Objective: Arterial Doppler waveform recordings are commonly used to assess lower extremity arter... more 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 trea...
Background: Arterial Doppler Ultrasound waveform (DW) analysis allows the detection and evaluatio... more 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 ...
Lower extremity peripheral artery disease (PAD) induces an ischemic pain in the lower limbs and l... more Lower extremity peripheral artery disease (PAD) induces an ischemic pain in the lower limbs and leads to walking impairment. Electrical stimulation has been used in patients with PAD, but no systematic review has been proposed to address the efficacy of the technique as a treatment for walking impairment in PAD. A systematic search was performed to identify trials focused on electrical stimulation for the treatment of walking impairment in patients with PAD in the Cochrane Central Register, PubMed, Embase, and the Web of Science. Studies were included where the primary outcomes were pain-free walking distance and/or maximal walking distance. When appropriate, eligible studies were independently assessed for quality using the Cochrane Collaboration’s tool for assessing risk of bias. Five studies eligible for inclusion were identified, of which only two were randomized controlled studies. Trial heterogeneity prevented the use of the GRADE system and the implementation of a meta-analys...
Scandinavian Journal of Medicine & Science in Sports
HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific re... more HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés. Time to redefine post-exercise pressure decrease and post-exercise ankle-brachial index to diagnose peripheral artery disease
Discordant knowledge about atherosclerosis disease among French general practitioners and residen... more Discordant knowledge about atherosclerosis disease among French general practitioners and residents We read with interest the paper entitled "Knowledge gap of peripheral artery disease starts in medical school" from AlHamzah and colleagues. 1 In their study of 72 graduating medical students, the authors found that students have a suboptimal knowledge of coronary artery disease (CAD) and lower extremity peripheral artery disease (PAD). In view of the small number of students, readers may doubt the generality of these results. However, we would like to underscore that we found similar results in two studies in France using a national survey with three clinical cases: one about CAD, one about ischemic stroke, and one about PAD. For each clinical case, we had a similar number of questions about diagnosis, definition, care network, supplementary investigations, treatment, low-density lipoprotein cholesterol threshold objectives, and risk for a patient's being polyvascular (ie, having several atherosclerotic locations). The primary end point was the number of physicians who correctly answered five questions for each clinical case. In a first study among 553 residents, 19.9% had a good knowledge about ischemic stroke, which was higher than the number of residents for CAD (0.9%) and PAD (0.4%). 2 In another study among 1724 French general practitioners, 48.2%, 3.0%, and 0.4% of general practitioners correctly answered the questions for ischemic stroke, CAD, and PAD cases, respectively. 3 AlHamzah and colleagues suggest that limited in-class time and difficulties in scheduling clinical opportunities could be an important explanation. 1 We totally agree with this assertion because we have already shown that a lack of practice under the supervision of a vascular physician is an explanation of the incompetency of the medical students to perform ankle-brachial index. 4,5 Therefore, development of a dedicated vascular surgery/medicine unit will help improve the residents' competencies.
Doppler waveforms analysis is a interesting to diagnose peripheral artery disease as suggested by... more Doppler waveforms analysis is a interesting to diagnose peripheral artery disease as suggested by the international recommendations. However as mentioned in the present letter, there is a lack of consensus about the terminology that should be used.
Peripheral artery disease of the lower limbs (PAD) is a common disease. Evaluation of PAD is prim... more Peripheral artery disease of the lower limbs (PAD) is a common disease. Evaluation of PAD is primarily based on non-invasive examinations with analysis of the arterial Doppler signal being a key element. However, the description of arterial Doppler waveforms morphologies varies considerably across medical schools and from country to country. In order to overcome this issue, the French College of Teachers for Vascular Medicine (Collège des Enseignants de Médecine Vasculaire; CEMV) has summarised the published data on Doppler waveforms analysis and proposes a new "Saint-Bonnet" classifi cation system to describe Doppler waveforms morphologies. The simplifi ed Saint-Bonnet classifi cation comprises eight types and allows taking into account if the Doppler signal does not revert to baseline. This classifi cation, which is based on previous classifi cations, could improve the descriptions of both physiological and pathological waveforms, recorded in lower limb arteries. According to the reviewed literature, recommendations about the use of Doppler waveforms are proposed. This statement is a preamble to reach an international consensus on the subject, which would standardize the description of arterial waveforms and improve the management of PAD patients.
