmHg) was significantly higher (sensitivity = 81% [95% CI, 71–92]) than using only one exercise test (post-exercise AHA criteria (sensitivity = 57% [43–70]) or exercise-TcPO2 alone (sensitivity = 59% [45–72]).Conclusions: Combination of post-exercise ABI with Exercise-TcPO2 criteria shows better sensitivity to diagnose arterial stenoses compared with the AHA post-exercise criteria alone or Exercise-TcPO2 criteria used alone. A trend of a better accuracy of this combined strategy was observed but an external validation should be performed to confirm this diagnostic strategy.

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“…These hypotheses are of particular interest, since on the one hand, it is generally admitted that research into the consequences of ischemia in patients with claudication and an abnormal ankle to brachial index (ABI) should give further consideration to the calf muscles [8][9][10][11]; and on the other hand, it is well known that a normal ABI does not exclude the vascular origin of calf claudication, but although post exercise ABI is of interest, it cannot be used interchangeably with Ex-TcpO2 for the diagnosis of LEAD in patients with exertional symptoms and normal rest ABI [12].…”

Section: Introductionmentioning

confidence: 99%

The hidden side of calf claudication: Hemodynamic and clinical results of treadmill testing in 584 patients complaining of isolated exertional calf pain

et al. 2020

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Discordance of peripheral artery disease diagnosis using exercise transcutaneous oxygen pressure measurement and post-exercise ankle-brachial index

Abstract: weak with only a fair rating with a k value of 0.23[0.04-0.41] (Table 2). The characteristics of the concordant and discordant patients are presented in Table 3. Figure 2 depicts the results of both tests in the included population.

Cited by 5 publications

References 37 publications

Prospective clinical study for claudication after endovascular aneurysm repair involving hypogastric artery embolization

Prospective clinical study for claudication after endovascular aneurysm repair involving hypogastric artery embolization

Combination of Exercise Testing Criteria to Diagnose Lower Extremity Peripheral Artery Disease

The hidden side of calf claudication: Hemodynamic and clinical results of treadmill testing in 584 patients complaining of isolated exertional calf pain

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