toe pressure
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2022 ◽  
Author(s):  
Mae Azeez ◽  
Mirjami Laivuori ◽  
Johanna Tolva ◽  
Nina Linder ◽  
Johan Lundin ◽  
...  

Abstract Vascular calcification exists in different forms that reflect variable clinical and histological implications. Categories of calcification have not been quantified in relation to the clinical presentation of lower extremity arterial disease. The study analyzed 51 femoral plaques collected during femoral endarterectomy, characterized by > 90% stenosis. The plaques were longitudinally sectioned, stained with Hematoxylin and Eosin and digitized for a deep learning platform for quantification of the relative area of nodular calcification to the plaque section area. Vessel measurements and quantity of each calcification category was compared to the clinical risk factors and outcomes. nodular calcification area proportion is associated with reduced risk of severely lowered toe pressure (< 30mmHg) (OR=0.910, 95%CI =0.835-0992, p<0.05), severely lowered ankle brachial index (<0.4), (OR=0.912, 95%CI=0.84-0.986, p<0.05), and semi-urgent operation (OR=0.882, 95%CI=0.797-0.976, p<0.05). The analysis was adjusted by age, gender, hypertension, diabetes and dyslipidaemia. Increase of the relative amount of nodular calcification in femoral plaques with over 90% stenosis is associated with protection against severe LEAD, identified by severely lowered toe pressure and ankle brachial index and semi-urgent operations. Nodular calcification may contribute to a slower obstruction, hence milder obstructive ischaemic presentation.


Angiology ◽  
2021 ◽  
pp. 000331972110636
Author(s):  
Loubna Dari ◽  
Damien Barcat ◽  
Benjamin Ally ◽  
David Lagarde ◽  
Carine Boulon ◽  
...  

An objective hemodynamic assessment is mandatory to confirm Critical Limb Ischemia (CLI). Toe pressure measurement is recommended. We compared toe measurements obtained using the Laser Doppler method (LD) (PERIMED PeriFlux, Sweden) considered as the reference test, with those obtained with a portable device using photoplethysmography (PPG) (Sys Toe Atys Medical, France). A total of 93 (123 legs) patients from 3 French hospitals with a clinical suspicion of CLI were included and had measurements with each device carried out by skilled operators. PPG was unable to provide a measurement in 10 patients. Lin’s Coefficient correlation concordance (CCC) and Bland and Altman’s scatter plot were analyzed for the 83 remaining patients, CCC was .84 95%CI (.77–.89). For detection of CLI, Cohen’s kappa was .67 95%CI (.53–.81). The PPG device is fairly reliable for toe pressure measurement in patients suspected of CLI and could be useful when LD is not available. However, it fails to deliver a measurement in approximately 10% of cases. No conclusion should be made about CLI for these patients when no measurement is obtainable and other methods should be used (LD, transcutaneous oxygen pressure) to assess perfusion of the limbs.


2021 ◽  
Vol 62 (6) ◽  
pp. e76-e77
Author(s):  
Thordur S. Gunnarsson ◽  
Håkan Pärsson ◽  
Anders Gottsäter ◽  
Hans Lindgren

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259122
Author(s):  
V. Koivunen ◽  
M. Juonala ◽  
M. Venermo ◽  
M. Laivuori ◽  
J. M. Jalkanen ◽  
...  

Objective Although lower extremity arterial disease (LEAD) is most often multisegmental, the predominant disease location and risk factors differ between patients. Ankle-brachial index (ABI), toe-brachial index (TBI), and toe pressure (TP) are predictive of outcome in LEAD patients. Previously, we reported a classification method defining the most diseased arterial segment (MDAS); crural (CR), femoropopliteal (FP), or aortoiliac (AOI). Current study aimed to analyze the associations between MDAS, peripheral pressure measurements and cardiovascular mortality. Materials and methods We reviewed retrospectively 729 consecutive LEAD patients (Rutherford 2–6) who underwent digital subtraction angiography between January, 2009 to August, 2011 and had standardized peripheral pressure measurements. Results In Cox Regression analyses, cardiovascular mortality was associated with MDAS and non-invasive pressure indices as follows; MDAS AOI, TP <30 mmHg (HR 3.00, 95% CI 1.13–7.99); MDAS FP, TP <30 mmHg (HR 2.31, 95% CI 1.36–3.94), TBI <0.25 (HR 3.20, 95% CI 1.34–7.63), ABI <0.25 (HR 5.45, 95% CI 1.56–19.0) and ≥1.30 (HR 6.71, 95% CI 1.89–23.8), and MDAS CR, TP <30 mmHg (HR 4.26, 95% CI 2.19–8.27), TBI <0.25 (HR 7.71, 95% CI 1.86–32.9), and ABI <0.25 (HR 2.59, 95% CI 1.15–5.85). Conclusions Symptomatic LEAD appears to be multisegmental with severe infrapopliteal involvement. Because of this, TP and TBI are strongly predictive of cardiovascular mortality and they should be routinely measured despite the predominant disease location or clinical presentation.


