Toe Amputation Research Articles

Considerations for furbearer trapping regulations to prevent grizzly bear toe amputation and injury

AbstractUnder the North American Model of wildlife Conservation, wildlife managers are encouraged to update management approaches when new information arises whose implementation could improve the viability of wildlife populations and the well‐being of animals. Here we detail an observation of several grizzly bears with amputated toes in southeast British Columbia between 2016‐2020 and assemble evidence to inform management strategies to remedy the issue. During the capture of 59 grizzly bears, 4 individuals (~7%) had amputated toes on one of their front feet. The wounds were all healed and linear in nature. Further opportunistic record collection revealed that similar examples of amputated toes occurred beyond our study area in neighboring mountain ranges and internationally. We found evidence that seasonal overlap between the active season for grizzly bears and the fall trapping seasons—for small furbearers with body‐gripping traps and for wolves with foothold traps—were frequently responsible for toe amputation. Photo evidence suggested that body‐gripping traps were the main trap type associated with toe amputation. Multiple options to reduce or eliminate the incidental amputation of grizzly bear toes exist, and the options have varying degrees of expected efficacy and require differing levels of monitoring. One option is to delay the start of the marten trapping season until December 1, when most bears have denned, instead of opening the season on or prior to November 1, when more than 50% of bears are still active. An alternative solution, such as a license condition that requests trappers narrow trap‐box entrances to exclude bear feet while still allowing entrance of target furbearers, has the potential to minimize accidental capture of bears, but the effectiveness of this approach is unknown. Finally, experimental toe extraction trials suggested that better anchoring traps was not a viable solution given that adult grizzly bear feet only came free from body‐gripping traps 20% of the time under maximum human force. At least 230 kg pull was required to consistently free toes from body‐gripping traps, which not all bears will be able to produce unless the cable is long and allows a running start. Solutions that do not involve season changes will require monitoring of efficacy and compliance to ensure success.

Impact of time in range during hospitalization on clinical outcomes in diabetic patients with toe amputation: a propensity score matching analysis

PurposeIn recent years, time in range (TIR), defined as a percentage within a target time range, has attracted much attention. This study was aimed to investigate the short-term effects of Time in Rang on diabetic patients undergoing toe amputation in a more specific and complete manner.MethodsA retrospective analysis on patients with diabetic foot ulcer (DFU) treated by toe amputation or foot amputation at the First Affiliated Hospital of Wenzhou Medical University between January 2015 and December 2019 were evaluated. A 1:1 match was conducted between the TIR < 70% group and the TIR ≥ 70% group using the nearest neighbor matching algorithm. Data were analyzed using Chi-squared, Fisher’s exact, and Mann–Whitney U tests.ResultsCompared with patients in the TIR ≥ 70% group, patients in the TIR < 70% had a higher rate of re-amputation, and a higher rate of postoperative infection. Multivariate analysis revealed that smoking, lower extremity arterial disease and TIR < 70% were risk factors for surgery of re-amputation. The results of subgroup analysis found that the TIR < 70% was associated with a greater risk of re-amputation in patients with HbA1c < 7.5%, lower extremity arterial disease, and non-smokers.ConclusionsTIR can be used as a short-term glycemic control indicator in patients with DFUs and should be widely accepted in clinical practice. However, a future multicenter prospective study is needed to determine the relationship between TIR and toe re-amputation in diabetic foot patients.

Cross-Sectional Analysis of 180,595 Lower Limb Amputations in the State of Sao Paulo Over 12 Years.

