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Elastic compressions are standard treatment for leg ulcers of venous etiology. The effect of compressions on ulcers of mixed (arterial or venous) etiology, however, has rarely been studied. The objective of this study was to evaluate the variation in transcutaneous oxygen pressure (TcPO2) in patients with ulcers of mixed arterial or venous etiology treated with 1 month of compression. This prospective cohort study was conducted at a university hospital in France. Patient eligibility was for those attending a consultation of a work-up of a leg ulcer of mixed arterial-venous etiology lasting at least 4 to 6 weeks. Compressions were prescribed according to the hemodynamic status and were evaluated by the ankle-brachial index and toe-brachial index using a decision-making algorithm based on French national guidelines. Quality of life was assessed using the Short-Form 36-Item (SF-36) questionnaire. In total, 32 patients were included between September 30, 2018 and May 31, 2019. A difference was observed between TcPO2 before compression (49.3 ± 13.01 mm Hg) and after 1 month (51.2 ± 15.05 mm Hg), average change 1.9 ± 2.04 mm Hg (p = 0.025). The average ulcer size prior to compression was 49 ± 102 cm2 versus 37 ± 94 cm2 after 1 month of effective compression, corresponding to a reduction of 12 ± 8 cm2 (p

Aim To investigate the effectiveness of fast-track pathway (FTP) in the management of diabetic foot ulceration (DFU) after 2 years of implementation. Methods The study group was composed of patients who referred to a specialized DF centre due to DFUs. Those were divided in two groups: early referral (ER) and late referral (LR) patients. According to FTP, ER were considered patients who referred after 2 weeks in the case of uncomplicated non-healing ulcers (superficial, not infected, not ischemic), within 4 days in the case of complicated ulcers (ischemic, deep, mild infection) and within 24 h in the case of severely complicated ulcers (abscess, wet gangrene, fever). Healing, healing time, minor and major amputation, hospitalization, and survival were evaluated. The follow-up was 6 months. Results Two hundred patients were recruited. The mean age was 70 ± 13 years, 62.5% were male, 91% were affected by type 2 diabetes with a mean duration of 18 ± 11 years. Within the group, 79.5% had ER while 20.5% had LR. ER patients showed increased rates of healing (89.9 vs. 41.5%, p = 0.001), reduced healing time (10 vs. 16 weeks, p = 0.0002), lower rates of minor (17.6 vs. 75.6%, p p p = 0.001), and mortality (4.4 vs. 19.5%, p = 0.02) in comparison to LR. At multivariate analysis, ER was an independent predictor of healing, while LR was an independent predictor for minor and major amputation and hospitalization. Conclusion After the FTP implementation, less cases of LR were reported in comparison to ER. ER was an independent predictor of positive outcomes such as healing, healing time, limb salvage, hospitalization, and survival.

Resume Introduction Les plaies de pied diabetique (PPD) sont un probleme frequent, associe a un risque eleve d’amputation et de mortalite. L’adressage rapide a une structure specialisee du pied diabetique permet d’ameliorer le taux de cicatrisation et de diminuer le risque d’amputation. Une proportion importante de patients avec une PPD sont adresses tardivement vers ces structures specialisees. Un parcours de soins primaires des patients avec une PPD a ete developpe par l’International Diabetic Foot Care Group en collaboration avec le D-Foot International pour ameliorer l’orientation de ces patients vers les structures specialisees. Nous presentons une version adaptee au systeme de soin francais avec pour but de faire connaitre cet outil aux professionnels de sante de premiers recours francophones. Methodes L’orientation des patients se fait en trois niveaux de severite, qui dependent des comorbidites du patient, des caracteristiques de la plaie, de la presence d’une infection et du statut vasculaire. Resultats Les PPD non compliquees sont prises en charge en soins primaires avec mise en place d’une decharge. Une reevaluation de la plaie a 15 jours permet de savoir si le patient doit etre oriente vers une structure specialisee. Les PPD compliquees doivent etre adressees en moins de 48 h vers une structure specialisee, tandis que les plaies de pied en urgence absolue necessitent une hospitalisation en urgence. Conclusion Ce parcours de soins destine aux professionnels de sante en soins primaires a pour but d’ameliorer la prise en charge et le pronostic des patients diabetiques porteurs d’une plaie de pied.

