91 results on '"Hersant J"'
Search Results
2. Paralegals and the casualisation of legal labour markets
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Abel, RL, Hammerslev, O, Sommerlad, H, Ulrike, U, Hersant, J, Holvast, N, Verzelloni, L, Gustafsson, S, Sandefur, R, Clarke, T, Sommerlad H., Hersant J., Holvast N., Verzelloni L., Gustafsson S., Sandefur R., Clarke T., Abel, RL, Hammerslev, O, Sommerlad, H, Ulrike, U, Hersant, J, Holvast, N, Verzelloni, L, Gustafsson, S, Sandefur, R, Clarke, T, Sommerlad H., Hersant J., Holvast N., Verzelloni L., Gustafsson S., Sandefur R., and Clarke T.
- Published
- 2022
3. 10-year experience of surgical management of Paget-Schroetter syndrome
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Deveze, E., primary, Ammi, M., additional, Hersant, J., additional, Papon, X., additional, Henni, S., additional, Abraham, P., additional, and Picquet, J., additional
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- 2023
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4. Paralegals and the casualisation of legal labour markets
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Sommerlad H., Hersant J., Holvast N., Verzelloni L., Gustafsson S., Sandefur R., Clarke T., Abel, RL, Hammerslev, O, Sommerlad, H, Ulrike, U, Hersant, J, Holvast, N, Verzelloni, L, Gustafsson, S, Sandefur, R, and Clarke, T
- Subjects
paralegal ,SPS/09 - SOCIOLOGIA DEI PROCESSI ECONOMICI E DEL LAVORO ,legal profession ,casualisation ,legal labour market - Published
- 2022
5. Rôle du tabac et de ses composants dans la maladie de Buerger : revue systématique de la littérature
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Cordon, Pauline, primary, Gentil, A., additional, Fernandez-Legrand, M.S., additional, Hersant, J., additional, Mechenin, M., additional, Henni, S., additional, and Mzid, Maroua, additional
- Published
- 2022
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6. Bayesian estimation of degradation model defined by a Wiener process - Application on disc brake wear
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GUERIN, Fabrice, BARREAU, M., CLOUPET, S., HERSANT, J., and HAMBLI, R.
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- 2010
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7. Concordance inter- et intra-observateur de l’échographie de contraste dans l’artérite à cellules géantes
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Espitia, O., Robin, O., Hersant, J., Roncato, C., Gautier, G., Raimbeau, A., and Lapébie, F.X.
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- 2023
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8. Ankle and arm pressure recordings for the diagnosis of exercise-induced arterial endofibrosis
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Abraham, Pierre, primary, Zegar, G, additional, Hersant, J, additional, Rouvière, O, additional, Bruneau, A, additional, Ramondou, P, additional, and Feugier, P, additional
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- 2020
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9. Screening for peripheral artery disease in people with diabetes
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Hersant, J., primary, Bigou, Y., additional, Ammi, M., additional, Henni, S., additional, and Abraham, P., additional
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- 2019
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10. Near-infrared spectroscopy of the thigh fails to discriminate cyclists with arterial endofibrosis from normal asymptomatic athletes
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Abraham, P, primary, Julienne, T, additional, Ammi, M, additional, Hersant, J, additional, and Henni, S, additional
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- 2018
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11. # Constraints on the Formation Regions of Comets from their D:H Ratios
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Horner O. Mousis Et F. Hersant, J., Debray, Bernard, Institut Bisontin en Sciences Fondamentales (IBSF), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)
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[PHYS.ASTR.CO]Physics [physics]/Astrophysics [astro-ph]/Cosmology and Extra-Galactic Astrophysics [astro-ph.CO] ,[PHYS.ASTR.CO] Physics [physics]/Astrophysics [astro-ph]/Cosmology and Extra-Galactic Astrophysics [astro-ph.CO] - Published
- 2007
12. Reliability estimation from test data using two different approaches
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Hersant, J., primary, Cloupet, S., additional, Guerin, F., additional, and Chevalier, L., additional
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- 2012
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13. Ten-year Experience of Surgical Management of Paget-Schroetter Syndrome
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Deveze, E., Ammi, M., Hersant, J., Papon, X., Henni, S., Abraham, P., and Picquet, J.
- Abstract
Paget-Schroetter syndrome (PSS) or effort-induced thrombosis is an acute (<14 days) venous thrombosis of the axillosubclavian vein. Early catheter-directed thrombolysis (CDT) is required to improve patency rate and avoid postthrombotic syndrome. This study aimed to report the management of PSS in our center across 10 years and compare it to the established guidelines.
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- 2023
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14. Etude d'un phénomène de dégradation par usure : Phénomène physique, modélisation et analyse
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Hersant, J., Fabrice Guerin, Cloupet, S., Guenael GERMAIN, Sciencesconf.org, CCSD, Laboratoire en Sûreté de Fonctionnement, Qualité & Organisation (LASQUO), and ISTIA-Université d'Angers (UA)
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[SPI]Engineering Sciences [physics] ,[SPI] Engineering Sciences [physics] ,usure ,processus stochastiques ,tests statistiques ,dégradation ,processus de Wienner - Abstract
Cet article propose de détailler une méthode utilisant les processus stochastiques pour modéliser le phénomène d'usure de composants mécaniques et en particulier l'usure par enlèvement de matière dans les contacts roulants acier sur acier. Cette estimation est réalisée en considérant une dérive d'usure au cours du temps (mesure périodique ou continue du niveau de dégradation) à partir d'essais. La méthode, basée sur les processus stochastiques, utilise le processus de Wiener pour modéliser l'évolution de la dégradation au cours du temps. Pour identifier les paramètres du processus, une longue campagne d'essai a été lancée afin de caractériser finement les effets aléatoires. En effet, peu d'études ont été menées pour étudier et modéliser l'usure par une approche stochastique. A partir des résultats de la campagne d'essai menée, il sera possible d'analyser les effets aléatoires et proposer les modèles adaptés. Ainsi, nous proposons dans cet article une méthodologie d'analyse statistique des processus stochastiques afin de choisir les meilleurs modèles.
15. Parallel evaluation of Astra 8 and Astra 4 multichannel analyzers in two hospital laboratories.
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Truchaud, A, primary, Hersant, J, additional, Glikmanas, G, additional, Fievet, P, additional, and Dubois, O, additional
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- 1980
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16. Liquid-phase reactions started by rehydrating lyophilized reagents in a centrifugal analyzer.
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Truchaud, A, primary, Glikmanas, G, primary, Gourmelin, Y, primary, Hersant, J, primary, Trepo, D, primary, Foray, G, primary, and Collombel, C, primary
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- 1985
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17. Informations réactifs
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Wirquin, E., primary, Hersant, J., additional, and Leroy, M., additional
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- 1987
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18. Informations réactifs
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Wirquin, E., primary and Hersant, J., additional
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- 1988
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19. Response of ion-selective sodium and potassium electrodes in the Beckman Astra 4 and Astra 8 analyzers.
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Fievet, P, primary, Truchaud, A, additional, Hersant, J, additional, and Glikmanas, G, additional
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- 1980
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20. Informations réactifs: Marqueurs tumoraux
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Wirquin, E. and Hersant, J.
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- 1988
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21. Informations réactifs: Marqueurs tumoraux
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Wirquin, E., Hersant, J., and Leroy, M.
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- 1987
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22. DETECTION AND QUANTIFICATION OF MICROCIRCULATORY DYSFUNCTION IN SEVERE COVID-19 NOT REQUIRING MECHANICAL VENTILATION: A THREE-ARM COHORT STUDY.