Lower limb amputations represent a high social, economic and health burden. Most of them are preventable and reflect areas for improvement in health care, making it essential to know their epidemiology. This is a retrospective population-based cross-sectional analysis on all lower limb amputations performed in public hospitals in Sao Paulo between 2009 and 2020, the most populous Brazilian state, with 46 million inhabitants. Using a public database, we evaluated types, rates and trends of the amputations performed, main etiologies leading to the indication for amputation, hospital length of stay and in-hospital mortality rates, demographics of the amputees and procedure costs. In total, 180,595 lower limb amputations and surgical revision of amputations were performed, with toe amputations (45%) and major amputations (33%) being the most frequent types of surgeries, with a recent significant increase in the rates for both these procedures. Peripheral artery disease was the most frequent etiology, followed by diabetes mellitus, with both showing an upward trend over the years. Most patients were male (69.3%), Caucasians (55.6%) and elderly. August was the month with the highest number of amputations in all years. Overall in-hospital mortality after lower limb amputations was 6.6%. Total reimbursed by the government was US$ 67,675,875.55. Peripheral artery disease is the most frequent underlying diagnosis for lower limb amputations, followed by diabetes mellitus, with both showing an upward trend over the years. We observed seasonality in procedure rates, with peaks in August in all years.

Efficacy of Early Closed Toe Amputation for Toe Ulcers with Suspected Osteomyelitis after Revascularization for Chronic Limb-Threatening Ischemia.

Objective: In this study, we aim to evaluate the efficacy of early closed toe amputation on the wound management of toe ulcers with suspected osteomyelitis after revascularization for chronic limb-threatening ischemia (CLTI).Methods: This retrospective study included patients who have underwent revascularization for toe ulcers associated with CLTI at Shizuoka Red Cross Hospital from 2015 to 2021. Wound management comprised early closed toe amputation for toe ulcers with suspected osteomyelitis (19 toes in 17 patients) or conservative treatment (35 toes in 26 patients). The primary endpoint was wound healing after revascularization. We compared the wound healing rate at 90 days and median healing time of early closed toe amputation versus conservative treatment.Results: Compared with the conservative treatment, early closed toe amputation was able to achieve a better wound healing rate at 90 days (89.5% vs. 68.6%; P<0.01) and a shorter median healing time (19 days vs. 62 days; P=0.01).Conclusion: There remains no established wound management for toe lesions associated with CLTI. Despite its several disadvantages including wound infection and possible foot deformity, early closed toe amputation for toe ulcers with suspected osteomyelitis can be considered a safe approach in terms of wound management.

Early outcomes of excimer laser atherectomy for below-the-knee lesions in patients with diabetic foot

Objective: To evaluate the clinical outcomes of excimer laser atherectomy (ELA) in the treatment of diabetic foot with below-the-knee(BTK) lesions. Methods: The clinical data of 11 patients with diabetic foot with BTK lesions who underwent ELA at Department of Vascular Surgery,Zhongshan Hospital of Fudan University and Department of Vascular and Wound Treatment Center,Jinshan Hospital of Fudan University from September 2019 to May 2021 were retrospectively analyzed.There were 10 males and 1 female,aged 70.5 years(range:41 to 83 years).There were 20 lesions in 12 limbs,including 19 chronic total occlusion.All of the limbs were classified as Rutherford class 5 and suffered ulceration.The surgical efficacy,complications and ankle brachial index(ABI) after operation were record. Results: All patients underwent the operation successfully,the technical success rate was 12/12.No distal embolization,flow-limiting dissection,perforation or bailout stenting was occurred.The follow-up period was 8.2 months(range:3 to 13 months).The ABI increased from 0.58(range:0.24 to 1.57) before operation to 0.88(range:0.68 to 1.05) after operation.At 3 months after the operation,1 limb (1/12) underwent endovascular operation again due to restenosis,ulcers were healed in 5 limbs(5/12),and no amputation (limb/toe),death or loss of follow-up patients.Six months after the operation,2 patients were lost to follow-up and 2 died,ulcers were healed in 6 limbs(6/8),1 limb (1/8) underwent toe amputation due to prolonged healing of ulcers of toe. Conclusion: ELA is feasible and effective in the treatment of DF with BTK lesions,providing a new option of debulking atherectomy in such a group of patients.

