Exercise therapy for chronic symptomatic peripheral artery disease.

All guidelines worldwide strongly recommend exercise as a pillar of the management of patients affected by lower extremity peripheral artery disease (PAD). Exercise therapy in this setting presents different modalities, and a structured programme provides optimal results. This clinical consensus paper is intended for clinicians to promote and assist for the set-up of comprehensive exercise programmes to best advice in patients with symptomatic chronic PAD. Different exercise training protocols specific for patients with PAD are presented. Data on patient assessment and outcome measures are narratively described based on the current best evidence. The document ends by highlighting disparities in access to supervised exercise programmes across Europe and the series of gaps for evidence requiring further research.

Challenges and opportunities in the management of type 2 diabetes in patients with lower extremity peripheral artery disease: a tailored diagnosis and treatment review.

Lower extremity peripheral artery disease (PAD) often results from atherosclerosis, and is highly prevalent in patients with type 2 diabetes mellitus (T2DM). Individuals with T2DM exhibit a more severe manifestation and a more distal distribution of PAD compared to those without diabetes, adding complexity to the therapeutic management of PAD in this particular patient population. Indeed, the management of PAD in patients with T2DM requires a multidisciplinary and individualized approach that addresses both the systemic effects of diabetes and the specific vascular complications of PAD. Hence, cardiovascular prevention is of the utmost importance in patients with T2DM and PAD, and encompasses smoking cessation, a healthy diet, structured exercise, careful foot monitoring, and adherence to routine preventive treatments such as statins, antiplatelet agents, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. It is also recommended to incorporate glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) in the medical management of patients with T2DM and PAD, due to their demonstrated cardiovascular benefits. However, the specific impact of these novel glucose-lowering agents for individuals with PAD remains obscured within the background of cardiovascular outcome trials (CVOTs). In this review article, we distil evidence, through a comprehensive literature search of CVOTs and clinical guidelines, to offer key directions for the optimal medical management of individuals with T2DM and lower extremity PAD in the era of GLP-1RA and SGLT2i.

Exercise Therapy for Chronic Symptomatic Peripheral Artery Disease: A Clinical Consensus Document of the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases in Collaboration With the European Society of Vascular Medicine and the European Society for Vascular Surgery.

All guidelines worldwide strongly recommend exercise as a pillar in the management of patients affected by lower extremity peripheral artery disease (PAD). Exercise therapy in this setting presents different modalities, and a structured programme provides optimal results. This clinical consensus paper is intended to promote and assist the set up of comprehensive exercise programmes and best advice for patients with symptomatic chronic PAD. Different exercise training protocols specific for patients with PAD are presented. Data on patient assessment and outcome measures are described based on the current best evidence. The document ends by highlighting supervised exercise programme access disparities across Europe and the evidence gaps requiring further research.

Test-retest Reliability and Minimal Detectable Change in Exercise Oximetry in Claudicants.

BACKGROUND: Exercise transcutaneous oxygen pressure measurement (Exercise-TcPO2) can be used to diagnose Lower Extremity Artery Disease (LEAD) and allows the quantification of limb ischemia during exercise on treadmill. Exercise-TcPO2 test-retest reliability in patients with LEAD and severe walking impairment is unknown. The aim of this study was to evaluate the test-retest reliability, standard error of measurement (SEM), and Minimal Detectable Change (MDC) of exercise-TcPO2 in patients with claudication. METHODS: Data were collected from patients that performed 2 treadmill tests within a 1-month interval. Delta from Rest of Oxygen Pressure (DROP) values were measured at both buttocks (proximal) and both calves (distal). Test-retest reproducibility was assessed by recording transcutaneous oximetry measurements twice and expressed as SEM and intra-class correlation coefficients. MDC was calculated using the formula MDC = SEM x 1.96 x √ 2. RESULTS: Twenty eight LEAD patients (61 ± 9 years old) were included. Intra-class correlation coefficients were 0.66 [0.50, 0.79] and 0.65 [0.49, 0.79] for the proximal and distal levels, respectively. The SEM of DROP at the proximal and distal levels were 7 [6, 9] mm Hg and 9 [8, 11] mm Hg, respectively. The SEM for all (proximal and distal) DROP values was 8 [7, 10] mm Hg and the MDC of DROP was 23 mm Hg. CONCLUSIONS: Exercise-TcPO2 with measurement of DROP values has a moderate test-retest reliability in LEAD patients with a maximal walking distance ≤ 300m. For an individual, an improvement or deterioration in DROP of ≥ 23 mm Hg after an intervention would be required to be 95% confident that the change is significant. It should be considered in evaluating the impact of treatment in patients with claudication.