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Abrard S, Coquet T, Riou J, Rineau E, Hersant J, Vincent A, Cordoval J, Jacquet-Lagrèze M, Allaouchiche B, Lukaszewicz AC, and Henni S
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- Aged, Female, Humans, Male, Middle Aged, Cohort Studies, Prospective Studies, Respiration, Artificial, Severity of Illness Index, COVID-19 physiopathology, COVID-19 complications, Microcirculation physiology
- Abstract
Abstract: Aim: To identify and describe microcirculatory dysfunction (MD) in severe COVID-19 cases. Methods: This prospective, cohort study evaluated microvascular function in COVID-19 patients with acute respiratory failure not requiring mechanical ventilation and compared it with that of non-COVID-19 intensive care unit (ICU)-matched controls. A validation cohort included healthy, comorbidity-free patients. The primary outcome compared tissue oxygen resaturation slope (rStO 2 ) in COVID-19 patients and non-COVID ICU controls. rStO 2 was measured post a 3-min vaso-occlusive test during post-occlusive reactive hyperemia (PORH). Additionally, microvascular reactivity was assessed using perfusion index (PI) during PORH and laser speckle contrast imaging post iontophoresis with acetylcholine (ACH), sodium nitroprusside (SNP), and sublingual microcirculation. Results: Overall, 75 patients (25 per cohort) were included. COVID-19 patients exhibited greater severity than ICU controls, as indicated by their SOFA scores (4.0 [3.0; 4.0] vs. 1.0 [0; 1.0], P < 0.001) and PaO 2 /FiO 2 ratios (113 [82; 150] vs. 443 [348; 533], P < 0.001). No significant difference was observed in rStO 2 between the groups. COVID-19 patients showed longer time in reaching peak PI ( P = 0.025), reduced vasodilation with ACH and SNP ( P = 0.010 and P = 0.018, respectively), and increased microvascular density ( P = 0.019) compared to non-COVID-19 ICU controls. Conclusion: We observed evidence of MD in COVID-19 patients through various microcirculatory parameters. This study's reproducible multimodal approach facilitates acute MD detection across multiple clinical applications. Limitations included the observational design, limited statistical power, single-time microvascular measurements, varying illness severity among groups, and possible influences of treatments and vaccinations on MD. Trial registration : Clinical-Trials.gov (NCT04773899)., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by the Shock Society.)
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- 2024
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23. Estimation of the prevalence of isolated inter-scalene compression from simultaneous arterial and venous photoplethysmography in patients referred for suspected thoracic outlet syndrome.
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Lecoq S, Hersant J, and Abraham P
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- Humans, Female, Male, Adult, Middle Aged, Prevalence, Photoplethysmography, Thoracic Outlet Syndrome physiopathology, Veins physiopathology, Arteries physiopathology
- Abstract
Objective. In patients with suspected thoracic outlet syndrome (TOS), diagnosing inter-scalene compression could lead to minimally invasive treatments. During photo-plethysmography, completing a 30 s 90° abduction, external rotation ('surrender' position) by addition of a 15 s 90° antepulsion 'prayer' position, allows quantitative bilateral analysis of both arterial (A-PPG) and venous (V-PPG) results. We aimed at determining the proportion of isolated arterial compression with photo-plethysmography in TOS-suspected patients. Approach. We studied 116 subjects recruited over 4 months (43.3 ± 11.8 years old, 69% females). Fingertip A-PPG and forearm V-PPG were recorded on both sides at 125 Hz and 4 Hz respectively. A-PPG was converted to PPG amplitude and expressed as percentage of resting amplitude (% rest). V-PPG was expressed as percentage of the maximal value (% max) observed during the 'Surrender-Prayer' maneuver. Impairment of arterial inflow during the surrender (As+) or prayer (Ap+) phases were defined as a pulse-amplitude either <5% rest, or <25% rest. Incomplete venous emptying during the surrender (Vs+) or prayer (Vp+) phases were defined as V-PPG values either <70% max, or <87% max. Main results. Of the 16 possible associations of encodings, As - Vs - Ap - Vp- was the most frequent observation assumed to be a normal response. Isolated arterial inflow without venous outflow (As + Vs-) impairment in the surrender position was observed in 10.3% (95%CI: 6.7%-15.0%) to 15.1% (95%CI: 10.7%-20.4%) of limbs. Significance. Simultaneous A-PPG and V-PPG can discriminate arterial from venous compression and then potentially inter-scalene from other levels of compressions. As such, it opens new perspectives in evaluation and treatment of TOS., (© 2024 Institute of Physics and Engineering in Medicine.)
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- 2024
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24. Maximum acceleration and acceleration time as markers to assess severity of peripheral artery disease.
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Trihan JE, Hersant J, Lecoq S, Henni S, Fontaine C, Prigent R, Mahé G, and Lanéelle D
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- Humans, Time Factors, Predictive Value of Tests, Acceleration, Blood Flow Velocity, Peripheral Arterial Disease physiopathology, Peripheral Arterial Disease diagnosis, Severity of Illness Index
- Abstract
Competing Interests: Disclosures None.
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- 2024
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25. Accuracy of maximal acceleration time of pedal arteries to diagnose critical limb-threatening ischemia.
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Trihan JE, Croquette M, Hersant J, Prigent R, Fontaine C, Henni S, and Lanéelle D
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- Humans, Retrospective Studies, Arteries, Chronic Limb-Threatening Ischemia, Predictive Value of Tests, Acceleration, Ankle Brachial Index, Peripheral Arterial Disease diagnostic imaging
- Abstract
Introduction: Maximal acceleration time of distal arteries of the foot (AT
max ) is correlated to ankle-brachial index (ABI) and toe-brachial index (TBI), and seems very promising in diagnosing severe peripheral artery disease (PAD) and especially critical limb-threatening ischemia (CLTI). Our goal was to confirm the cut-off value of 215 ms to predict a toe pressure (TP) ⩽ 30 mmHg., Methods: A 4-month retrospective study was conducted on patients addressed for suspicion of PAD. Demographic data, ABI, TBI, and Doppler ultrasound scanning parameters of the dorsal pedis and lateral plantar arteries (DPA and LPA) were recorded., Results: A total of 137 patients with 258 lower limbs were included. ATmax was highly correlated to TBI ( r = -0.89, p < 0.001). With the cut-off value of 215 ms, ATmax was effective to diagnose TP ⩽ 30 mmHg with a sensitivity of 93% [95% CI 77-99], a specificity of 96% [95% CI 92-98], a positive predictive value of 73% [95% CI 56-86], a negative predictive value of 99% [95% CI 97-100], and an area under the receiver operating characteristics curve of 0.99 [95% CI 0.98-1.00]. ATmax also showed promising results to rule out PAD in healthy patients., Conclusion: ATmax is a reliable diagnostic tool to diagnose low TP and could be a new easily performed hemodynamic criterion for diagnosis of CLTI., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.- Published
- 2024
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26. Caliper, contrast enhanced-ultrasound or laser speckle contrast imaging: Techniques to follow mice melanoma growth.
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Mellinger A, Hersant J, Bourreau C, Lecoq S, Deveze E, Clere N, and Henni S
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- Mice, Animals, Blood Flow Velocity, Mice, Inbred C57BL, Ultrasonography, Lasers, Laser-Doppler Flowmetry, Microcirculation, Regional Blood Flow, Melanoma diagnostic imaging
- Abstract
Due to morphological characteristics, metastatic melanoma is a cancer for which vascularization is not a diagnostic criterion. Laser speckle contrast imaging (LSCI) and contrast enhanced ultrasound (CEUS) are two imaging techniques that will be explored in this study, which aims to confirm these two techniques for monitoring tumor vascularization. B16F10 cells were xenografted to C57BL/6 mice treated with anti-PD1 or 0.9% NaCl. Tumor volume was measured daily while CEUS and LSCI were performed weekly. LSCI and CEUS analyses showed a decrease in tumor perfusion in both groups of mice. Although both CEUS and LSCI are useful for measuring tumor volume, LSCI appears to be more robust and effective for monitoring tumor microcirculation. Non-invasive investigations are needed to better predict tumor vascularization: CEUS and LSCI have a good applicability in a mice model., (© 2024 The Authors. Journal of Biophotonics published by Wiley‐VCH GmbH.)
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- 2024
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27. Preoperative endothelial dysfunction for the prediction of acute kidney injury after cardiac surgery using cardiopulmonary bypass: a pilot study based on a second analysis of the MONS study.
