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In some clinical conditions (diabetes, renal insufficiency, advanced age), ABI can be falsely normal and other tests are required for the PAD diagnosis (American Heart Association statement). This study was conducted to determine the accuracy of exercise transcutaneous oxygen pressure measurement (exercise-TcPo2) in detection of arterial stenosis ≥50% using computed tomography angiography (CTA) as the gold standard. For stenosis ≥50%, sensitivity and specificity of distal minimal DROP were 73.2% [60.3-83.1], 83.3% [53.8-96.2], respectively. For stenosis ≥60%, sensitivity and specificity of proximal minimal DROP were 82.5% [67.6-91.5] and 85.7% [67.7-94.8] respectively. For stenosis ≥60%, sensitivity and specificity of distal minimal DROP were 80.4% [67.3-89.1] and 88.2% [64.2-97.7], respectively. Exercise-TcPo2 is safe and non-invasive test that might be used in second line for PAD diagnosis.
Abstract : Abstract: Peripheral artery disease (PAD) is a highly prevalent disease diagnosed by the use of ankle-brachial index (ABI) at rest. In some clinical conditions (diabetes, renal insufficiency, advanced age), ABI can be falsely normal and other tests are required for the PAD diagnosis (American Heart Association statement). This study was conducted to determine the accuracy of exercise transcutaneous oxygen pressure measurement (exercise-TcPo2) in detection of arterial stenosis ≥50% using computed tomography angiography (CTA) as the gold standard. We retrospectively analyzed consecutive patients referred to our vascular unit (University Hospital, Rennes, France) for exercise-TcPo2 testing from 2014 to 2015. All included patients had a CTA performed within 3 months of the exercise-TcPo2 test. Exercise-TcPo2 was performed on treadmill (10% slope; 2 mph speed). We calculated the Delta from Resting Oxygen Pressure (DROP) index (expressed in mm Hg) at the proximal and distal levels. Two blinded physicians performed stenosis quantification on CTA. The receiver operating characteristic (ROC) curve was used to define a cutoff point to detect arterial stenosis ≥50%, stenosis ≥60%, and stenosis ≥70%. A total of 34 patients (mean age 64 ± 2 years old; 74% men) were analyzed. The highest areas under the curve (AUC) were found for 60% stenosis at both proximal and distal levels. For stenosis ≥50%, sensitivity and specificity of proximal minimal DROP were 80.9% [67.1–89.7], 81.0% [59.3–92.7] respectively. For stenosis ≥50%, sensitivity and specificity of distal minimal DROP were 73.2% [60.3–83.1], 83.3% [53.8–96.2], respectively. For stenosis ≥60%, sensitivity and specificity of proximal minimal DROP were 82.5% [67.6–91.5] and 85.7% [67.7–94.8] respectively. For stenosis ≥60%, sensitivity and specificity of distal minimal DROP were 80.4% [67.3–89.1] and 88.2% [64.2–97.7], respectively. For stenosis ≥70%, sensitivity and specificity of proximal minimal DROP were 85.7% [67.7–94.8] and 75.0% [59.6–85.9] respectively. For stenosis ≥70%, sensitivity and specificity of distal minimal DROP were 86.0% [72.2–93.7] and 76.0% [56.1–88.7], respectively. Exercise-TcPo2 using a proximal minimal DROP value ≤−15 mm Hg or a distal minimal DROP value ≤−16 mm Hg is accurate to diagnose arterial stenosis especially stenosis ≥60% on the lower limbs. Exercise-TcPo2 is safe and noninvasive test that might be used in second line for PAD diagnosis.
Explains the mathematics involved in understanding and choosing an array of diagnostic and prognostic tests, in order to improve treatment.
Objective: Exercise transcutaneous oxygen pressure treadmill test (Exercise-TcPO2) can be used to diagnose Lower Extremity Artery Disease (LEAD) and allows the quantification of limb ischemia during exercise. The exercise-tcPO2's test-retest reliability in patients with LEAD and maximum walking distance
A comprehensive review the state-of-the-art in atherosclerosis of the arteries of the legs and feet. The authors discuss in detail the primary symptom-claudication-an intermittent pain in the leg or foot while walking, its predisposing factors, the current diagnostic methodologies, the impressive advances in the therapeutic armamentarium, and the need to screen for co-existing coronary artery disease. Additional chapters describe cutting-edge noninvasive angiography and vascular flow studies, specific drug therapy for claudication, regression of atherosclerosis therapy, gene therapy, and drug eluting stents for peripheral arterial disease. The authors also examine the epidemiology of LEAD, the effects of smoking and effective smoking cessation programs, its pathogenesis and its association with lipid abnormalities and hypertension, aggressive risk factor modification, and the need to measure the ankle brachial index of every patient over 45.
In this issue of Medical Clinics of North America, guest editors Drs. Geno Merli and Raghu Kolluri bring their considerable expertise to the topic of Vascular Medicine. Top experts in the field provide evidence-based recommendations on vascular issues and diseases for those in primary care, non-vascular medicine specialists, and nurse practitioners, including articles on atherosclerotic disease, peripheral artery disease, lower extremity vascular ulcers, vasculitis, vascular imaging for the primary care provider, and more. - Contains 12 practice-oriented topics including unprovoked venous thromboembolism: the search for a cause; approach to the patient with non-cardiac leg swelling; cold hands or feet: is it Raynaud's or not?; varicose veins: approaching assessment and management; and more. - Provides in-depth clinical reviews of vascular medicine, offering actionable insights for clinical practice. - Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.
The latest edition of this must-have text book promises an evidence-based and practical approach covering the very latest in cardiorespiratory care. The textbook covers a wide range of cardiorespiratory conditions and discusses treatment of patients in different clinical settings such as critical care, the ward area and out-patient departments. It begins with physiology and pathology and progresses into a detailed patient assessment section and a discussion of specific respiratory and cardiac conditions. The final section covers different groups of people who may require physiotherapy such as infants, children, and adults with specific conditions including a considered section on palliative care. Critical thinking is facilitated by clinical reasoning boxes in the text, and problem-solving is aided by case studies at the end of each chapter. There are also relevant practice tips to enable transfer of learning into the clinical environment. The text is supported by over 280 line drawings and diagrams along with over 70 x-rays and photographs to further illustrate the points under discussion. - Q & A case studies, with scans and x-rays - Outcome measures for problems and diseases - Boxes with learning and practice tips to encourage reflection - Tables with definitions, normal values and comparisons - Practical techniques described with precision - Expanded cardiovascular section - Updated practical details on physiotherapy techniques - Extra chapters on surgical complications and interventions - Comprehensive coverage of Critical Care procedures and rehabilitation - Practicalities of the management of children and infants Update on the evaluation of outcomes
This large format book is the definitive text on vascular surgery written by expert editors and contributors. It is well supported by exceptional illustrative material. The book is invaluable to all those who work in vascular laboratories as wel.l as internists, cardiologists, vascular laboratory directors and staff, general surgeons involved in vascular surgery and the vascular surgery community in general Noninvasive Vascular Diagnosis comprehensively covers all aspects of noninvasive evaluation of the circulatory system in the extremities. The increasing popularity of noninvasive techniques is not reflected in the number of comprehensive works on the topic and it is clear from the success of the first edition that the demand for an updated volume is increasing.