Update About the Management of Low-Density Lipoprotein Cholesterol and Hypertriglyceridemia in Lower Extremity Peripheral Artery Disease Patients: Consensus of the French Society of Vascular Medicine and the French Society for Vascular and Endovascular Surgery.

BACKGROUND: A French intersociety consensus on behalf the Société Française de Médecine Vasculaire and the Société de Chirurgie Vasculaire et Endovasculaire was proposed in 2021 for the management of patients with lower extremity peripheral artery disease (LEAD). Recent studies have been published and an update of this consensus about the management of low-density lipoprotein cholesterol (LDLc) and hypertriglyceridemia was required. METHODS: A steering committee of 12 vascular physicians and surgeons defined questions of interest about LDLc and hypertriglyceridemia management. A French expert panel voted the proposals. Consensus was considered to have been achieved if more than 80% of the responses corresponded to either "Agreement" or "Disagreement". RESULTS: Among the 56 experts who were asked to participate, 46 (82%) accepted. After the first round of the Delphi procedure, the 4 proposals reached consensus. The following suggestions and recommendations were approved: 1. For LEAD patients treated by the highest tolerated statin dose ± ezetimibe and who have an LDLc ≥0.70 g/L, we recommend adding a proprotein convertase subtilisin/kexin type 9 inhibitor. 2. For LEAD patients treated by statin and who have elevated triglyceride level between ≥150 mg/dL and ≤500 mg/dL, we suggest adding Icosapent Ethyl. 3. Before adding Icosapent Ethyl in LEAD patients treated with statin, we suggest looking for symptoms that may suggest atrial fibrillation. 4. For LEAD patients treated by Icosapent Ethyl and who have symptoms that suggest atrial fibrillation, we recommend performing an electrocardiogram. CONCLUSIONS: This update will help clinicians to improve LEAD patient management.

Exercise therapy for chronic symptomatic peripheral artery disease.

All guidelines worldwide strongly recommend exercise as a pillar in the management of patients affected by lower extremity peripheral artery disease (PAD). Exercise therapy in this setting presents different modalities, and a structured programme provides optimal results. This clinical consensus paper is intended to promote and assist the set up of comprehensive exercise programmes and best advice for patients with symptomatic chronic PAD. Different exercise training protocols specific for patients with PAD are presented. Data on patient assessment and outcome measures are described based on the current best evidence. The document ends by highlighting supervised exercise programme access disparities across Europe and the evidence gaps requiring further research.

Performance of finger systolic blood pressure measurement to detect digital occlusive arterial disease in systemic sclerosis.