1486-PUB: Single-Toe Necrosis over Diabetic Foot Ulcer (DFU) : Amputation Surgery at Bedside by a Diabetologist or in the Operating Room by a Surgeon

Single toe necrosis complicating DFU requires an amputation performed in the operating room by a surgeon (ORAS) . Bedside amputation by a diabetologist (BAD) complying with the surgical rules might be an option in case of disagreement with the surgeon about the amputation level (major favored by the surgeon) and/or an anesthetic contraindication. In our monocentric, retrospective study, we assessed the one year prognosis (healing rate without extra surgery) of a single toe necrosis amputation over DFU performed by a diabetologist or a surgeon. Amputation levels (transphalangeal, TPA, metatarsophalangeal disarticulation, MPD, single transmetatarsal, TMA) were decided by our multidisciplinary team. Out of 7patients admitted with DFU (05.2016-10.2020) , 57 (8%) were included because of single toe necrosis (BAD n=33, 58%; ORAS n=24, 42%) . Amputation levels TPA, MPD, TMA were respectively 26, 47, 27%. The median duration of follow-up was 28 months. Patients characteristics were non statistically different between groups except for the dorsal arch permeability: males 74%; median age 64y; Type 2 Diabetes Mellitus (DM) 97%; median DM duration 17y. The rate of permeable dorsal arch was significantly lower in the BAD group (45% vs. 75%, p=0.03) . Single TMA rate was significantly higher in the ORAS group (50% vs. 9%, p=0.001) . The one year healing rate without extra surgery was statistically different between the two groups (BAD 58% vs. ORAS 83%, p=0.05) . The need for extra surgery was significantly higher in the BAD group (42% vs. ORAS 13%, p=0.02) . The overall mortality was non significantly different between groups (BAD 21% vs. ORAS 4%, p=0.12) . For a single toe necrosis over DFU, in patients with a high risk for a circumscribed toe amputation failure as stated by the surgeon, the results of bedside amputation performed by a diabetologist invalidated this unfavorable prognosis in most cases. Disclosure F.Féron: None. J.Riveline: None. J.Gautier: Other Relationship; Novo Nordisk, Sanofi, Speaker's Bureau; Eli Lilly and Company. J.Kevorkian: None.

1147-P: Trends in Diabetes-Related Foot Disease Hospitalization, Revascularization, and Amputations in Australia 20to 2019

Hospitalization for diabetes-related foot disease adds considerable burden for people living with diabetes and often leads to lower extremity amputation. We evaluated trends in the incidence of foot disease related hospital admission, revascularization and amputation procedures among people with type 1 and type 2 diabetes in Australia from 2010-2019. We included 70,766 people with type 1, and 1.1 million people with type 2 diabetes from the Australian diabetes registry (55% male) . We linked the diabetes registry to hospital admissions data to obtain the number of hospital admissions for foot disease, revascularization and amputation procedures. We estimated the annual incidence rates, using people with diabetes as the denominator, and evaluated trends over time with Joinpoint regression. In type 1 diabetes, rates of admission for foot disease and revascularization increased, while amputation rates were relatively stable (Table) . In type 2 diabetes, rates of foot disease admission and revascularization increased. While above the knee amputations decreased, below the knee amputations were stable, and foot and toe amputations increased. Average annual percent changes were generally higher for men than women (i.e. men showed greater increases or less of a decrease over time) . These findings highlight the importance of improving management of diabetes-related foot disease. Disclosure M.Quigley: None. J.I.Morton: None. P.A.Lazzarini: None. J.E.Shaw: Advisory Panel; Abbott Diagnostics, AstraZeneca, Eli Lilly and Company, Pfizer Inc., Roche Diagnostics, Research Support; AstraZeneca, Boehringer Ingelheim International GmbH, Speaker's Bureau; AstraZeneca, Eli Lilly and Company, Novo Nordisk, Sanofi. D.J.Magliano: None. Funding MQ is supported by an Australian Government Research Training Program (RTP) Scholarship. JIM is supported by an Australian Government Research Training Program (RTP) Scholarship and Monash Graduate Excellence Scholarship. PAL is supported by a National Health and Medical Research Council Early Career Fellowship. JES is supported by a National Health and Medical Research Council Investigator Grant. DJM is supported by a National Health and Medical Research Council Senior Research Fellowship. This work is partially supported by the Victorian Government’s Operational Infrastructure Support Program.