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Abrard S, Streichenberger A, Riou J, Hersant J, Rineau E, Jacquet-Lagrèze M, Fouquet O, Henni S, and Rimmelé T
- Abstract
Background: Up to 42% of patients develop acute kidney injury (AKI) after cardiac surgery. The aim of this study was to describe the relationship between preoperative microcirculatory function and postoperative AKI after cardiac surgery using cardiopulmonary bypass (CPB)., Methods: The prospective observational cohort MONS enrolled 60 patients scheduled for valvular (n = 30, 50%) or coronary (n = 30, 50%) surgery using CPB. Preoperative microcirculation was assessed during preoperative consultation from January 2019 to April 2019 at the University Hospital of Angers, France, using endothelium-dependent and endothelium-independent reactivity tests on the forearm (iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP), respectively). Skin blood flow was measured by laser speckle contrast imaging. The primary endpoint was the occurrence of AKI according to the KDIGO classification during the hospital stay., Results: Forty-three (71.7%) patients developed AKI during the in-hospital follow-up, and 15 (25%) were classified as KDIGO stage 1, 20 (33%) KDIGO stage 2, and 8 (13%) KDIGO stage 3. Regarding preoperative microcirculation, a higher peak amplitude of vasodilation in response to iontophoresis of ACh was found in patients with postoperative occurrence of AKI (35 [20-49] vs 23 [9-44] LSPU, p = 0.04). Iontophoresis of SNP was not significantly different according to AKI occurrence (34 [22-49] vs 36 [20-50] LSPU, p = 0.95). In a multivariable model, the preoperative peak amplitude at iontophoresis of ACh was independently associated with postoperative AKI (OR 1.045 [1.001-1.092], p = 0.045)., Conclusions: The preoperative peak amplitude of endothelium-dependent vasodilation is independently associated with the postoperative occurrence of AKI., Trial Registration: Clinical-Trials.gov, NCT03631797. Registered 15 August 2018, https://clinicaltrials.gov/ct2/show/NCT03631797., (© 2024. The Author(s).)
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- 2024
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28. Role of Lifestyle in Thoracic Outlet Syndrome: A Narrative Review.
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Abraham P, Lecoq S, Mechenin M, Deveze E, Hersant J, and Henni S
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Introduction: The presence of a positional compression of the neurovascular bundle in the outlet between the thorax and the upper limb during arm movements (mainly abduction) is common but remains asymptomatic in most adults. Nevertheless, a certain number of subjects with thoracic outlet positional compression will develop incapacitating symptoms or clinical complications as a result of this condition. Symptomatic forms of positional neurovascular bundle compression are referred to as "thoracic outlet syndrome" (TOS)., Materials and Methods: This paper aims to review the literature and discuss the interactions between aspects of patients' lifestyles in TOS. The manuscript will be organized to report (1) the historical importance of lifestyle evolution on TOS; (2) the evaluation of lifestyle in the clinical routine of TOS-suspected patients, with a description of both the methods for lifestyle evaluation in the clinical routine and the role of lifestyle in the occurrence and characteristics of TOS; and (3) the influence of lifestyle on the treatment options of TOS, with a description of both the treatment of TOS through lifestyle changes and the influence of lifestyle on the invasive treatment options of TOS., Results: We report that in patients with TOS, lifestyle (1) is closely related to anatomical changes with human evolution; (2) is poorly evaluated by questionnaires and is one of the factors that may induce symptoms; (3) influences the sex ratio in symptomatic athletes and likely explains why so many people with positional compression remain asymptomatic; and (4) can sometimes be modified to improve symptoms and potentially alter the range of interventional treatment options available., Conclusions: Detailed descriptions of the lifestyles of patients with suspected TOS should be carefully analysed and reported.
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- 2024
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29. Exercise Oximetry Correlates Better With Exercise-Induced Lactate Increase, than Ankle Brachial Index or Walking Time, in Vascular Claudicants.
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Semporé WY, Hersant J, Ramondou P, Hamel JF, Abraham P, and Henni S
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- Humans, Prospective Studies, Walking, Intermittent Claudication diagnosis, Exercise Test adverse effects, Ischemia diagnosis, Blood Gas Monitoring, Transcutaneous, Ankle Brachial Index, Lactic Acid
- Abstract
In claudication, the correlation between walking-induced biomarkers and indices of clinical severity (e.g., walking distance or ankle brachial index (ABI)), is fair. We hypothesized that a correlation would be observed between the clinical estimation of ischemia severity with exercise transcutaneous oximetry (Ex-TcpO2) and lactate increase. A prospective study was performed among 377 patients with arterial claudication. We recorded age, sex, ABI, body mass index (BMI), systolic arterial blood pressure (SBP), and glycemia. Capillary blood lactate was measured at rest and 3 min after a constant load treadmill test. We recorded maximum walking time (MWT), heart rate (HRmax), the sum of minimal decrease from oxygen values for buttocks, thighs and calves Ex-TcpO2 (DROPmin), as well as the amplitude of chest-TcpO2 decrease. A multilinear regression model was used to assess the variables associated with lactate increase. BMI, SBP, HRmax, the amplitude of decrease in chest-TcpO2 and DROPmin, but not age, sex, ABI, MWT, diabetes mellitus nor glycemia, were significantly associated to lactate increase in the model. Because it accounts for the severity and diffusion of lower-limb exercise-induced ischemia and detects exercise induced hypoxemia, TcpO2 may be preferable to ABI or MWT to estimate the metabolic consequences of walking in claudicants.
- Published
- 2023
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30. Multiple concomitant arterial aneurysms in Behçet's disease.
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Hersant J, Maurel B, and Espitia O
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- Male, Humans, Adult, Aorta, Abdominal surgery, Behcet Syndrome complications, Behcet Syndrome diagnosis, Behcet Syndrome drug therapy, Aortic Aneurysm, Abdominal diagnostic imaging, Aortic Aneurysm, Abdominal etiology, Aortic Aneurysm, Abdominal surgery, Blood Vessel Prosthesis Implantation methods, Iliac Aneurysm diagnostic imaging, Iliac Aneurysm etiology, Iliac Aneurysm surgery
- Abstract
Background: Behçet's disease (BD) is a rare form of systemic vasculitis that affects small to large vessels. It is characterized by mucocutaneous, pulmonary, cardiovascular, gastrointestinal, and neurological manifestations. Large vessel involvement may occur in a third of cases. Veins are usually more affected than arteries. Furthermore aneurysms are the most frequent arterial complication., Case Presentation: A 41-year-old man presented with multiple arterial aneurysms. He had previous medical history of a right popliteal aneurysm treated with a reversed femoro-popliteal venous bypass, long-term steroids and immunosuppressive treatment. On admission, diagnostic computed tomography angiography revealed multiple aneurysms, including an 87 mm aneurysm of the femoro-popliteal bypass and an abdominal aortic and left common iliac artery aneurysm. He received an intensification of medical treatment with methylprednisolone and infliximab intravenous infusion. Aorto iliac artery aneurysms were treated by infrarenal bifurcated stent graft implantation. The aneurysm of the venous femoro-popliteal bypass was treated by explantation and prosthetic repair. One month later, he presented with acute right limb ischemia related to occlusion of the right limb of the stent graft despite anticoagulation which was treated by mechanical thrombectomy., Conclusions: Vascular BD can worsen the vascular outcome after surgery. Except in an urgent context, BD must be controlled before surgery. This case report illustrates the importance of combined medical and surgical management, with first BD activity control with corticosteroids and immunosuppressive treatment, then surgical or endovascular treatment.
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- 2023
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31. Predictive Factors of Stent Patency in Iliofemoral Venous Diseases in a Multicentre Cohort Study.