OBJECTIVE: Digital ulcers related to digital occlusive arterial disease (DOAD) are frequent in patients with SSc. Finger systolic blood pressure (FSBP) and digital-brachial pressure index (DBI) using laser Doppler flowmetry constitute a non-invasive means of detecting DOAD in SSc, although thresholds have yet to be established for defining DOAD. The purpose of this study was to ascertain FSBP and DBI thresholds to detect DOAD in SSc patients. The intra/interday reproducibility of curve reading by four vascular physicians in relation to finger pressure measurement was also investigated. METHODS: SSc patients were followed in this single-centre study (Rennes University Hospital, France) between November 2017 and October 2019.These patients underwent tests before and after heating at two visits spaced 10 days apart. DOAD was diagnosed on the basis of post-warming skin blood flow of ≤206 arbitrary units measured by laser Doppler flowmetry, contingent on previous results validated by arteriography as a gold standard. An interday kappa coefficient with a 95% confidence interval was used to assess reproducibility. RESULTS: Sixteen [10 females; mean age: 63 (9) years] SSc patients were included. Mean time interval between visits was 9 (5) days. The best FSBP threshold for DOAD diagnosis was 76 mmHg and DBI was 0.74 after warming. FSBP and DBI sensitivity/specificity were 59.1% (95% CI: 49.6, 68.5%)/92.5% (95% CI: 85.3, 99.6%) and 73.3% (95% CI: 64.9, 81.8%)/83.0% (95% CI: 72.9, 93.1%), respectively. Intra/interday reproducibility ranged from fair to good. CONCLUSION: The conclusions drawn from this study suggest that FSBP ≤ 76 mmHg and DBI ≤ 0.74 thresholds are potentially reliable indicators of DOAD and demonstrate fair to good intra- and interday reproducibility. TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT03264820.

Phasicity and resistance of the arterial spectral Doppler waveform in a canine femoral focal artery stenosis model.

INTRODUCTION: This study aims to evaluate changes in the arterial spectral Doppler waveform in a canine artery stenosis model. METHODS: Canine femoral artery stenosis models were established in 12 beagle dogs. Doppler waveforms were recorded in the femoral artery preoperatively and postoperatively in the femoral artery and at the ankle after formation of a 50%, 70%, and 90% stenosis or occlusion. Major descriptors for arterial Doppler waveform were used to analyse waveforms. RESULTS: The proportion of multiphasic waveforms proximal to a moderate stenosis decreased compared to normal baseline, although the difference was not statistically significant, whereas the decreases at the stenosis, distal to the stenosis, and at the ankle were significant (p < 0.05). The decreases in arteries with a more severe stenosis or occlusion were significant at all locations (p < 0.05). The proportion of high resistive waveforms decreased significantly at the ankle in the arteries with a moderate stenosis (50%) (p = 0.002), but the decreases proximal to, at, and distal to the stenosis were not significant. The decreases were significant at all locations in the arteries with a more severe stenosis (p < 0.05). The decrease was significant at the ankle in the arteries with an occlusion (p < 0.001) but not significant pre, at, and post an occlusion. CONCLUSIONS: Phasicity and resistance of Doppler waveforms alter in canine femoral arteries with a stenosis. Phasicity change seems more sensitive in response to an arterial stenosis than resistance change. Additional information on arterial resistance could be obtained using end-diastolic ratios, resistive indices, and potentially end-systolic notch velocity measurements.

Agreement Between StepWatch3 and ActiGraph wGT3X+ for Measuring Step-Based Metrics in People With Peripheral Artery Disease.

The authors investigated the agreement between StepWatch3™ (SW3) and ActiGraph™ wGT3X+ monitors for measuring step-based metrics in patients with peripheral artery disease and older adults. In 23 patients with peripheral artery disease and 38 older participants, the authors compared the metrics obtained during an outdoor (400-m track) walking session (step count) and a 7-day free-living period (step count and 60/30/5/1-min maximal or peak step accumulation) using the SW3 (ankle) and the wGT3X+ (hip) with the low-frequency extension filter enabled (wGT3X+/LFE) or not (wGT3X+/N). During outdoor walking session, agreement was high, particularly for wGT3X+/LFE: correlations ≥.98, median absolute percentage errors <1%, and significant equivalence using a ± 15% equivalence zone or narrower. In free living, no wGT3X+ method was equivalent to SW3 for step count. The wGT3X+/LFE was equivalent to SW3 regarding all step accumulation metrics using a ± 20% equivalence zone or narrower, with median absolute percentage errors <11%. The wGT3X+/LFE method is the best option for comparisons with SW3 in peripheral artery disease and older adults.

