Comparison of the Use of Arterial Doppler Waveform Classifications in Clinical Routine to Describe Lower Limb Flow

Guilcher, Antoine; Lanéelle, Damien; Hoffmann, Clément; Guillaumat, Jérôme; Constans, J.; Bressollette, L; Boissier, C.; Bura-Rivière, A.; Jaquinandi, Vincent; Omarjee, Loukman; Lacroix, Philippe; Pernod, Gilles; Abbadie, F.; Sevestre, M.-A.; Boulon, Carine

doi:10.3390/jcm10030464

Cited by 8 publications

(13 citation statements)

References 24 publications

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“…Classification systems are a very useful tool in improving the homogeneity of Doppler flow waveform characterization (38)(39)(40). The simplified Saint-Bonnet classification system was used in the present study as recommended by professors of the French College of Vascular Medicine (13,19) the SFMV/SCVE consensus (14), and a study has shown that it yields superior categorization rates by comparison with other classification systems (41).…”

Section: Discussionmentioning

confidence: 99%

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

Miossec

Tollenaere

Lanéelle

et al. 2021

Front. Cardiovasc. Med.

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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.

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Section: Discussionmentioning

confidence: 99%

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

Miossec

Tollenaere

Lanéelle

et al. 2021

Front. Cardiovasc. Med.

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“…This Saint-Bonnet classification is the classification taught in France for the past 2 years for the vascular residents but which is not part of the continuing education program for practicing physicians ( 8 ). It contains 13 categories that allow a better classification of the DW than other classification ( 11 , 15 ). In the present study, the reliability is considered as weak to moderate (κ = 0.546 [0.544–0.547], p < 0.005) in vascular caregivers unfamiliar with this Saint-Bonnet classification.…”

Section: Discussionmentioning

confidence: 99%

“…The simplified Saint-Bonnet classification was proposed in 2017, comprises eight types, and allows considering the continuous character of the flow (mentioned with the abbreviation CF) for 13 total categories. The various types are described as follows in the original publication ( 8 , 11 ):…”

Section: Methodsmentioning

confidence: 99%

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

Lanéelle

Guillaumat

Trihan

et al. 2021

Front. Cardiovasc. Med.

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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.

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“…There is extensive evidence supporting the relationship between Doppler waveform contours with the presence and extent of PAD. The contours of the Doppler waveform change with PAD progression, from normal, triphasic waveforms towards biphasic or monophasic ones in the case of high degree stenosis [ 16 ].…”

Section: Clinical Relevance Of Mac In Patients With Padmentioning

confidence: 99%

Inflammatory, Metabolic, and Coagulation Effects on Medial Arterial Calcification in Patients with Peripheral Arterial Disease

Nikolajević

Šabovič

2023

IJMS

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Calcium deposits in the vessel wall in the form of hydroxyapatite can accumulate in the intimal layer, as in atherosclerotic plaque, but also in the medial layer, as in medial arterial calcification (MAC) or medial Möenckeberg sclerosis. Once considered a passive, degenerative process, MAC has recently been shown to be an active process with a complex but tightly regulated pathophysiology. Atherosclerosis and MAC represent distinct clinical entities that correlate in different ways with conventional cardiovascular risk factors. As both entities coexist in the vast majority of patients, it is difficult to estimate the relative contribution of specific risk factors to their development. MAC is strongly associated with age, diabetes mellitus, and chronic kidney disease. Given the complexity of MAC pathophysiology, it is expected that a variety of different factors and signaling pathways may be involved in the development and progression of the disease. In this article, we focus on metabolic factors, primarily hyperphosphatemia and hyperglycemia, and a wide range of possible mechanisms by which they might contribute to the development and progression of MAC. In addition, we provide insight into possible mechanisms by which inflammatory and coagulation factors are involved in vascular calcification processes. A better understanding of the complexity of MAC and the mechanisms involved in its development is essential for the development of potential preventive and therapeutic strategies.

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Comparison of the Use of Arterial Doppler Waveform Classifications in Clinical Routine to Describe Lower Limb Flow

Cited by 8 publications

References 24 publications

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

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

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

Inflammatory, Metabolic, and Coagulation Effects on Medial Arterial Calcification in Patients with Peripheral Arterial Disease

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