Proficiency of Medical Students at Obtaining Pressure Measurement Readings Using Automated Ankle and Toe Measuring Devices for Diagnosis of Lower Extremity Peripheral Artery Disease

Catillon, Floriane; Tuffier, Stéphane; Guilcher, Antoine; Tollenaere, Quentin; Métairie, Antoine; Miossec, Annaïg; Mauger, Chadi; Lanéelle, Damien

doi:10.1016/j.avsg.2019.10.092

Cited by 6 publications

(5 citation statements)

References 30 publications

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“…Furthermore, although the artery caliber between both arteries does not appear significantly different in several studies (39, 40), there is a trend for an augmented prevalence of stenosis on the dorsalis pedis artery vs. the posterior tibial artery (40). Third, we followed the AHA procedure to measure the ABI except for the measurement of the brachial pressure that was measured with an automatic blood pressure monitor (Carescap Dinamap V100; GE Healthcare) as previously done in other papers (7,22,32). We are confident with our results since (i) Montgomery and Gardner (41) found no statistical difference between Doppler measurement and automatic measurement at the brachial level, and (ii) this is suggested by the French guidelines (7).…”

Section: Limitssupporting

confidence: 55%

“…The measurement time is a key point in the daily use of this test. The mean time for an ABI measurement was recently reported around 5 min by a trained vascular physician (32) without taking into account the 10min rest time recommended (8). Another study found a mean time for ABI measurement by general practitioners around 17 min among more than 13,000 patients (33).…”

Section: Discussionmentioning

confidence: 99%

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Simplification of ankle-brachial-index measurement using Doppler-waveform classification in symptomatic patients suspected of lower extremity artery disease

Métairie

Tollenaere

Lanéelle

et al. 2022

Front. Cardiovasc. Med.

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ObjectivesAnkle-brachial index (ABI) is commonly used for screening lower extremity peripheral artery disease (PAD) according to the international guidelines. Arterial Doppler waveform recordings is a tool to diagnose and assess PAD severity. We hypothesized that ABI measurement could be simplified by measuring only the pressure where the best arterial flow is recorded. The aim of this study was to evaluate the concordance between ABI performed according to the American Heart Association guidelines (AHA-ABI) and ABI measured according to best arterial waveform (FLOW-ABI).DesignThis was a monocentric cross-sectional study.MethodsWe included patients with exertional limb symptoms suspected of PAD. Arterial Doppler waveforms and ABI were acquired on both lower extremities at the pedis and tibial posterior arteries. Each arterial waveform was classified using the Saint-Bonnet classification. Concordances were analyzed with the kappa coefficient (confidence interval 95%). Exercise PAD study was registered n° NCT03186391.ResultsIn total, one hundred and eighty-eight patients (62+/−12 years and 26.8+/−4.5 kg/m2) with exertional limb symptoms were included from May 2016 to June 2019. On each extremity, FLOW-ABI had excellent concordance for the diagnosis of PAD with the AHA-ABI with a kappa of 0.95 (95% CI: 0.90, 0.99) in the right extremity and 0.91 (95% CI: 0.86, 0.97) in the left extremity.ConclusionThere is almost perfect concordance between AHA-ABI and FLOW-ABI. Thus, ABI can be simplified into five pressure measurements instead of seven in patient suspected of PAD with exertional limb symptoms. The question remains in patients with chronic limb ischemia.

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Section: Limitssupporting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Simplification of ankle-brachial-index measurement using Doppler-waveform classification in symptomatic patients suspected of lower extremity artery disease

Métairie

Tollenaere

Lanéelle

et al. 2022

Front. Cardiovasc. Med.

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“…Catillon et al similarly showed that an educational intervention for medical students in how to diagnose peripheral artery disease using the ankle-brachial index was effective. 8 Our data emphasize the importance of introducing vascular medicine lectures into both the medical school and the postgraduate training curricula.…”

Section: Vascular Medicine 25(4)mentioning

confidence: 60%

A survey of commonly misunderstood vascular medicine physical exam findings among medical trainees

et al. 2020

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“…The device works in a user-friendly way, and the measurements are easy to perform and do not require a considerable learning curve. In one study with the MESI ABPI MD device (a previous development of MESI Ltd., which measured blood pressure on three extremities simultaneously), no interobserver variability was found between the ABI readings obtained by medical students and experienced vascular specialists [39].…”

Section: Discussionmentioning

confidence: 99%

Screening for Peripheral Artery Disease Using an Automated Four-Limb Blood Pressure Monitor Equipped with Toe–Brachial Index Measurement

Fendrik,

Biró,

Endrei

et al. 2023

JCM

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Toe–brachial index (TBI) measurement helps to detect peripheral artery disease (PAD) in patients with incompressible ankle arteries due to medial arterial calcification, which is most frequently associated with diabetes. We aimed to evaluate how an automated four-limb blood pressure monitor equipped with TBI measurement could contribute to PAD screening. In 117 patients (mean age 63.2 ± 12.8 years), ankle–brachial index (ABI) measurement was performed using the Doppler-method and the MESI mTablet. TBI was obtained via photoplethysmography (MESI mTablet, SysToe) and a laser Doppler fluxmeter (PeriFlux 5000). Lower limb PAD lesions were evaluated based on vascular imaging. A significant correlation was found between Doppler and MESI ankle–brachial index values (r = 0.672), which was stronger in non-diabetic (r = 0.744) than in diabetic (r = 0.562) patients. At an ABI cut-off of 0.9, Doppler (AUC = 0.888) showed a sensitivity/specificity of 67.1%/97.4%, MESI (AUC 0.891) exhibited a sensitivity/specificity of 57.0%/100%; at a cut-off of 1.0, MESI demonstrated a sensitivity/specificity of 74.7%/94.8%. The TBI values measured using the three devices did not differ significantly (p = 0.33). At a TBI cut-off of 0.7, MESI (AUC = 0.909) revealed a sensitivity/specificity of 92.1%/67.5%. Combining MESI ABI and TBI measurements recognised 92.4% of PAD limbs. Using an ABI cut-off level of 1.0 and sequential TBI measurement increases the sensitivity of the device in detecting PAD. The precise interpretation of the obtained results requires some expertise.

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Proficiency of Medical Students at Obtaining Pressure Measurement Readings Using Automated Ankle and Toe Measuring Devices for Diagnosis of Lower Extremity Peripheral Artery Disease

Cited by 6 publications

References 30 publications

Simplification of ankle-brachial-index measurement using Doppler-waveform classification in symptomatic patients suspected of lower extremity artery disease

Simplification of ankle-brachial-index measurement using Doppler-waveform classification in symptomatic patients suspected of lower extremity artery disease

A survey of commonly misunderstood vascular medicine physical exam findings among medical trainees

Screening for Peripheral Artery Disease Using an Automated Four-Limb Blood Pressure Monitor Equipped with Toe–Brachial Index Measurement

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