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Espitia O, Douane F, Hersant J, Abbadie F, Sobocinski J, Heautot JF, Miossec A, Lapébie FX, and Hartung O
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- Humans, Platelet Aggregation Inhibitors therapeutic use, Treatment Outcome, Stents, Anticoagulants therapeutic use, Iliac Vein diagnostic imaging, Cohort Studies, Vascular Patency, Retrospective Studies, Postthrombotic Syndrome diagnostic imaging, Postthrombotic Syndrome etiology, Postthrombotic Syndrome surgery, Venous Thrombosis diagnostic imaging, Venous Thrombosis therapy
- Abstract
Objective: This study assessed primary stent patency predictive factors in three groups of patients with history of lower limb (LL) vein thrombosis: non-thrombotic iliac vein lesion (NIVL), acute deep vein thrombosis (aDVT), and post-thrombotic syndrome (PTS)., Methods: Consecutive patients from January 2014 to December 2020 with history of LL vein stenting from seven hospitals were included. All patients received an iliac or common femoral venous stent and had at least a six month follow up available with stent imaging. Anticoagulant and antiplatelet therapy strategies employed after venous stenting are reported and compared between groups., Results: This study included 377 patients: 134 NIVL, 55 aDVT, and 188 PTS. Primary patency was statistically significantly higher in the NIVL group (99.3%) compared with the PTS group (68.6%) (p < .001) and the aDVT group (83.6%) (p = .002). PTS patients received a statistically significantly greater number of stents (p < .001) and had more stents below the inguinal ligament (p < .001). Median follow up was 28.8 months (IQR 16, 47). Discontinuation of antiplatelet therapy at the last assessment was 83.6% for NIVL, 100% for aDVT, and 95.7% for the PTS group (p < .001). Discontinuation of anticoagulation therapy at the last assessment was 93.2% for NIVL, 25.0% for aDVT, and 70.3% for the PTS group (p < .001). The only predictor of worse primary patency in the aDVT group was long term anticoagulation before stenting., Conclusion: Patients with NIVL have better primary patency after venous stenting than patients with venous thrombotic disorders. Long term anticoagulation before stenting was the only factor associated with poorer primary patency in patients with aDVT., (Copyright © 2023 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)
- Published
- 2023
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32. Popliteal Entrapment Syndrome: Diagnostic, Surgical Management, and Short-Term Results of a Ten-Year Experience.
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Deveze E, Bruneau A, Hersant J, Ammi M, Abraham P, and Picquet J
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- Adolescent, Adult, Female, Humans, Male, Young Adult, Popliteal Artery diagnostic imaging, Popliteal Artery surgery, Popliteal Artery pathology, Retrospective Studies, Treatment Outcome, Arterial Occlusive Diseases diagnostic imaging, Arterial Occlusive Diseases surgery, Popliteal Artery Entrapment Syndrome
- Abstract
Background: Popliteal artery entrapment syndrome (PAES) is a rare cause of lower limb claudication in young sportsperson without cardiovascular risk factor. We reported our diagnostic approach, surgical management, and short-term outcomes of this syndrome, over a 10-year period., Methods: Sportsperson with intermittent claudication systematically received color duplex ultrasonography with dynamic maneuvers in the sport medicine department. In case of PAES suspicion, diagnosis was confirmed by dynamic computed tomography or dynamic magnetic resonance angiography. Each patient was then evaluated by a vascular surgeon and surgery was performed. We retrospectively screened patients who underwent PAES surgery between 2010 and 2020 in the Department of Surgery in Angers University Hospital., Results: Between January 2010 and December 2020, 38 patients with 67 symptomatic legs underwent surgery for PAES. Twenty three (60.5%) were men. The mean age at the time of surgery was 24.7 +/- 9 years. Clinical presentation was bilateral in 30 patients (81.1%). Duplex ultrasound demonstrated severe stenosis or occlusion in 45 legs (77%). When performed, CT-scan demonstrated popliteal artery compression in all cases (100%). As per Whelan and Rich classification, 36 patients (94.7%) had type 6 PAES. There was no mortality or severe complication after surgery. Morbidity included 4 postoperative hematoma (6%) and 8 prolonged healing (13%). The mean time of follow-up was 2.3 months +/- 1.2 months. After surgery, D-scan showed no signs of remaining popliteal artery compression in 92.5% of the case. Twelve patients (33.3%) were able to resume sport, 18 (50%) partially, and 6 (16.6%) did not resume sport yet., Conclusions: We report a cohort of 38 patients who underwent surgery for PAES. Among them, 36 (94.7%) were functional PAES. Morbidity included 13% of prolonged healing. Two months follow-up demonstrated good results at dynamic D-scan without signs of remaining popliteal artery compression in 92.5% of the cases. These short-term results showed that one-third of patients were able to resume sport activity at an initial level., (Copyright © 2022 Elsevier Inc. All rights reserved.)
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- 2023
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33. Inter and intra-observer agreement of arterial wall contrast-enhanced ultrasonography in giant cell arteritis.
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Espitia O, Robin O, Hersant J, Roncato C, Théry A, Vibet MA, Gautier G, Raimbeau A, and Lapébie FX
- Abstract
Objective: The aim of this study was to analyze inter- and intra-observer agreement for contrast-enhanced ultrasonography (CEUS) for monitoring disease activity in Giant Cell Arteritis (GCA) in the wall of axillary arteries, and common carotid arteries., Methods: Giant cell arteritis patients have CEUS of axillary arteries and common carotid. These images were rated by seven vascular medicine physicians from four hospitals who were experienced in duplex ultrasonography of GCA patients. Two weeks later, observers again rated the same images. GCA patients were recruited in from December 2019 to February 2021. An analysis of the contrast of the ultrasound images with a gradation in three classes (grade 0, 1, and 2) was performed. Grade 0 corresponds to no contrast, grade 1 to moderate wall contrast and grade 2 to intense contrast. A new analysis in 2 classes: positive or negative wall contrast; was then performed on new series of images., Results: Sixty arterial segments were evaluated in 30 patients. For the three-class scale, intra-rater agreement was substantial: κ 0.70; inter-rater agreement was fair: κ from 0.22 to 0.27. Thirty-four videos had a wall thickness of less than 2 mm and 26 videos had a wall thickness greater than 2 mm. For walls with a thickness lower than 2 mm: intra-rater agreement was substantial: κ 0.69; inter-rater agreement was fair: κ 0.35. For walls with a thickness of 2 mm or more: intra-rater agreement was substantial: κ 0.53; inter-rater agreement was fair: κ 0.25. For analysis of parietal contrast uptake in two classes: inter-rater agreement was fair to moderate: κ from 0.35 to 0.41; and for walls with a thickness of 2 mm or more: inter-rater agreement was fair to substantial κ from 0.22 to 0.63., Conclusion: The visual analysis of contrast uptake in the wall of the axillary and common carotid arteries showed good intra-rater agreement in GCA patients. The inter-rater agreement was low, especially when contrast was analyzed in three classes. The inter-rater agreement for the analysis in two classes was also low. The inter-rater agreement was higher in two-class analysis for walls of 2 mm thickness or more., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Espitia, Robin, Hersant, Roncato, Théry, Vibet, Gautier, Raimbeau and Lapébie.)
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- 2022
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34. Upper arm versus forearm transcutaneous oximetry during upper limb abduction in patients with suspected thoracic outlet syndrome.
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Hersant J, Lecoq S, Ramondou P, Feuilloy M, Abraham P, and Henni S
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Context: Thoracic outlet syndrome (TOS) is common among athletes and should be considered as being of arterial origin only if patients have "clinical symptoms due to documented symptomatic ischemia." We previously reported that upper limb ischemia can be documented with DROPm (minimal value of limb changes minus chest changes) from transcutaneous oximetry (TcpO2) in TOS. Purpose: We aimed to test the hypothesised that forearm (F-) DROPm would better detect symptoms associated with arterial compression during abduction than upper arm (U-) DROPm, and that the thresholds would differ. Methods: We studied 175 patients (retrospective analysis of a cross-sectional acquired database) with simultaneous F-TcpO2 and U-TcpO2 recordings on both upper limbs, and considered tests to be positive (CS+) when upper limb symptoms were associated with ipsilateral arterial compression on either ultrasound or angiography. We determined the threshold and diagnostic performance with a receiver operating characteristic (ROC) curve analysis and calculation of the area under the ROC curve (AUROC) for absolute resting TcpO2 and DROPm values to detect CS+. For all tests, a two-tailed p < 0.05 was considered indicative of statistical significance. Results: In the 350 upper-limbs, while resting U-TcpO2 and resting F-TcpO2 were not predictive of CS + results, the AUROCs were 0.68 ± 0.03 vs. 0.69 ± 0.03 (both p < 0.01), with the thresholds being -7.5 vs. -14.5 mmHg for the detection of CS + results for U-DROPm vs. F-DROPm respectively. Conclusion: In patients with suspected TOS, TcpO2 can be used for detecting upper limb arterial compression and/or symptoms during arm abduction, provided that different thresholds are used for U-DROPm and F-DROPm. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT04376177., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Hersant, Lecoq, Ramondou, Feuilloy, Abraham and Henni.)