Successful treatment of type ii diabetes mellitus with infected diabetic foot ulcer caused by ESBL producing Klebsiella pneumonia with cefepime plus sulbactam (Supime): A case report

Diabetic patients are at significant risk of developing neuropathy, leading to a diabetic foot injury. Complications of diabetic foot injury may lead to gangrene and non-traumatic lower extremity amputations. Diabetic patients with diabetic foot ulcers are more prone to bacterial infections and are associated with high chances of amputation. The diabetic patient flora provides an ideal environment for Gram-positive and Gram-negative bacterial growth, leading to increased morbidity and mortality. The antimicrobial-resistant Gram-negative bacterial infections in diabetic patients have a higher probability of amputation. Here we discuss a case of a 70-year male diabetic patient successfully treated with Supime (cefepime plus sulbactam) who had undergone an amputation of the right great toe and infected left foot ulcer due to ESBL producing K. Pneumonia.

Recurrent foot ulcers in patients with diabetes mellitus in out-patient care

OBJECTIVE. Relapses of diabetic foot ulcers are an urgent problem of outpatient surgery, however, risk factors for relapse, as well as the definition of relapse itself remain a subject of discussion. The presented study investigates the frequency of relapses of ulcerative foot defects in diabetes mellitus, the risk factors for their development and treatment outcomes, based on the definition of relapse as the development of a repeated defect in the same place as the healed defect.METHODS AND MATERIALS. The data of 1714 patients with foot ulcers (2213 ulcerative defects) from 01.2012 to 01.2017 were studied. Patients were divided into two groups: with relapses (n=239, 13.9%) and without them (n=1475). Risk factors for relapse, characteristics of patients and ulcerative defects, and treatment outcomes were evaluated.RESULTS. Relative risk for relapse: type 1 diabetes mellitus (1.36); Charcot foot (1.65); history of amputation of the great toe (1.35); severe polyneuropathy (1.25); neuropathic foot (1.37). Relapses/single ulcer (%): superficial lesion 72.8/63.3 (р&lt;0.01); primary healing: 61.1/52.7 (p=0.025); healing after surgery (amputations excluded): 4.2/4.5 (ns); amputations: 7.1/6.6 (ns) of which major 5.9/20.6 (p=0.01); non-healing (%): 11.7/5.5 (р=0.001); loss of follow-up (%): 15.9/30.7 (р=0.0001). Median duration of the treatment (days) of relapses/single ulcer: conservative 147/114; healing after surgery (amputations excluded) 241/170; after amputation 286/182. Revascularization in relapses – 7 (100%), with single ulcers – 66 (59.5% of patients with critical ischemia).CONCLUSION. 5-years relapse rate was 13.9 %. Patients with Charcot foot, postoperative deformities and with neuropathic form of diabetic foot syndrome are more prone for foot reulceration. Recurrent ulcers are characterized with longer duration of the treatment however their primary healing rate is higher compared with single ulcer group. The results of the study were significantly influenced by the high frequency of loss of follow-up in both groups.