Disparities Between International Guidelines (AHA/ESC/ESVS/ESVM/SVS) Concerning Lower Extremity Arterial Disease: Consensus of the French Society of Vascular Medicine (SFMV) and the French Society for Vascular and Endovascular Surgery (SCVE).

Several international guidelines concerning lower extremity arterial disease (LEAD) have been published recently, in particular, by the American Heart Association the European Society of Cardiology/European Society for Vascular Surgery, the European Society for Vascular Medicine and the Society for Vascular Surgery. These guidelines differ in some respects and certain issues are not addressed. The objective of this consensus driven by the French Societies of vascular Medicine and surgery was to analyze the disparities between the different guidelines, as well as certain issues not covered, and develop proposals with regard to these points. The following fields of LEAD have been explored: 1) classifications, 2) clinical evaluation, 3) diagnostic criteria, 4) quantification of arterial stenosis using duplex ultrasound, 5) detection of asymptomatic multisite lesions, 6) screening for LEAD in the context of cardiac disease, 7) medical treatment, 8) supervised exercise therapy, 9) revascularization and revascularization of the internal artery stenosis, 10) management of chronic limb ischemia, 11) longitudinal follow-up, and 12) diet.

A systematic review of lower extremity electrical stimulation for treatment of walking impairment in peripheral artery disease.

Lower extremity peripheral artery disease (PAD) induces an ischemic pain in the lower limbs and leads to walking impairment. Electrical stimulation has been used in patients with PAD, but no systematic review has been proposed to address the efficacy of the technique as a treatment for walking impairment in PAD. A systematic search was performed to identify trials focused on electrical stimulation for the treatment of walking impairment in patients with PAD in the Cochrane Central Register, PubMed, Embase, and the Web of Science. Studies were included where the primary outcomes were pain-free walking distance and/or maximal walking distance. When appropriate, eligible studies were independently assessed for quality using the Cochrane Collaboration's tool for assessing risk of bias. Five studies eligible for inclusion were identified, of which only two were randomized controlled studies. Trial heterogeneity prevented the use of the GRADE system and the implementation of a meta-analysis. Three types of electrical stimulation have been used: neuromuscular electrical stimulation (NMES, n = 3), transcutaneous electrical stimulation (n = 1), and functional electrical stimulation (n = 1). The two available randomized controlled studies reported a significant improvement in maximal walking distance (+40 m/+34% and +39 m/+35%, respectively) following a program of NMES. Owing to the low number of eligible studies, small sample size, and the risk of bias, no clear clinical indication can be drawn regarding the efficacy of electrical stimulation for the management of impaired walking function in patients with PAD. Future high-quality studies are required to define objectively the effect of electrical stimulation on walking capacity.

Interpretation of peripheral arterial and venous Doppler waveforms: A consensus statement from the Society for Vascular Medicine and Society for Vascular Ultrasound.

This expert consensus statement on the interpretation of peripheral arterial and venous spectral Doppler waveforms was jointly commissioned by the Society for Vascular Medicine (SVM) and the Society for Vascular Ultrasound (SVU). The consensus statement proposes a standardized nomenclature for arterial and venous spectral Doppler waveforms using a framework of key major descriptors and additional modifier terms. These key major descriptors and additional modifier terms are presented alongside representative Doppler waveforms, and nomenclature tables provide context by listing previous alternate terms to be replaced by the new major descriptors and modifiers. Finally, the document reviews Doppler waveform alterations with physiologic changes and disease states, provides optimization techniques for waveform acquisition and display, and provides practical guidance for incorporating the proposed nomenclature into the final interpretation report.

Proficiency of Medical Students at Obtaining Pressure Measurement Readings Using Automated Ankle and Toe Measuring Devices for Diagnosis of Lower Extremity Peripheral Artery Disease.