International audience; BACKGROUND/OBJECTIVES: Peripheral arterial disease is a frequent and severe disease with high cardiovascular morbidity and mortality. However, female patients appear to be undertreated. OBJECTIVES: The primary goal was to compare the prescription of optimal medical treatment (OMT) of peripheral arterial disease between women and men in primary health care. MATERIAL AND METHODS: An observational retrospective study was based on the data collected from general practitioners (GP) office in Brittany. RESULTS: The study included 100 patients, aged 71 ± 10 years old, with 24% of women. Compared to men, women received the OMT less frequently (29.2% vs. 53.9%, p = 0.038), especially after 75 years old. Antiplatelet therapy was largely prescribed (100%), statins less frequently (70.8% women vs. 85.5% men), and prescription of renin-angiotensin-aldosterone system inhibitors was still not optimal in the two genders (41.7% women vs. 61.9% men). Active smoking is important for both women and men (33% and 30% respectively). CONCLUSION: Optimal medical treatment of peripheral artery disease is insufficiently prescribed, especially in women in this region of France.

The Wells score had shown weak performance to determine pre-test probability of deep vein thrombosis (DVT) for inpatients. So, we evaluated the impact of thromboprophylaxis on the utility of the Wells score for risk stratification of inpatients with suspected DVT. This bicentric cross-sectional study from February 1, 2018 to January 31, 2019 included consecutive medical and surgical inpatients who underwent lower limb ultrasound study for suspected DVT. Wells score clinical predictors were assessed by both ordering and vascular physicians within 24 h after clinical suspicion of DVT. Primary outcome was the Wells score’s accuracy for pre-test risk stratification of suspected DVT, accounting for anticoagulation (AC) treatment (thromboprophylaxis for ⩾ 72 hours or long-term anticoagulation). We compared prevalence of proximal DVT among the low, moderate and high pre-test probability groups. The discrimination accuracy was defined as area under the receiver operating characteristics (ROC) curve. Of the 415 included patients, 30 (7.2%) had proximal DVT. Prevalence of proximal DVT was lower than expected in all pre-test probability groups. The prevalence in low, moderate and high pre-test probability groups was 0.0%, 3.1% and 8.2% ( p = 0.22) and 1.7%, 4.2% and 25.8% ( p < 0.001) for inpatients with or without AC, respectively. Area under ROC curves for discriminatory accuracy of the Wells score, for risk of proximal DVT with or without AC, was 0.72 and 0.88, respectively. The Wells score performed poorly for discrimination of risk for proximal DVT in hospitalized patients with AC but performed reasonably well among patients without AC; and showed low inter-rater reliability between physicians. ClinicalTrials.gov Identifier: NCT03784937.

Background: Characterisation of arterial Doppler waveforms is a persistent problem and a source of confusion in clinical practice. Classifications have been proposed to address the problem but their efficacy in clinical practice is unknown. The aim of the present study was to compare the efficacy of the categorisation rate of Descotes and Cathignol, Spronk et al. and the simplified Saint-Bonnet classifications. Methods: This is a multicentre prospective study where 130 patients attending a vascular arterial ultrasound were enrolled and Doppler waveform acquisition was performed at the common femoral, the popliteal, and the distal arteries at both sides. Experienced vascular specialists categorized these waveforms according to the three classifications. Results: of 1033 Doppler waveforms, 793 (76.8%), 943 (91.3%) and 1014 (98.2%) waveforms could be categorized using Descotes and Cathignol, Spronk et al. and the simplified Saint-Bonnet classifications, respectively. Differences in categorisation between classifications were significant (Chi squared test, p &lt, 0.0001). Of 19 waveforms uncategorized using the simplified Saint-Bonnet classification, 58% and 84% were not categorized using the Spronk et al. and Descotes and Cathignol classifications, respectively. Conclusions: The results of the present study suggest that the simplified Saint-Bonnet classification provides a superior categorisation rate when compared with Spronk et al. and Descotes and Cathignol classifications.