The bad contretemps causes mid-shaft tibia and fibula fracture with traumatic amputation of 2nd toe: A case report

The bad contretemps causes mid-shaft tibia and fibula fracture with traumatic amputation of 2nd toe: A case report

Use of Diperoxocholric Acid in Infected Diabetic Foot Ulcers Leading to Osteomyelitis: Case Reports

This article describes three patients who had an episode of infected diabetic foot ulcer with osteomyelitis, and subsequently treated with a Diperoxochloric acid topical solution. Diperoxochloric acid is a new chemical entity approved in the treatment of diabetic foot ulcer. It has properties to heal the wound and kill the microbes in wound, which is the need of hour. As most of the products that are available in market have either antimicrobial activity or wound growth factors, which have no action on microbes makes Diperoxochloric acid mechanism unique. All three ulcers showed positive wound contraction and reduction in size throughout the follow-up period ranging from 3 to 10 weeks. All the three patients showed positive signs of wound healing. One of the patients in whom amputation of great toe was advised also healed completely without any need of amputation.&#x0D; Keywords: Diabetic foot ulcer, Diperoxochloric acid

Three-Dimensional-Printed Lesser Metatarsal Replacement: The First Case Report.

Different procedures have been reported for severe and recurrent lesser toes deformity. These included DuVries metatarsophalangeal joint arthroplasty, resection arthroplasty, partial proximal phalangectomy, syndactylization, or lesser toe amputation. In the presence of a failed metatarsal head resection, the surgeon is faced with limited salvage options including Hoffman procedure or lesser toe amputation. The 3D printing technology has allowed orthopaedic surgeons to expand the therapeutic arsenal to address challenging situations. We herein present the first case of 3D-printed second lesser metatarsal replacement performed after a failed second metatarsal head resection.Level of Evidence: V.

The Role of Maggot Debridement Therapy in Wound Healing

Abstract The upward trend of diabetes and its complications had taken a big toll on developing countries where big budgets are allocated to manage it. Diabetes-based foot ulcerations has become a nightmare for patients and equally the clinicians due to its chronicity and devastating complications. Diabetic foot ulcers (DFU) take a long time to heal and generally resistant to conventional methods. DFU are commonly associated with high numbers of foot complications such as infection, gangrene and lower limb amputations. Despite the technological advancement in chronic wound management, the numbers of preventable foot complications especially amputations of toes and limb are still in the upward trend as the number of diabetics increases across the globe. Alternative method using sterile maggots of Lucilia spp has been much talked about for the past few decades to improve wound healing outcomes and ultimately reduce foot complications. Maggot debridement therapy, commonly known as MDT has been widely used as an alternative tool in the debridement of chronic wounds to remove slough, necrotic tissue from the wound bed. The usage of MDT has produced significant debridement and healing outcomes in diabetic foot ulcers and has been shown to reduce infections and stimulate healing. Despite numerous findings pointing to the relevance of MDT in the treatment protocol of chronic wounds especially DFU, MDT remains as the last resort in the process of salvaging limbs.

54-Year-Old Man With Acute Dyspnea on Exertion

54-Year-Old Man With Acute Dyspnea on Exertion

Subungual melanoma with blue naevus-like morphological features: a clinicopathological retrospective analysis of nine cases

Melanocytic lesions in the nail apparatus are often challenging. Both subungual melanomas (SUM) and blue naevus of the nail are very rare. Occasionally, melanomas may mimic blue naevus histologically. Benign and malignant blue melanocytic lesions are commonly associated with G protein mutations, a distinct abnormality not associated with conventional subungual melanomas. We describe the clinical, histological and immunohistochemical features of nine cases of SUM with blue naevus-like morphological features. Mutations in exon 4 and 5 of GNAQ and GNA11 were investigated in two cases, which showed no mutations. RNA-seq of one case revealed unknown mutations along with mutations in ATM, METK and ARID1A. Our study delineates a variant of SUM that mimics blue naevus. Awareness of this pitfall is important when evaluating heavily pigmented lesions around the nail in order to avoid misdiagnosis. Appropriate sampling of subungual lesions and clinicopathological correlation are paramount to reach the correct diagnosis.