BACKGROUND: Pressure measurement is a key component in the diagnosis of lower extremity peripheral artery disease (PAD) but is technically challenging and time-consuming for nonvascular specialists, thus hindering its wider implementation. The aim of this study was to assess the proficiency of students at obtaining satisfactory ankle or toe pressure readings for PAD diagnosis using 2 automated devices. METHODS: Medical students followed a training session after which they performed ankle and toe pressure measurements to calculate the ankle-brachial index (ABI) using the MESI ABPI MD® device, and the toe-brachial index (TBI) using the SYSTOE® device. Blinded vascular specialists took the same measurements. Use of the automated devices was considered satisfactory when a valid reading was measured in as few attempts as possible. A comparison was made of each student's proficiency at performing valid ankle and toe pressure measurements. The secondary objective was to compare the readings taken by the vascular specialists with those of the students. RESULTS: Forty-three medical students were included. Mean number of attempts was 1.23 ± 0.48 with the MESI ABPI MD device and 1.44 ± 0.55 with the SYSTOE device (P = 0.04). There was no statistically significant difference between ABI readings taken by the students and those taken by the vascular specialists, 1.17 (0.90; 1.39) vs. 1.18 (0.86; 1.39) (P = 0.33), contrary to TBI readings 0.70 (0.22; 1.74) vs. 0.72 (0.23; 1.16) (P = 0.03). Measurement duration for the students and vascular specialists was 3.75 min ± 1.12 min and 2.26 min ± 0.82 min (P < 0.01) with the MESI ABPI MD device and 4.30 min ± 1.23 min and 3.33 min ± 1.49 min (P = 0.03) with the SYSTOE device. Correlation coefficients between the students and the vascular specialists were 0.56 and 0.34 with the MESI ABPI MD and SYSTOE devices (P < 0.05). CONCLUSIONS: After a brief theoretical training session, the medical students were better at taking ankle pressure measurements than toe pressure measurements with an automated device for the purposes of PAD diagnosis. It would be of value to assess the advantages of these automated devices in primary care practice in future research.

Impact of an Educational Intervention on Ankle-Brachial Index Performance Among Medical Students and Fidelity Assessment at Six Months.

BACKGROUND: The resting ankle-brachial index (ABI) is a clinical test to diagnose peripheral artery disease. The Wyatt's score has been proposed to assess the students' performance on ABI measurement on a healthy volunteer (HV). No study has shown that this score is sensitive to different teaching methods. In this randomized controlled trial, we wanted to determine whether didactic learning alone or didactic learning combined with experiential learning improves proficiency in the ABI procedure assessed by the Wyatt's score. METHODS: Medical students (n = 30) received a didactic learning, including (1) a presentation of the ABI guidelines and (2) a video demonstration. Each student was then randomized into 2 groups ("the no experiential learning group" and "the experiential learning group"). An initial evaluation was performed after the didactic learning and then the final evaluation at the end of the intervention. A student was considered to be proficient when he performed a correct ABI procedure on an HV. The correct procedure corresponds to the following: (1) correctly answered Wyatt's score and (2) a difference in the ABI measurement between a professor in vascular medicine and a student was ≤0.15. RESULTS: No student was proficient at the initial evaluation. At the final evaluation, there was a significant difference between the number of proficient students for the Wyatt's score depending on their learning group [didactic alone (1/10) or didactic + experiential training (15/20)] and also for the ABI procedure [didactic alone (0/10) or didactic + experiential training (16/20)]. At 6 months, among the 12 students who passed the final evaluation, 4 students passed both the Wyatt's score and the ABI measurement. CONCLUSIONS: Our study demonstrates that the Wyatt's score was sensitive to an educational intervention and no improvement was found in the case of "no experiential learning." The Wyatt's score could be used to evaluate the student on ABI measurement after an educational intervention. TRIAL REGISTRATION: A randomized controlled trial was conducted in the Vascular Medicine Department of Rennes University Hospital (France). This was approved by the ethics review board of our institution (no. 16.150).