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- 2022
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35. Quantitative analysis of venous outflow with photo-plethysmography in patients with suspected thoracic outlet syndrome.
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Hersant J, Ramondou P, Josse C, Lecoq S, Henni S, and Abraham P
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Background: Venous compression is the second most frequent form of thoracic outlet syndrome (TOS). Although venous photo-plethysmography (PPG) has been largely used to estimate the consequences of chronic thromboses (Paget Schroetter syndrome), systematic direct quantitative recording of hemodynamic consequences of positional venous outflow impairment in patients with suspected TOS has never been reported., Objective: We hypothesized that moving the arms forward (prayer: "Pra" position) while keeping the hands elevated after a surrender/candlestick position (Ca) would allow quantification of 100% upper limb venous emptying (PPGmax) and quantitative evaluation of the emptying observed at the end of the preceding abduction period (End-Ca-PPG), expressed in %PPGmax., Materials and Methods: We measured V-PPG in 424 patients referred for suspected TOS (age 40.9 years old, 68.3% females) and retrieved the results of ultrasound investigation at the venous level. We used receiver operating characteristics curves (ROC) to determine the optimal V-PPG values to be used to predict the presence of a venous compression on ultrasound imaging. Results are reported as a median (25/75 centiles). Statistical significance was based on a two-tailed p < 0.05., Results: An End-Ca-PPG value of 87% PPGmax at the end of the "Ca" period is the optimal point to detect an ultrasound-confirmed positional venous compression (area under ROC: 0.589 ± 0.024; p < 0.001). This threshold results in 60.9% sensitivity, 47.6% specificity, 27.3% positive predictive value, 79.0% negative predictive value, and 50.8% overall accuracy., Conclusion: V-PPG is not aimed at detecting the presence of a venous compression due to collateral veins potentially normalizing outflow despite subclavicular vein compression during abduction, but we believe that it could be used to strengthen the responsibility of venous compression in upper limb symptoms in TOS-suspected patients, with the possibility of non-invasive, bilateral, recordable measurements of forearm volume that become quantitative with the Ca-Pra maneuver., Clinical Trial Registration: [ClinicalTrials.gov], identifier [NCT04376177]., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Hersant, Ramondou, Josse, Lecoq, Henni and Abraham.)
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- 2022
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36. Lower Extremity Arterial Disease and Lumbar Spinal Stenosis: A Study of Exercise-Induced Arterial Ischemia in 5197 Patients Complaining of Claudication.
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Lecoq S, Hersant J, Feuilloy M, Parent HF, Henni S, and Abraham P
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Only few studies have analyzed the associations of lower extremity artery disease (LEAD) with lumbar spinal stenosis (LSS), although it is expected to be a frequent association. With exercise-oximetry, we determined the presence of exercise-induced regional blood flow impairment (ischemia) in 5197 different patients complaining of claudication and referred for treadmill testing. We recorded height, weight, age, sex, ongoing treatments, cardiovascular risk factor (diabetes, high blood pressure, current smoking habit), and history of suspected or treated LSS and/or lower limb revascularization. An ankle-brachial index at rest < 0.90 or >1.40 on at least one side was considered indicative of the presence of LEAD (ABI+). Ischemia was defined as a minimal DROP (Limb-changes minus chest-changes from rest) value < −15 mmHg during exercise oximetry. We analyzed the clinical factors associated to the presence of exercise-induced ischemia in patients without a history of LSS, using step-by-step linear regression, and defined a score from these factors. This score was then tested in patients with a history of LSS. In 4690 patients without a history of (suspected, diagnosed, or treated) LSS, we observed that ABI+, male sex, antiplatelet treatment, BMI< 26.5 kg//m2, age ≤ 64 years old, and a history of lower limb arterial revascularization, were associated to the presence of ischemia. The value of the score derived from these factors was associated with the probability of exercise-induced ischemia in the 507 patients with a history of LSS. This score may help to suspect the presence of ischemia as a factor of walking impairment in patients with a history of lumbar spinal stenosis.
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- 2022
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37. Evaluation of Quality of Life after Surgical Treatment of Thoracic Outlet Syndrome.
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Ammi M, Hersant J, Henni S, Daligault M, Papon X, Abraham P, and Picquet J
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- Disability Evaluation, Female, Humans, Male, Surveys and Questionnaires, Treatment Outcome, Quality of Life, Thoracic Outlet Syndrome diagnostic imaging, Thoracic Outlet Syndrome surgery
- Abstract
Background: To evaluate the quality of life of surgically treated patients for TOS., Methods: A prospective observational study, including patients treated surgically for TOS in 2018. Two standardized questionnaires: Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and the Short-Form 12 (SF-12) were used. The SF-12 consists of a physical and mental component (PCS-SF-12 and MCS-SF-12). The questionnaires were completed during the preoperative and postoperative consultations and at 3, 6, and 12 months., Results: We performed 53 interventions. The population was mostly female (n = 35, 66.0%) of 40.1 ± 10.0 years. The preoperative DASH score was 46.3 ± 19.7. It was 40.9 ± 21.7 at 6 weeks, 33.5 ± 22.7 at 3 months, 28.9 ± 22.6 at 6 months, and 21.1 ± 20 at 9 to 12 months. The improvement of DASH becomes statistically significant at 3 months (P = 0.036), 6 months (P = 0.002), and 12 months (P = 0.001). The preoperative MCS-SF-12 was 36.6 ± 9.4. It was 41.6 ± 10.9 at 6 weeks, 43.8 ± 11.1 at 3 months, 46.2 ± 11.8 at 6 months, and 51.4 ± 8 at 8 to 12 months. The improvement of MCS-SF-12 became significant at 3 months (P = 0.009), 6 months (P = 0.001), and 12 months (P = 0.001). The preoperative PCS-SF-12 was 35.5 ± 6.4. It was 37.1 ± 8.7 at 6 weeks, 39.9 ± 8.7 at 3 months, 41.6 ± 8.4 at 6 months, and 46.1 ± 8.1 to 12 months. The improvement of PCS-SF-12 became significant at 6 months (P = 0.005) and 12 months (P = 0.001)., Conclusions: The surgical management of TOS allows for an improvement in quality of life in the short and medium terms., (Copyright © 2022 Elsevier Inc. All rights reserved.)
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- 2022
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38. Case-Control Study on Exercise-Induced Vasculitis in Hikers.
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Quéneau A, Pistorius MA, Connault J, Raimbeau A, Gautier G, Bergère G, Artifoni M, Durant C, Bénichou A, Hersant J, and Espitia O
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- Case-Control Studies, Chronic Disease, Female, Humans, Male, Vasculitis diagnosis, Vasculitis epidemiology, Venous Insufficiency diagnosis, Venous Insufficiency epidemiology
- Abstract
The aim of this study was to identify clinical factors associated with exercise-induced vasculitis (EIV). This study included EIV cases and controls matched for age. Cases included were all members of a hiking club and participated in extended hiking trips. Exercise-induced vasculitis was diagnosed based on clinical signs occurring only after prolonged walks. Chronic venous disease was defined using the Clinical Etiological Anatomical Pathophysiologic classification. This study included 162 hikers: 32 EIV cases and 130 matched controls. Mean age at EIV diagnosis was 47.1 years and 24 (75.0%) of EIV cases were women. Chronic venous disease was present in 19 (57.6%) of EIV cases vs 39 (30.0%) in controls ( P = .001); those with EIV had significantly more saphenous vein insufficiency and C3 venous insufficiency than controls, 85.0 vs 52.6% and 8 (25.0%) vs 13 (10.0%) ( P = .02), respectively. For EIV cases, mean walking distance per hike was significantly higher than for controls ( P = .002). Exercise-induced vasculitis symptoms were typical with rash and/or purpura on the leg in warm conditions. Lesions spontaneously disappear in <10 days. In this study, EIV cases had more chronic venous disease and longer mean walking distances than controls.