Cutaneous Manifestation of Diabetes Mellitus in an Unsheltered Male Leading to Emergent Hospitalization

Diabetes mellitus (DM) is one of the most common chronic diseases in the United States. It is characterized by increased patient morbidity and mortality due to the many complications that can arise. Certain dermatological findings can be indicative of poorly controlled DM and can be a useful clue to further management. Persons experiencing homelessness (PEH) with DM often have higher rates of diabetic complications than the general diabetic population. Medical providers caring for PEH in the setting of limited resources should carefully evaluate cutaneous disease as a potential indicator of underlying illness. This physical manifestation of illness can serve to guide the next appropriate steps in management. A 41-year-old unsheltered male with an extensive medical history of hypertension, seizures, chronic diarrhea, and cocaine use was seen at a “foot-washing” medical outreach event. He presented with fevers, chills, and multiple painless right lower extremity ulcerated lesions of unspecified origin. A finger-stick glucose measurement was found to be 650 mg/dL. After immediate administration of 10 units of insulin, he was transported immediately to the emergency department and admitted. His month-long hospital course was complicated and involved the amputation of multiple toes. Preemptive outreach and management could have prevented the marked deterioration of his disease and represents the importance of outreach and regular follow-up with the PEH community.

Clinical Effect Analysis of Spinal Cord Electrical Stimulator Implantation for Diabetic Foot

ObjectiveTo investigate the clinical effect of spinal cord electrical stimulator implantation in the treatment of a diabetic foot (DF). Materials and MethodsWe recruited 19 patients with DF who were admitted to Shengjing Hospital of China Medical University between January 2018 and May 2020. All the patients were treated with spinal cord electrical stimulator implantation. Skin temperature, degree of pain, quality of life (QOL) score, limb (toe) preservation, and nerve conduction velocity of the patients were compared pre- and postoperatively. ResultsThe diameter and peak velocity of multisegment arteries in the lower limbs had significantly increased post surgery. Foot skin temperature significantly increased in patients with good effect. The postoperative visual analog scale score of the patients was significantly lower than that noted preoperatively (p < 0.05). The conduction velocities of the lower limb sensory nerves (eg, superficial peroneal nerve and sural nerve) and motor nerves (eg, common peroneal nerve and tibial nerve) had improved post surgery. Moreover, patients' QOL score had significantly improved postoperatively (p < 0.05). The limb (toe) salvage rate was 94.74%. ConclusionThe implantation of a spinal cord electrical stimulator for treating DF can effectively relieve pain and other associated symptoms. Additionally, this device can promote nerve function recovery and lower limb blood supply and reduce the risk of toe amputation; therefore, it is clinically effective and should be considered in the treatment of DF.

A Population-Based Analysis of Diabetes-Related Care Measures, Foot Complications, and Amputation During the COVID-19 Pandemic in Ontario, Canada