Using wearable monitors to assess daily walking limitations induced by ischemic pain in peripheral artery disease.

PURPOSE: To develop, assess the feasibility of, and determine the clinical validity of an event-based analysis method using wearable monitors to quantify walking pain manifestations (WPMs) and stops induced by walking pain (SIWPs) during daily life walking in people with peripheral artery disease (PAD). METHODS: The following two conditions were studied: a standardized outdoor walking session (OWS) and a seven-day free-living measurement (FLM) period. The PAD participants (n = 23) wore an accelerometer and a watch. They were asked to press the event marker button on the watch to indicate events related to WPMs and SIWPs. To assess the clinical validity of the method, the computed pain-free walking time (PFWT) and maximal walking time (MWT) were compared with the PFWT and MWT assessed using standard treadmill walking protocols, respectively. RESULTS: Following OWSs, the PFWT[OWS] and MWT[OWS] were significantly correlated with the PFWT[Strandness] (r = .955, P < .001) and MWT[Strandness] (r = .821, P < .001), respectively. During the FLM, PAD participants experienced only 2 WPMs/day and 1 SIWP/day, although severely limited on the treadmill and during the OWS. The average WPMs/day were moderately correlated with the PFWT[Strandness] (r = -.54, P = .016). The PFWT[FLM] was on average 12 times longer than the PFWT[Strandness] . Interestingly, the intensity of the walking bouts as assessed by the accelerometer counts during the FLM was significantly lower than that during the OWS (45 ± 15 vs 66 ± 20 counts/s, P < .001). CONCLUSION: This new method offers opportunities for studies investigating the experience of living with PAD and the assessment of daily life walking capacity for both diagnostic and therapeutic purposes.

French vascular physicians' practices in indicating antiplatelet and anticoagulation therapy in venous thromboembolism.

Background: As antiplatelet therapy becomes widespread, physicians face the issue patients being treated with antiplatelet agents (APA) and anticoagulants for venous thromboembolism (VTE). Bleeding risk of this combination is increased 1.5-2.5-fold. The aim of this survey is to assess French vascular physician's management of this combination at the beginning of the treatment and at 6 months of treatment for VTE. Patients and methods: French vascular physicians were surveyed between September and December 2017, using 4 fictional scenarios regarding a VTE event diagnosed in a patient under antiplatelet therapy plus isolated questions in an online questionnaire, sent by the French Society of Vascular Medicine to its members. Out of 1812 physicians, 179 returned valid questionnaires: the response rate was 9.9%. Results: Firstly 97.2% of respondents acknowledged extra risk with this combination; and 63% ceased antiplatelet therapy when initiating anticoagulants; while 36% did not. Secondly, four strategies emerged: 31.4% ceased APA and prescribed full-dose anticoagulants at initiation and at 6 months; 32% associated reduced-dose anticoagulation with APA at 6 months, regardless of what they decided at initiation; 16.5% prescribed isolated full-dose anticoagulants at initiation and reduced-dose at 6 months; lastly 11.2% associated full-dose anticoagulant with antiplatelet therapy at initiation and at 6 months. Conclusions: French vascular physicians adopted different strategies according to estimated risk/benefit ratio. Prospective randomized controlled trials should compare these strategies in order to make recommendations.

How to become proficient in performance of the resting ankle-brachial index: Results of the first randomized controlled trial.