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- 2022
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39. Relationship Between the Severity of Exercise Induced Ischaemia and the Prevalence of Exercise Induced Calf Symptoms During Treadmill Testing With Transcutaneous Oximetry.
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Hersant J, Ramondou P, Picquet J, Feuilloy M, Abraham P, and Henni S
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- Animals, Cattle, Cross-Sectional Studies, Humans, Intermittent Claudication diagnosis, Intermittent Claudication epidemiology, Ischemia diagnosis, Ischemia epidemiology, Pain, Prevalence, Retrospective Studies, Blood Gas Monitoring, Transcutaneous, Exercise Test
- Abstract
Objective: It was hypothesised that there is a linear relationship between the severity of exercise induced calf ischaemia and the prevalence of calf claudication on a treadmill until a plateau is reached. It was expected that no pain would be present in the absence of ischaemia and all severely ischaemic calves would be symptomatic., Methods: This was a retrospective analysis of a cross sectional acquired database recording. Transcutaneous oxygen pressure (TcPO
2 ) on the chest and on each calf was used to evaluate calf ischaemia during treadmill tests with simultaneous recording of calf pain in 7 884 subjects (15 768 calves). The minimum value of calf changes from rest minus chest changes from rest (DROPm) was calculated. Regression analyses were used to determine the correlation between the proportion of exercise induced symptoms present in the calves and each unit of DROPm values. Analysis was repeated after objective determination of the cutoff point between the linear increase and the plateau., Results: A linear relationship was found between the degree of ischaemia and the proportion of symptomatic calves for DROPm values ranging from 0 mmHg to -28 mmHg (proportion = -0.014 × DROPm + 0.32, r = 0.961, p <.001). For DROPm values lower than -28 mmHg (severe ischaemia), on average one of three limbs remained asymptomatic. The biphasic relationship between DROPm and prevalence of symptoms persists after exclusion of patients with diabetes mellitus, exercise induced hypoxaemia, and no evidence of lower extremity arterial disease (LEAD)., Conclusion: The relationship between exercise induced pain and ischaemia is biphasic with a linear increase in the proportion of symptomatic limbs with ischaemia severity, until a plateau is reached for the more severely ischaemic limbs. The presence of exercise related calf symptoms should not automatically be reported as indicating the presence of LEAD; and the absence of exercise induced symptoms is not proof that ischaemia does not occur during exercise., (Copyright © 2022 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)- Published
- 2022
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40. Comparison between conventional duplex ultrasonography and the dual-gate Doppler mode for hemodynamic measurements of the carotid arteries.
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Hersant J, Ramondou P, Douillet D, Abrard S, Vandeputte P, Lapébie FX, Abraham P, and Henni S
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Purpose: This study investigated the correlations of hemodynamic parameters measured to quantify stenosis between the gold-standard duplex ultrasonography and the dual-gate Doppler mode., Methods: Patients examined due to suspicion of carotid artery stenosis or for surveillance of known stenosis were invited to participate in this prospective single-center study. Upon acceptance, the hemodynamic characteristics of the carotid arteries were determined successively in standard duplex and dual-gate Doppler modes. The correlations between the two modes were analyzed by computing Pearson coefficients (r2) and Lin concordance coefficients (ρc). The degree of agreement between the two methods was visualized using Bland-Altman graphical representations., Results: The correlation between internal carotid artery peak systolic velocity measured by standard duplex ultrasonography and dual-gate Doppler mode was good (r2=0.642). The same high level of correlation was observed for the carotid ratio (r2=0.544). However, the Bland-Altman graphical representation and the Lin concordance coefficients (ρc=0.75 and ρc=0.74 for the internal carotid artery peak systolic velocity and carotid ratio, respectively) showed that a lack of precision generated some discrepancies between the two measurement methods., Conclusion: Although some discrepancies were observed, the hemodynamic measurements were closely correlated between the two ultrasonography modes. Therefore, the dual-gate Doppler mode may have obvious advantages over conventional ultrasonography, offering interesting development possibilities.
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- 2022
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41. Relationship Between Inflow Impairment and Skin Oxygen Availability to the Upper Limb During Standardized Arm Abduction in Patients With Suspected Thoracic Outlet Syndrome.
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Hersant J, Lecoq S, Ramondou P, Papon X, Feuilloy M, Abraham P, and Henni S
- Abstract
Objective: Thoracic outlet syndrome (TOS) should be considered of arterial origin only if patients have clinical symptoms that are the result of documented symptomatic ischemia. Simultaneous recording of inflow impairment and forearm ischemia in patients with suspected TOS has never been reported to date. We hypothesized that ischemia would occur in cases of severely impaired inflow, resulting in a non-linear relationship between changes in pulse amplitude (PA) and the estimation of ischemia during provocative attitudinal upper limb positioning., Design: Prospective single center interventional study., Material: Fifty-five patients with suspected thoracic outlet syndrome., Methods: We measured the minimal decrease from rest of transcutaneous oximetry pressure (DROPm) as an estimation of oxygen deficit and arterial pulse photo-plethysmography to measure pulse amplitude changes from rest (PA-change) on both arms during the candlestick phase of a "Ca + Pra" maneuver. "Ca + Pra" is a modified Roos test allowing the estimation of maximal PA-change during the "Pra" phase. We compared the DROPm values between deciles of PA-changes with ANOVA. We then analyzed the relationship between mean PA-change and mean DROPm of each decile with linear and second-degree polynomial (non-linear) models. Results are reported as median [25/75 centiles]. Statistical significance was p < 0.05., Results: DROPm values ranged -11.5 [-22.9/-7.2] and - 12.3 [-23.3/-7.4] mmHg and PA-change ranged 36.4 [4.6/63.8]% and 38.4 [-2.0/62.1]% in the right and left forearms, respectively. The coefficient of determination between median DROPm and median PA-change was r
2 = 0.922 with a second-degree polynomial fitting, but only r2 = 0.847 with a linear approach., Conclusion: Oxygen availability was decreased in cases of severe but not moderate attitudinal inflow impairments. Undertaking simultaneous A-PPG and forearm oximetry during the "Ca + Pra" maneuver is an interesting approach for providing objective proof of ischemia in patients with symptoms of TOS suspected of arterial origin., Competing Interests: PA is the beneficiary of support from the Radiometer®, Perimed®, and Medicap® companies. None of these companies interfered with the present project. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Hersant, Lecoq, Ramondou, Papon, Feuilloy, Abraham and Henni.)- Published
- 2022
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42. Prevalence of post-thrombotic syndrome in a cohort of upper extremity vein thrombosis.
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Hervé H, Toquet C, Ploton G, Connault J, Gautier G, Raimbeau A, Bergère G, Hersant J, Durant C, Artifoni M, Brebion N, Kubina JM, Pistorius MA, and Espitia O
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Case-Control Studies, Female, Humans, Male, Middle Aged, Prevalence, Prospective Studies, Young Adult, Postthrombotic Syndrome epidemiology, Postthrombotic Syndrome etiology, Upper Extremity Deep Vein Thrombosis complications
- Abstract
Objective: Post-thrombotic syndrome (PTS) is one of the main complications that occurs after venous thrombosis. There are few data on the proportion of patients that will develop upper extremity PTS (UE-PTS) after upper extremity venous thrombosis (UEVT). The main objective of the study was to assess the prevalence of PTS in a UEVT cohort and to identify predictive factors of UE-PTS., Methods: This study included patients with a history of proximal or arm UEVT, diagnosed on duplex ultrasound examination, between January 1, 2015, and December 31, 2017, in a university hospital. After UEVT, each patient was evaluated by a prospective standardized recording of clinical manifestations and duplex ultrasound examination in case of upper limb symptoms. UE-PTS was defined as a modified Villalta score of 4 or higher., Results: Ninety-two patients were included; 68 (73.9%) had deep vein thrombosis (DVT) and 24 (19.2%) arm superficial vein thrombosis. Thirteen patients had PTS (14.1%), 12 (17.6%) in the DVT group and 1 (4.2%) in the superficial vein thrombosis group. There was a history of DVT in 92.3% of the cases of PTS. PTS was more frequent in patients with strokes with limb movement reduction (P = .01). On multivariate Cox analysis, a history of stroke (hazard ratio, 5.4; 95% confidence interval, 1.46-20.22; P = .01) was predictive of UE-PTS., Conclusions: UE-PTS occurred in 14.1% of cases after UEVT. Stroke with a decrease in limb movement was a predictor of developing PTS. Diagnostic criteria should be established for UE-PTS and prospective studies are needed to improve the description and management of UE-PTS., (Copyright © 2021 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2022
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43. Thoracic Outlet Syndrome: Fingertip Cannot Replace Forearm Photoplethysmography in the Evaluation of Positional Venous Outflow Impairments.