2021 ◽  
Vol 74 (3) ◽  
pp. e310-e311
Author(s):  
Alicia M. Stafford ◽  
Peyton Tharp ◽  
Elizabeth Genovese ◽  
Ravi Veeraswamy ◽  
Mathew D. Wooster

2021 ◽  
Vol 111 (5) ◽  
Author(s):  
Ana María Pérez Pico ◽  
María José Iglesias Sánchez ◽  
Félix Marcos Tejedor ◽  
Raquel Mayordomo Acevedo

Background Maintaining autonomy is one of the principal objectives for seniors and people with psychiatric disorders. Podiatric medical care can help them maintain autonomy. This work aimed to characterize and quantify the support of the toes in a psychiatric population by analyzing the influence of psychotropic medications and toe and foot support parameters on the prevalence of falls. Methods We conducted a cross-sectional descriptive study in 67 participants (31 people with psychiatric disorders and 36 without diagnosed disorders [control population]). Toe support pattern was analyzed with a pressure platform. Variables were measured in static and dynamic loading and related to falls and psychotropic medication use. Results The psychiatric population fell more than the control population and presented less toe-ground contact in static measurements, although it has more foot-ground contact time. Maximum toe pressure during toe-off is also less intensive in the psychiatric population and is related to people who take psychotropic medications. Conclusions Toe support pattern could be used as a predictive factor for falls and to improve stability in these populations.


2021 ◽  
Vol 15 (6) ◽  
pp. 2063-2066
Author(s):  
Afghani Reza ◽  
Cheraghali Roozbeh

Ten to 25 % of all diabetic patients will develop a lower limb ulcer in their lifetime. Ankle-brachial index is not accurate in diabetic patients .The resting systolic toe pressure (TP) may be a measure of small arterial function within the periphery. Objective: The purpose of this article is to consider the effect of below-knee angioplasty on systolic toe pressure changes in diabetic patients with critical limb ischemia. Methods/Materials: In this prospective study 114 patients, were included who satisfied the inclusion criteria: patients with critical limb ischemia in the form of tissue loss(ulcer or gangrene) or rest pain, presence of below-knee vessel lesion, and absence of proximal vessels lesion or stenosis. We evaluated the effect of angioplasty on toe pressure of diabetic patients and compared them to non-diabetics. Results: Among 114 patients, 78(68/4%) were men and 36(31/6%) were women. Diabetic patients were 96(84/2%) and non-diabetics were 18 (15.8%). In Paired T-Test analysis we compared toe pressure values of each patient before and after angioplasty and it was a significant difference in both Diabetic and non-diabetic groups.(0.00 and 0.008 respectively). The mean of systolic toe pressure before angioplasty had no difference between the 2 groups (PValue: 0.13). The mean of toe pressure in non-diabetic patients was 42±31.9 and in diabetics was 25.6 and after angioplasty, the mean of toe pressure raised 44.3 in non-diabetics and 19.4 in diabetics. Conclusions: Systolic toe pressure is a valuable tool to evaluate and predict angioplasty effect on below-knee ulcers especially in diabetic patients. Keywords: Below knee Angioplasty, Systolic toe pressure, Diabetes


2020 ◽  
pp. 193229682097997
Author(s):  
Jérôme Patry ◽  
Louis Laurencelle ◽  
Justine Bélisle ◽  
Maryse Beaumier

Background: Vascular assessment of the lower limbs is essential in patients with diabetes. In the presence of noncompressible arteries, the ankle brachial index (ABI) can either be inconclusive or provide false-positive results. Toe pressure measurement has been suggested as an alternative as a noninvasive method for detecting peripheral arterial disease (PAD). Toe pressure measurement can be performed either by photoplethysmography (PPG) or by Laser Doppler flowmetry (LDF). The aim of this study was to determine correlations between the two techniques in order to promote the use of PPG in clinical practice. Methods: This was a prospective correlational study of 108 consecutive recruited adult patients, with and without diabetes, with at least one lower limb wound from a University-affiliated hospital wound care clinic. Toe pressure measurements were both performed with PPG and LDF devices. Results: Mean toe pressure values for PPG and LDF were, respectively, 83.7 (SD 35.4) and 79.5 (SD 32.0) mmHg (with a paired t-test 3.969, P < 0.01). In patients with at least one lower limb wound, a strong linear relation was found between PPG and LDF toe pressure techniques with a Pearson’s r correlation coefficient of 0.920 ( P < 0.001). Conclusions: PPG and LDF toe pressure techniques are equivalent in patients with at least one lower limb wound, irrespective of the presence of diabetes. Therefore, in the presence of an ABI with inconclusive results, such as in a patient with noncompressible vessels, both toe pressure techniques can be used for assessing the vascular supply of the lower limb with a wound.


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