The resting ankle-brachial index (ABI) is a first-line test to diagnose peripheral artery disease (PAD). No randomized controlled trial (RCT) has yet been conducted to determine the best teaching method to become proficient in the ABI procedure. We conducted a monocentric RCT to determine whether didactic learning alone or didactic learning combined with experiential learning improved proficiency in the ABI procedure. Medical students ( n = 30) received didactic learning, including (i) a presentation of the ABI guidelines and (ii) a video demonstration. Each student was then randomized into two groups ('no experiential learning group' and 'experiential learning group'). An initial evaluation was performed after the didactic learning and a final evaluation at the end of the intervention. A student was considered to be proficient when he or she performed a correct ABI procedure on a healthy individual and a patient. The correct procedure corresponds to (i) following guidelines and (ii) a difference in ABI measurement between a vascular specialist and a student of ≤ 0.15. No student was proficient at the initial evaluation. At the final evaluation, in the didactic learning group, the number of proficient students was not improved compared with the initial evaluation (0/10 vs 1/10). In the experiential learning group, the number of proficient students was significantly improved (0/20 vs 11/20; p < 0.05). At the final evaluation, there was a significant difference between the number of proficient students depending on their learning group. In conclusion, didactic learning alone is insufficient to gain proficiency in the ABI procedure. Combining didactic learning with experiential learning significantly improved the students' proficiency.

Noninvasive Peripheral Artery Disease Screening Tools: A Deficient Knowledge among French Vascular Residents from 4 Medical Schools.

BACKGROUND: Ankle-brachial index (ABI) at rest, postexercise ABI, and toe-brachial index (TBI) are essential diagnostic tools recommended for peripheral artery disease (PAD) diagnosis. Our study investigates the level of knowledge on these 3 tests among vascular medicine residents from 4 French medical schools in France. METHODS: We included 19 vascular medicine residents in a cross-sectional study. During an annual obligatory seminar, all residents accepted to fill 3 questionnaires concerning knowledge about these 3 tests. RESULTS: All residents accepted to fill 3 questionnaires. None of the residents correctly knows how to perform all pressure measurements (ABI, postexercise ABI, and TBI). Two residents had the knowledge to perform the whole ABI at rest procedure, whereas no resident had the knowledge to perform neither the postexercise ABI (P = 0.48) nor the TBI (P = 0.48). Twelve residents correctly completed the question regarding the interpretation of ABI at rest, whereas 2 correctly completed the postexercise ABI question (P = 0.001) and 4 the TBI question (P = 0.02). The number of residents who have performed more than 20 measurements is higher regarding ABI at rest than postexercise ABI and TBI (84%, 5%, and 37% respectively; P < 0.001 and P = 0.006 respectively) and significantly less often in postexercise ABI than TBI (5% vs. 37%; P = 0.04). CONCLUSIONS: This study shows for the first time that residents' knowledge of pressure measurements (resting-ABI, postexercise ABI, and TBI) of 4 French medical school are insufficient although the importance of pressure measurement has been strongly highlighted by the newly released PAD guidelines (2016) for PAD diagnosis.

Heterogeneity of Doppler waveform description is decreased with the use of a dedicated classification.

BACKGROUND: The analysis of Doppler ultrasound waveforms (DW) provides a method for detecting and evaluating arterial stenosis in the lower limb arteries but no recommendation exists on how to describe the DWs. Aims of this study were to assess the heterogeneity of the description of DWs among vascular residents and the impact of the use of a 4-item classification. METHODS: Thirty different DWs were presented to residents using Microsoft PowerPoint® slides. They were invited to describe the 30 DWs before and after the presentation of a 4-item classification (triphasic, biphasic, monophasic, and others). The heterogeneity was assessed by the number of different answers used by the residents. Nineteen residents with six to eighteen months of vascular medicine training and ultrasound experience were included. RESULTS: The average of different answers was 9 ± 4 for the whole analysis of the 30 DWs without the use of a specific classification, whereas the average was 2 ± 1 using the 4-item classification (p < 0.005). There was a significant difference in correct answers, i. e. in combined continuous waveforms and pulsed waveforms between experienced residents and younger residents (p < 0.05). CONCLUSIONS: Using a 4-item classification for DWs reduced the heterogeneity of the DW description. There is an urgent need to standardize the DW description in order to improve the patients care with peripheral artery disease.