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Hersant J, Ramondou P, Durand S, Feuilloy M, Daligault M, Abraham P, and Henni S
- Abstract
Objective: Fingertip photoplethysmography (PPG) resulting from high-pass filtered raw PPG signal is often used to record arterial pulse changes in patients with suspected thoracic outlet syndrome (TOS). Results from venous (low-pass filtered raw signal) forearm PPG (V-PPG) during the Candlestick-Prayer (Ca + Pra) maneuver were recently classified into four different patterns in patients with suspected TOS, two of which are suggestive of the presence of outflow impairment. We aimed to test the effect of probe position (fingertip vs. forearm) and of red ( R ) vs. infrared ( IR ) light wavelength on V-PPG classification and compared pattern classifications with the results of ultrasound (US). Methods: In patients with suspected TOS, we routinely performed US imaging (US + being the presence of a positional compression) and Ca + Pra tests with forearm V-PPG
IR . We recruited patients for a Ca + Pra maneuver with the simultaneous fingertip and forearm V-PPGR . The correlation of each V-PPG recording to each of the published pattern profiles was calculated. Each record was classified according to the patterns for which the coefficient of correlation was the highest. Cohen's kappa test was used to determine the reliability of classification among forearm V-PPGIR , fingertip V-PPGR , and forearm V-PPGR . Results: We obtained 40 measurements from 20 patients (40.2 ± 11.3 years old, 11 males). We found 13 limbs with US + results, while V-PPG suggested the presence of venous outflow impairment in 27 and 20 limbs with forearm V-PPGIR and forearm V-PPGR , respectively. Fingertip V-PPGR provided no patterns suggesting outflow impairment. Conclusion: We found more V-PPG patterns suggesting venous outflow impairment than US + results. Probe position is essential if aiming to perform upper-limb V-PPG during the Ca + Pra maneuver in patients with suspected TOS. V-PPG during the Ca + Pra maneuver is of low cost and easy and provides reliable, recordable, and objective evidence of forearm swelling. It should be performed on the forearm (close to the elbow) with either PPGR or PPGIR but not at the fingertip level., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Hersant, Ramondou, Durand, Feuilloy, Daligault, Abraham and Henni.)- Published
- 2021
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44. Exercise-Induced Plasma Metabolomic Profiles in Patients With Peripheral Arterial Disease.
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Semporé WY, Chao De La Barca JM, Hersant J, Ouédraogo N, Yaméogo TM, Henni S, Reynier P, and Abraham P
- Abstract
Aim: A better knowledge of the biological consequences in the blood of these exercise-induced ischemic events in lower extremity artery disease (LEAD) may improve the prospects of disease management. We explored the preminus postexercise metabolomic difference in 39 patients with LEAD referred for a treadmill oximetry test [transcutaneous oximetry (TcPO
2 )]. Methods: Ischemia was estimated through the sum of decrease from rest of oxygen pressure (DROPs) (limb TcPO2 changes minus chest TcPO2 changes) at buttocks, thighs, and calves regions. Targeted metabolomic analyses measuring 188 metabolites were performed on a few microliters blood samples taken at the earlobe at rest and 3 min after exercise. Results: Maximum walking distance (MWD) was 290 m (120-652 m) and ankle brachial index (ABI) was 0.67 ± 0.17. Supervised paired partial least squares discriminant analysis based on 23,345 models showed good predictive performance for test sets with a median area under the receiver operating characteristic (AUROC) curve value of 0.99 and a p -value of 0.00049. The best discriminant metabolites contributing to the model included a subset of 71 (47%) of the 150 accurately measured metabolites in the plasma, comprising 3 acylcarnitines, 3 amino acids, 5 biogenic amines, 9 sphingomyelin, 7 lysophosphatidylcholines, and 44 phosphatidylcholines. In addition, 16 of these metabolites were found to correlate with one or more severity scores of the LEAD. Conclusion: Our results provide new insights into the biological changes that accompany exercise in LEAD and contribute to a better understanding of walking impairment pathophysiology in LEAD, highlighting new candidate biomarkers., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Semporé, Chao De La Barca, Hersant, Ouédraogo, Yaméogo, Henni, Reynier and Abraham.)- Published
- 2021
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45. Kneeling-induced calf ischemia: a pilot study in apparently healthy European young subjects.
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Ramondou P, Hersant J, Bernardeau E, Moumneh T, Feuilloy M, Henni S, and Abraham P
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- Adult, Female, France, Healthy Volunteers, Humans, Male, Pilot Projects, Prospective Studies, Ischemia physiopathology, Leg blood supply, Posture physiology
- Abstract
Purpose: Many tasks, sports or leisure activities require maximal knee flexion. We hypothesized that this position could result in reduced calf perfusion, in young European subjects., Methods: We quantified calf ischemia resulting from the knee flexion with transcutaneous oxygen pressure (TcpO2) sensors by assessing the decrease from rest of TcpO2 (DROP) defined as limb changes minus chest changes. A minimal DROP (DROPm) <-15 mmHg defines the presence of ischemia. From the crawling position, participants kneeled for 3 min while bending as in prostration/prayer position (P). Thirty-five participants repeated this maneuver a second time, while 7 participants were also required to sit on their heels with the torso in the vertical position to attain knee flexion without significant groin flexion (S)., Result: In 41 healthy young volunteers (30 males), 25 [20-31] years old, 37 patients showed a DROPm < -15 mmHg from "R" to "P" in one (n = 4) or both (n = 33) calves (90.2%; 95% CI 76.9-97.3). After backward regression of the DROPm, there was no significant association with side, body weight of systolic blood pressure. However, age was strongly associated with DROPm (OR 5.34 [2.45-8.69]) so that DROPm was significantly higher in older, with a correlation ρ = 0.31 (p = 0.003)., Conclusion: Kneeling dramatically reduces calf perfusion, likely through popliteal artery kinking, possibly through muscle crushing. Eastern lifestyle includes routine flexed position since childhood. Whether or not such a chronic training reduces the risk of kneeling-induced ischemia in adults is unknown to date., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2021
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46. Specific features to differentiate Giant cell arteritis aortitis from aortic atheroma using FDG-PET/CT.
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Espitia O, Schanus J, Agard C, Kraeber-Bodéré F, Hersant J, Serfaty JM, and Jamet B
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- Aged, Aorta, Thoracic diagnostic imaging, Female, Fluorodeoxyglucose F18 chemistry, Fluorodeoxyglucose F18 metabolism, Giant Cell Arteritis diagnostic imaging, Humans, Male, Middle Aged, Plaque, Atherosclerotic diagnostic imaging, Giant Cell Arteritis diagnosis, Plaque, Atherosclerotic diagnosis, Positron Emission Tomography Computed Tomography
- Abstract
Aortic wall
18 F-fluorodeoxyglucose (FDG)-uptake does not allow differentiation of aortitis from atheroma, which is problematic in clinical practice for diagnosing large vessel vasculitis giant-cell arteritis (GCA) in elderly patients. The purpose of this study was to compare the FDG uptake characteristics of GCA aortitis and aortic atheroma using positron emission tomography/FDG computed tomography (FDG-PET/CT). This study compared FDG aortic uptake between patients with GCA aortitis and patients with aortic atheroma; previously defined by contrast enhanced CT. Visual grading according to standardized FDG-PET/CT interpretation criteria and semi-quantitative analyses (maximum standardized uptake value (SUVmax ), delta SUV (∆SUV), target to background ratios (TBR)) of FDG aortic uptake were conducted. The aorta was divided into 5 segments for analysis. 29 GCA aortitis and 66 aortic atheroma patients were included. A grade 3 FDG uptake of the aortic wall was identified for 23 (79.3%) GCA aortitis patients and none in the atheroma patient group (p < 0.0001); grade 2 FDG uptake was as common in both populations. Of the 29 aortitis patients, FDG uptake of all 5 aortic segments was positive for 21 of them (72.4%, p < 0.0001). FDG uptake of the supra-aortic trunk was identified for 24 aortitis (82.8%) and no atheromatous cases (p < 0.0001). All semi-quantitative analyses of FDG aortic wall uptake (SUVmax , ∆SUV and TBRs) were significantly higher in the aortitis group. ∆SUV was the feature with the largest differential between aortitis and aortic atheroma. In this study, GCA aortitis could be distinguished from an aortic atheroma by the presence of an aortic wall FDG uptake grade 3, an FDG uptake of the 5 aortic segments, and FDG uptake of the peripheral arteries., (© 2021. The Author(s).)- Published
- 2021
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47. Muscle blood flow, oxygen pressure, and hemoglobin/myoglobin saturation: The infernal triad.