International audience; Summary. Doppler ultrasound is an effective, useful and remarkably powerful tool in pediatric imaging. If possible, its use is always favored to avoid exposure to radiation or sedatives. By waveform spectrum analysis, Doppler ultrasound reveals information on blood flow and details on normal physiology and pathological processes undiscernible from gray-scale imaging alone. However, Doppler ultrasound remains underused, largely due to the difficult interpretation of changes in Doppler waveforms during childhood. This article provides a narrative review of the literature regarding the normative values and the physiological arterial changes through childhood according to age, weight or height, as well as frequent pathological arterial findings in children, classified by arterial territory.

Introduction: the epidemiology of upper limb venous thrombosis (ULVT) is unknown. Objectives: to describe the epidemiological, clinical and etiological characteristics of hospitalized patients who have presented a ULVT. Then, describe the evolution and therapeutic management upper extremity deep venous thrombosis (UEDVT). Method: patients hospitalized at CHU de Caen between November 2015 and December 2017 who received a doppler ultrasound for suspicion of ULVT were included retrospectively. Age, sex, symptoms, risk factors, localization, treatments, and complications occurring within 3 months were analyzed. Results: among the 497 suspicions of TVMS included, 93 DVT and 138 superficial venous thrombosis were diagnosed. 8 (3.4%) were complicated by pulmonary embolism (EP). 77% of DVT had occurred on central venous device, 61% during neoplasia, 40% during sepsis. Exept for obstructive syndrome, no other clinical component was significantly associated with the presence of a DVT. Of the patients with DVT, 41 (44%) had a varicose control within 3 months, 22 (24%) had died, 30 (32%) were lost in sight. Of the 41 followed, 3 had an extension, 1 a recurrence, and 5 had developed a post-thrombotic syndrome (SPT). 3 had a major bleeding. Conclusion: most of the UEDVT occur on a central venous device. Neoplasia and sepsis are the most commonly implicated. The prevalence of EP and associated SPT is low.; Introduction : l’épidémiologie de la thrombose veineuse du membre supérieur (TVMS) est méconnue. Objectifs : décrire les caractéristiques épidémiologiques, cliniques et étiologiques de patients hospitalisés ayant présenté une TVMS. Puis, décrire l’évolution et les prises en charge thérapeutiques des thromboses veineuses profondes (TVP) du MS. Méthode : les patients hospitalisés au CHU de Caen entre novembre 2015 et décembre 2017 ayant bénéficié d’un écho-doppler pour suspicion de TVMS ont été inclus rétrospectivement. L’âge, le sexe, les symptômes, les facteurs favorisants, la localisation, les traitements et les complications survenues à 3 mois ont été analysés. Résultats : parmi les 497 suspicions de TVMS incluses, 93 TVP et 138 TV superficielles ont été diagnostiquées. 8 (3,4%) se sont compliquées d’embolie pulmonaire (EP). 77% des TVP étaient survenues sur dispositif veineux central, 61% au cours d’une néoplasie, 40% au cours d’un sepsis. Hormis, un syndrome obstructif, aucun autre élément clinique n’était associé significativement à la présence d’une TVP. Parmi les patients avec TVP, 41 (44%) avaient bénéficié d’un contrôle écho-doppler dans les 3 mois, 22 (24%) étaient décédés, 30 (32%) étaient perdus de vue. Parmi les 41 suivis, 3 avaient présenté une extension, 1 une récidive et 5 avaient développé un syndrome post-thrombotique (SPT). 3 ont présenté une hémorragie grave ayant entrainé le décès. Conclusion : l'essentiel des TVPMS surviennent sur dispositif endo-veineux central. La néoplasie et les sepsis sont les affections les plus souvent impliquées. La prévalence des EP et des SPT associée est faible.