Disparities Between International Guidelines (AHA/ESC/ESVS/ESVM/SVS) Concerning Lower Extremity Arterial Disease: Consensus of the French Society of Vascular Medicine (SFMV) and the French Society for Vascular and Endovascular Surgery (SCVE)

Front. Cardiovasc. Med.

et al. 2021

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Objective: Arterial Doppler waveform recordings are commonly used to assess lower extremity arterial disease (LEAD) severity. However, little is known about the relationship between arterial Doppler waveform profiles and patients' walking capacity. The purpose of this study was to assess whether arterial Doppler waveforms are independently associated with maximal walking distance (MWD) in patients experiencing exertional limb symptoms.Materials and Methods: This cross-sectional study included suspected LEAD patients experiencing exertional limb symptoms. In both lower extremities, arterial Doppler waveforms and ankle-brachial index (ABI) values were obtained from the pedis and tibial posterior arteries. Each arterial flow measurement was ranked using the Saint-Bonnet classification system. Treadmill stress testing (3.2 km/h, 10% slope) coupled with exercise oximetry (Exercise-TcPO2) were used to determine MWD. Delta from rest oxygen pressure (DROP) was calculated. Following treadmill stress testing, post-exercise ABI values were recorded. Univariate and multivariate analyses were used to determine the clinical variables associated with MWD.Results: 186 patients experiencing exertional limb symptoms (62 ± 12 years and 26.8 ± 4.5 kg/m2) were included between May 2016 and June 2019. Median [25th; 75th] treadmill MWD was 235 [125;500]m. Better arterial Doppler waveforms were associated with better walking distance (p = 0.0012). Whereas, median MWD was 524 [185;525]m in the group that yielded the best Doppler waveforms, it was 182 [125,305]m in the group with the poorest Doppler waveforms (p = 0.0012). MWD was significantly better (p = 0.006) in the patients with the best ABIs. However, arterial Doppler waveforms alone were significantly associated with MWD (p = 0.0009) in the multivariate model. When exercise variables (post-exercise ABI or DROP) were incorporated into the multivariate model, these were the only variables to be associated with MWD.Conclusion: Of the various clinical parameters at rest, Doppler flow waveform profiles were associated with MWD in suspected LEAD patients. A stronger link was however found between exercise variables and MWD.

Section: Discussionmentioning

confidence: 99%

“…Arterial Doppler waveform recordings are commonly used for the purposes of LEAD diagnosis and follow-up (12)(13)(14). Arterial Doppler waveforms are influenced by the extent of upstream arterial stenosis (13,15).…”

Section: Introductionmentioning

confidence: 99%

Arterial Doppler Waveforms Are Independently Associated With Maximal Walking Distance in Suspected Peripheral Artery Disease Patients

Miossec

Tollenaere

Front. Cardiovasc. Med.

et al. 2021

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“…Non-prescription of statin (28%) appears to be only partially related to the adverse effect (7.8%) and non-prescription of ACE/ARBs (43%) is clearly not secondary to the onset of cough or hyperkalemia (3.7%). The fact could be partially explained by the discrepancies in the latest recommendations, some recommending the prescription of ACE/ARBs for all patients with PAD and others only in case of hypertension [2][3][4][5].…”

Section: Discussionmentioning

confidence: 99%

“…Lifestyle change and optimal medical treatment are the core of the treatment [2][3][4]. Antiplatelet aggregation inhibitor (AAP), a statin, and an antihypertensive drug (Angiotensin-Converting Enzyme inhibitor, ACE, or an angiotensin Receptor Blocker, ARBs) is the Optimal Medical Treatment (OMT) for PAD [5].…”

Section: Introductionmentioning

confidence: 99%

Gender Differences in the Medical Treatment of Peripheral Artery Disease

Sauvet

Guillaumat

et al. 2021

JCM

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Background/Objectives: Peripheral arterial disease is a frequent and severe disease with high cardiovascular morbidity and mortality. However, female patients appear to be undertreated. Objectives: The primary goal was to compare the prescription of optimal medical treatment (OMT) of peripheral arterial disease between women and men in primary health care. Material and methods: An observational retrospective study was based on the data collected from general practitioners (GP) office in Brittany. Results: The study included 100 patients, aged 71 ± 10 years old, with 24% of women. Compared to men, women received the OMT less frequently (29.2% vs. 53.9%, p = 0.038), especially after 75 years old. Antiplatelet therapy was largely prescribed (100%), statins less frequently (70.8% women vs. 85.5% men), and prescription of renin-angiotensin-aldosterone system inhibitors was still not optimal in the two genders (41.7% women vs. 61.9% men). Active smoking is important for both women and men (33% and 30% respectively). Conclusion: Optimal medical treatment of peripheral artery disease is insufficiently prescribed, especially in women in this region of France.

“…Arterial Doppler ultrasound is commonly used for non-invasive diagnosis of peripheral artery disease (PAD) ( 1 ) and analysis of Doppler ultrasound waveforms (DW) is a proficient method for evaluating the disease severity ( 2 ). Indeed, the aspect of the DW at rest, below an arterial lesion is the hemodynamic result of several components: the vessel wall compliance, the direct effect of the stenosis or occlusion, and the distal vasodilatation level.…”

Section: Introductionmentioning

confidence: 99%

Inter-rater Reliability of a 13-Category Arterial Doppler Waveform Classification and Practice of French Vascular Physicians

Front. Cardiovasc. Med.

Guillaumat

Trihan

et al. 2021

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Background: Arterial Doppler Ultrasound waveform (DW) analysis allows the detection and evaluation of lower extremity peripheral artery disease. The high heterogeneity of the reported description of DW is reduced by the use of classification. However, the reliability of these classifications is either unknown or low to moderate and practices of vascular caregivers regarding the use of these classifications remain unknown.Aims: This study aims to assess the inter-observer reliability of the Saint-Bonnet classification, a 13-category DW classification. The secondary objective was to determine the utilization rate of the most common classifications and the ability of these classifications to describe DW.Methods: A national survey was conducted among all vascular physicians of French society of vascular medicine. They were invited by email to describe on a website 20 DW without and with the display of the Saint-Bonnet classification. The reliability of this classification was estimated by Fleiss' Kappa expressed with [95% confidence interval]. A semantic analysis allowed us to classify the physicians' responses according to the terms used. Finally we have evaluated for each classification the rate of misuse, i.e., the addition of a complementary term to the defined categories.Results: One hundred and ten physicians participated and only 5% of these were familiar with Saint-Bonnet classification. Fifty-four percent of vascular physicians used no classification at all. Vascular physicians used the Spronk (four-category), Descotes (five-category) and Saint-Bonnet (13-category) classifications for respectively, 31, 10, and 5%. Kappa coefficient of Fleiss (κ) was 0.546 [0.544–0.547] (p < 0.001). Reliability by category ranges from κ of 0.075 to 0.864. In multivariate analysis, the use of a classification was associated with fewer years of experience and was dependent on geographic location. Misuse rate by classification was 88, 82, and 5% using Spronk, Descotes and Saint-Bonnet classifications respectively.Conclusion: The reliability of Saint-Bonnet classification is weak to moderate by vascular physicians who are not familiar with its use. However, unlike the other classifications, it seems to be sufficiently precise so that the user does not need to complete its description. There is a significant heterogeneity in the use of arterial Doppler classifications in France.