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Abraham P, Ramondou P, Hersant J, and Henni S
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- Adult, Hemoglobins analysis, Humans, Magnetic Resonance Spectroscopy, Muscle, Skeletal chemistry, Muscle, Skeletal diagnostic imaging, Myoglobin analysis, Oxygen
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- 2021
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48. Effect of cannabis consumption on characteristics and evolution of thromboangitis obliterans.
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Bergère G, Toquet C, Hoffmann C, Bressollette L, Raimbeau A, Durant C, Artifoni M, Gautier G, Hersant J, Connault J, Pistorius MA, and Espitia O
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- Amputation, Surgical, Humans, Retrospective Studies, Cannabis, Thromboangiitis Obliterans
- Abstract
Background: Thromboangiitis obliterans (TAO) is a distal non atherosclerotic thrombotic vasculitis affecting tobacco smokers. The role of cannabis co-exposure remains controversial. The study aims to assess how cannabis consumption influences clinical presentation and outcome of TAO in tobacco smokers. Patients and methods: TAO patients, according to Papa's criteria, were included in a retrospective bicentric study between the 1
st January 2003 and the 1st march 2020. Clinical characteristics, arterial involvement at TAO diagnosis, vascular event and amputations during follow-up were analyzed according to cannabis consumption. Results: Seventy-three patients with TAO patients were included. Forty-five patients were in Tobacco group (T) and 28 in Tobacco and cannabis group (T&C). Tobacco exposure was less important in T&C group than in T group (19.4±11.3 vs 31.6±16.6 pack-years) (p=0.005) and patients in T&C group were younger at TAO diagnosis than in T group (p=0.008). Patients in T&C group presented more claudication (33.3% vs 8.9%, p=0.01) and less upper limbs resting ischemia (25.9% vs 51.1%, p=0.04) than patients in the T group. No differences were found between groups with regard to arterial distribution. Amputation rate for patients who had at least one major or minor amputation did not differ between T and T&C group (25% vs 14.8%, p=0.38). Conclusions: Cannabis consumption was associated with a younger age of TAO onset. However, it does not affect amputation-free survival, Tobacco exposure is less important in T&C patients; data of this bicentric study suggest that cannabis could be a cofactor of tobacco which accelerates TAO onset.- Published
- 2021
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49. Arterial Digital Pulse Photoplethysmography in Patients with Suspected Thoracic Outlet Syndrome: A Study of the "Ca+Pra" Maneuver.
- Author
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Hersant J, Ramondou P, Thouveny F, Daligault M, Feuilloy M, Saulnier P, Abraham P, and Henni S
- Abstract
The level of pulse amplitude (PA) change in arterial digital pulse plethysmography (A-PPG) that should be used to diagnose thoracic outlet syndrome (TOS) is debated. We hypothesized that a modification of the Roos test (by moving the arms forward, mimicking a prayer position ("Pra")) releasing an eventual compression that occurs in the surrender/candlestick position ("Ca") would facilitate interpretation of A-PPG results. In 52 subjects, we determined the optimal PA change from rest to predict compression at imaging (ultrasonography +/- angiography) with receiver operating characteristics (ROC). "Pra"-PA was set as 100%, and PA was expressed in normalized amplitude (NA) units. Imaging found arterial compression in 23 upper limbs. The area under ROC was 0.765 ± 0.065 ( p < 0.0001), resulting in a 91.4% sensitivity and a 60.9% specificity for an increase of fewer than 3 NA from rest during "Ca", while results were 17.4% and 98.8%, respectively, for the 75% PA decrease previously proposed in the literature. A-PPG during a "Ca+Pra" test provides demonstrable proof of inflow impairment and increases the sensitivity of A-PPG for the detection of arterial compression as determined by imaging. The absence of an increase in PA during the "Ca" phase of the "Ca+Pra" maneuver should be considered indicative of arterial inflow impairment.
- Published
- 2021
- Full Text
- View/download PDF
50. Predictive factors of venous recanalization in upper-extremity vein thrombosis.
- Author
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Ploton G, Brebion N, Guyomarch B, Pistorius MA, Connault J, Hersant J, Raimbeau A, Bergère G, Artifoni M, Durant C, Gautier G, Dumont R, Kubina JM, Toquet C, and Espitia O
- Subjects
- Adult, Aged, Catheterization, Central Venous methods, Catheterization, Peripheral adverse effects, Catheterization, Peripheral methods, Catheters, Indwelling adverse effects, Central Venous Catheters, Female, France, Humans, Logistic Models, Male, Middle Aged, Odds Ratio, Prognosis, Proportional Hazards Models, Retrospective Studies, Risk Assessment, Risk Factors, Thrombosis, Veins, Venous Thrombosis metabolism, Venous Thrombosis therapy, Catheterization, Central Venous adverse effects, Upper Extremity blood supply, Venous Thrombosis physiopathology
- Abstract
Background: Upper extremity venous thrombosis (UEVT) represents about 10% of venous thrombo-embolic disease. This is mainly explained by the increasing use of central venous line, for oncologic or nutritional care. The factors associated with venous recanalization are not known., Objective: The aim of this study was to investigate prognosis factor associated with venous recanalization after UEVT., Methods: This study included patients with UEVT diagnosed with duplex ultra-sonography (DUS) from January 2015 to December 2017 with DUS evaluations during follow-up. A multivariate Cox proportional-hazards-model analysis was performed to identify predictive factors of UEVT complete recanalization., Results: This study included 494 UEVT, 304 proximal UEVT and 190 distal UEVT. The median age was 58 years, 39.5% were women. Clinical context was: hematological malignancy (40.7%), solid cancer (14.2%), infectious or inflammatory context (49.9%) and presence of venous catheters or pacemaker leads in 86.4%. The rate of recanalization without sequelae of UEVT was 38%. For all UEVT, in multivariate analysis, factors associated with complete vein recanalization were: thrombosis associated with central venous catheter (CVC) (HR:2.40, [1.45;3.95], p<0.001), UEVT limited to a venous segment (HR:1.94, [1.26;3.00], p = 0.003), occlusive thrombosis (HR:0.48 [0.34;0.67], p<0.0001), the presence of a PICC Line (HR:2.29, [1.48;3.52], p<0.001), a thrombosis of deep and distal topography (HR:1.70, [1.10;2.63], p = 0.02) or superficial thrombosis of the forearm (HR:2.79, [1.52;5.12], p<0.001). For deep and proximal UEVT, non-occlusive UEVT (HR:2.23, [1.49;3.33], p<0.0001), thrombosis associated with CVC (HR:1.58, [1.01;2.47], p = 0.04) and infectious or inflammatory context (HR:1.63, [1.10;2.41], p = 0.01) were factors associated with complete vein recanalization., Conclusion: In this study, factors associated with UEVT recanalization were UEVT limited to a venous segment, thrombosis associated with CVC, a thrombosis of deep and distal thrombosis topography and superficial thrombosis of the forearm. Occlusive thrombosis was associated with the absence of UEVT recanalization., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2021
- Full Text
- View/download PDF
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