Deferred diabetic foot screening and delays in timely care of acute foot complications during the COVID-19 pandemic may have contributed to an increase in limb loss. To evaluate the association of the COVID-19 pandemic with diabetes-related care measures, foot complications, and amputation. This population-based cohort study included all adult residents of Ontario, Canada, with diabetes and compared the rates of selected outcomes from January 1, 2020, to February 23, 2021, vs January 1, 2019, to February 23, 2020. Comprehensive in-person diabetes care assessment, including foot examination; hemoglobin A1c (HbA1c) measurement; emergency department visit or hospitalization for diabetic foot ulceration, osteomyelitis, or gangrene; lower extremity open or endovascular revascularization; minor (toe or partial-foot) amputation; and major (above-ankle) leg amputation. Rates and rate ratios (RRs) comparing 2020-2021 vs 2019-2020 for each measure were calculated for 10-week periods, anchored relative to onset of the pandemic on March 11, 2020 (11th week of 2020). On March 11, 2020, the study included 1 488 605 adults with diabetes (median [IQR] age, 65 [55-74] years; 776 665 [52.2%] men), and on March 11, 2019, the study included 1 441 029 adults with diabetes (median [IQR] age, 65 [55-74] years; 751 459 [52.1%] men). After the onset of the pandemic, rates of major amputation in 2020-2021 decreased compared with 2019-2020 levels. The RR for the prepandemic period from January 1 to March 10 was 1.05 (95% CI, 0.88-1.25), with RRs in the pandemic periods ranging from 0.86 (95% CI, 0.72-1.03) in May 20 to July 28 to 0.95 (95% CI, 0.80-1.13) in October 7 to December 15. There were no consistent differences in demographic characteristics or comorbidities of patients undergoing amputation in the 2020-2021 vs 2019-2020 periods. Rates of comprehensive in-person diabetes care assessment and HbA1c measurement declined sharply and remained below 2019-2020 levels (eg, in-person assessment, March 11 to May 19: RR, 0.28; 95% CI, 0.28-0.28). The rates of emergency department visits (eg, March 11 to May 19: RR, 0.67; 95% CI, 0.61-0.75), hospitalization (eg, March 11 to May 19: RR, 0.77; 95% CI, 0.68-0.87), open revascularization (eg, March 11 to May 19: RR, 0.66; 95% CI, 0.56-0.79), endovascular revascularization (March 11 to May 19: RR, 0.70; 95% CI, 0.61-0.81), and minor amputation (March 11 to May 19: RR, 0.70; 95% CI, 0.60-0.83) initially dropped but recovered to 2019-2020 levels over the study period. In this population-based cohort study, disruptions in care related to the COVID-19 pandemic were not associated with excess leg amputations among people living with diabetes. As the pandemic ends, improved prevention and treatment of diabetic foot complications will be necessary to maintain these positive results.

Ainhum (Or Dactylolysis Spontaneous) at the Fousseyni Daou Hospital in Kayes about a Case

A&#239nhum or spontaneous dactylolysis is a progressive constriction of the digito-plantar fold of the fifth toe which leads after several years of evolution to a spontaneous amputation of the toe. Classically, a distinction is made between “true A&#239nhum” of unknown cause, which affects only blacks and those of African (sub-Saharan) descent; “pseudo-A&#239nhum”, which follows various causes such as an inflammatory flange or foreign body constriction; and finally, palmo-plantar keratoderma, of genetic origin, such as Vohwinkel disease. We report a case of A&#239nhum received at stage III of the pathology and who benefited from an amputation of the fifth toe.

Assessment of the PPG up-stroke time to predict peripheral lower limb arterial occlusive disease (PAOD): Application to the pOpmetre ®

Screening for peripheral lower limb arterial occlusive disease (PAOD) is a major challenge for the prevention, management and treatment of patients with arteriosclerosis. The Ankle Brachial Index (ABI) is the reference method, it requires expertise and time which are limiting factors for systematic screening. The analysis of a photoplethysmographic (PPG) wave form in the lower limb can be an interesting alternative. In a retrospective pilot study we analyzed the possibility of detecting PAOD by measuring the up-stroke time wave form (UTP) at the toe by PPG method. The ABI (minimum of 2 leg arteries) and the UTP (pOpmeter® - Axelife - France) were collected in 54 patients during a vascular assessment and presenting different stages of PAOD. Of the 108 lower limbs registered, 25 were excluded for technical difficulties (very severe PAOD, mediacalcosis, toe amputation). 83 lower limbs were analyzed. Mean age was 69 ± 12; 75% men, 28% diabetics, 47% hypertensive. 17% without PAOD (stage 0); 44% stage 1; 23% stage 2; and 2% Stage 3. The 200 milliseconds UTP threshold identifies PAOD from stage 1 with: sensitivity 77%, specificity 94%, a positive predictive value 96% and negative predictive value 68% (Yule Q = 0.96). UTP makes it possible to identify an PAOD in 100% of patients with mediacalcosis (ABPI > 1.4, n = 3, diabetic = 2). The UTP measured by PPG at the toe is a simple and rapid method (< 2 min) detects the PAOD stages 1 to 3 with 94% specificity, 77% sensitivity that must be improved by using other thresholds to optimize the test. These results have to be confirmed with a prospective study.