Objective: Arterial Doppler waveform recordings are commonly used to assess lower extremity arter... more 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 trea...
Background: Arterial Doppler Ultrasound waveform (DW) analysis allows the detection and evaluatio... more 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 ...
Lower extremity peripheral artery disease (PAD) induces an ischemic pain in the lower limbs and l... more Lower extremity peripheral artery disease (PAD) induces an ischemic pain in the lower limbs and leads to walking impairment. Electrical stimulation has been used in patients with PAD, but no systematic review has been proposed to address the efficacy of the technique as a treatment for walking impairment in PAD. A systematic search was performed to identify trials focused on electrical stimulation for the treatment of walking impairment in patients with PAD in the Cochrane Central Register, PubMed, Embase, and the Web of Science. Studies were included where the primary outcomes were pain-free walking distance and/or maximal walking distance. When appropriate, eligible studies were independently assessed for quality using the Cochrane Collaboration’s tool for assessing risk of bias. Five studies eligible for inclusion were identified, of which only two were randomized controlled studies. Trial heterogeneity prevented the use of the GRADE system and the implementation of a meta-analys...
Scandinavian Journal of Medicine & Science in Sports
HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific re... more HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés. Time to redefine post-exercise pressure decrease and post-exercise ankle-brachial index to diagnose peripheral artery disease
Discordant knowledge about atherosclerosis disease among French general practitioners and residen... more Discordant knowledge about atherosclerosis disease among French general practitioners and residents We read with interest the paper entitled "Knowledge gap of peripheral artery disease starts in medical school" from AlHamzah and colleagues. 1 In their study of 72 graduating medical students, the authors found that students have a suboptimal knowledge of coronary artery disease (CAD) and lower extremity peripheral artery disease (PAD). In view of the small number of students, readers may doubt the generality of these results. However, we would like to underscore that we found similar results in two studies in France using a national survey with three clinical cases: one about CAD, one about ischemic stroke, and one about PAD. For each clinical case, we had a similar number of questions about diagnosis, definition, care network, supplementary investigations, treatment, low-density lipoprotein cholesterol threshold objectives, and risk for a patient's being polyvascular (ie, having several atherosclerotic locations). The primary end point was the number of physicians who correctly answered five questions for each clinical case. In a first study among 553 residents, 19.9% had a good knowledge about ischemic stroke, which was higher than the number of residents for CAD (0.9%) and PAD (0.4%). 2 In another study among 1724 French general practitioners, 48.2%, 3.0%, and 0.4% of general practitioners correctly answered the questions for ischemic stroke, CAD, and PAD cases, respectively. 3 AlHamzah and colleagues suggest that limited in-class time and difficulties in scheduling clinical opportunities could be an important explanation. 1 We totally agree with this assertion because we have already shown that a lack of practice under the supervision of a vascular physician is an explanation of the incompetency of the medical students to perform ankle-brachial index. 4,5 Therefore, development of a dedicated vascular surgery/medicine unit will help improve the residents' competencies.
Doppler waveforms analysis is a interesting to diagnose peripheral artery disease as suggested by... more Doppler waveforms analysis is a interesting to diagnose peripheral artery disease as suggested by the international recommendations. However as mentioned in the present letter, there is a lack of consensus about the terminology that should be used.
Peripheral artery disease of the lower limbs (PAD) is a common disease. Evaluation of PAD is prim... more Peripheral artery disease of the lower limbs (PAD) is a common disease. Evaluation of PAD is primarily based on non-invasive examinations with analysis of the arterial Doppler signal being a key element. However, the description of arterial Doppler waveforms morphologies varies considerably across medical schools and from country to country. In order to overcome this issue, the French College of Teachers for Vascular Medicine (Collège des Enseignants de Médecine Vasculaire; CEMV) has summarised the published data on Doppler waveforms analysis and proposes a new "Saint-Bonnet" classifi cation system to describe Doppler waveforms morphologies. The simplifi ed Saint-Bonnet classifi cation comprises eight types and allows taking into account if the Doppler signal does not revert to baseline. This classifi cation, which is based on previous classifi cations, could improve the descriptions of both physiological and pathological waveforms, recorded in lower limb arteries. According to the reviewed literature, recommendations about the use of Doppler waveforms are proposed. This statement is a preamble to reach an international consensus on the subject, which would standardize the description of arterial waveforms and improve the management of PAD patients.
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Papers by Guillaume Mahé