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Claudication: The Artery and Beyond
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Claudication: The Artery and Beyond

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Vascular Medicine".

Deadline for manuscript submissions: closed (20 December 2022) | Viewed by 4197

Special Issue Editor

Prof. Dr. Pierre Abraham

E-Mail Website
Guest Editor
1. Exercise and Sports medicine, University Hospital of Angers, 4 Rue Larrey, 49100 Angers, France
2. University Angers, UMR CNRS 6015-INSERM 1083, MITOVASC, SFR ICAT, 49045 Angers, France
Interests: exercise and sports; claudication; thoracic outlet syndrome; non-invasive investigation; peripheral artery disease; microcirculation; diagnostic testing

Special Issue Information

Dear Colleagues,

Claudication is an exercise-related symptom characterized by pain or discomfort of the upper or lower limb during exercise. When of arterial origin, it results from the transient positional compression of a healthy artery (such as in the thoracic outlet or popliteal artery syndromes) or from the inability of permanently diseased vessels (atherosclerosis, dysplasia, endofibrosis) to fulfil the increased oxygen requirements of the muscles during physical activity. This Special Issue aims to see beyond the artery and consider an integrative or altitudinal view of the relationship between the complaints of the patients and the underlying cause of symptoms. We welcome papers dealing with the following topics: (1) claudication of non-arterial origin; (2) how the artery interacts with its local environment (veins, surrounding tissue, oxygen content of blood, hemoglobin concentration, collateral circulation to the target occluded artery, etc.) in patients with arterial claudication; (3) how comorbid conditions should be accounted for in the diagnosis, treatment and follow up of patients with claudication of suspected, debatable or uncertain arterial origin; (4) the relationship of symptoms and arterial disease severity such as the importance of exercise intensity and activity inactivity; and (5) the influence of factors such as gender, age, motivation, nutrition, mood and modulation of pain expression on the symptoms of underlying disease.

Prof. Dr. Pierre Abraham
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • limb pain
  • exercise
  • physiopathology
  • diagnosis
  • treatment
  • walking impairment

Published Papers (3 papers)

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Research

16 pages, 2119 KiB  
Article
Diagnosing Sport-Related Flow Limitations in the Iliac Arteries Using Near-Infrared Spectroscopy
by Martijn van Hooff, Jem Arnold, Eduard Meijer, Paul Schreuder, Marta Regis, Lin Xu, Marc Scheltinga, Hans Savelberg and Goof Schep
J. Clin. Med. 2022, 11(24), 7462; https://doi.org/10.3390/jcm11247462 - 16 Dec 2022
Cited by 2 | Viewed by 1814
Abstract
Background: A flow limitation in the iliac arteries (FLIA) in endurance athletes is notoriously difficult to diagnose with the currently available diagnostic tools. At present, a commonly used diagnostic measure is a decrease in ankle brachial index with flex hips (ABIFlexed) [...] Read more.
Background: A flow limitation in the iliac arteries (FLIA) in endurance athletes is notoriously difficult to diagnose with the currently available diagnostic tools. At present, a commonly used diagnostic measure is a decrease in ankle brachial index with flex hips (ABIFlexed) following a maximal effort exercise test. Near-infrared spectroscopy (NIRS) is a non-invasive technique that measures skeletal muscle oxygenation as reflected by the balance of O2 delivery from microvascular blood flow and O2 uptake by metabolic activity. Therefore, NIRS potentially serves as a novel technique for diagnosing FLIA. The purpose of this study is to compare the diagnostic accuracy of NIRS-derived absolute, amplitude, and kinetic variables in legs during and after a maximal exercise test with ABIFlexed. Methods: ABIFlexed and NIRS were studied in 33 healthy subjects and 201 patients with FLIA diagnosed with echo-Doppler. Results: After maximal exercise, NIRS kinetic variables, such as the half value time and mean response time, resulted in a range of 0.921 to 0.939 AUC for the diagnosis of FLIA when combined with ABIFlexed. Conversely, ABIFlexed measurements alone conferred significantly worse test characteristics (AUC 0.717, p < 0.001). Conclusions: NIRS may serve as a diagnostic adjunct in patients with possible FLIA. Full article
(This article belongs to the Special Issue Claudication: The Artery and Beyond)
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12 pages, 1210 KiB  
Article
Lower Extremity Arterial Disease and Lumbar Spinal Stenosis: A Study of Exercise-Induced Arterial Ischemia in 5197 Patients Complaining of Claudication
by Simon Lecoq, Jeanne Hersant, Mathieu Feuilloy, Henri-François Parent, Samir Henni and Pierre Abraham
J. Clin. Med. 2022, 11(19), 5550; https://doi.org/10.3390/jcm11195550 - 22 Sep 2022
Viewed by 1560
Abstract
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue Claudication: The Artery and Beyond)
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11 pages, 933 KiB  
Article
Quiescent-Interval Single-Shot Magnetic Resonance Angiography May Outperform Carbon-Dioxide Digital Subtraction Angiography in Chronic Lower Extremity Peripheral Arterial Disease
by Judit Csőre, Ferenc Imre Suhai, Marcell Gyánó, Ákos András Pataki, Georgina Juhász, Milán Vecsey-Nagy, Dániel Pál, Daniele Mariastefano Fontanini, Ákos Bérczi and Csaba Csobay-Novák
J. Clin. Med. 2022, 11(15), 4485; https://doi.org/10.3390/jcm11154485 - 1 Aug 2022
Cited by 2 | Viewed by 1988
Abstract
Nephroprotective imaging in peripheral arterial disease (PAD) is often crucial. We compared the diagnostic performance of non-contrast Quiescent-interval single-shot magnetic resonance angiography (QISS MRA) and carbon-dioxide digital subtraction angiography (CO2 DSA) in chronic lower extremity PAD patients. A 19-segment lower extremity arterial model [...] Read more.
Nephroprotective imaging in peripheral arterial disease (PAD) is often crucial. We compared the diagnostic performance of non-contrast Quiescent-interval single-shot magnetic resonance angiography (QISS MRA) and carbon-dioxide digital subtraction angiography (CO2 DSA) in chronic lower extremity PAD patients. A 19-segment lower extremity arterial model was used to assess the degree of stenosis (none, <50%, 50–70%, >70%) and the image quality (5-point Likert scale: 1-non-diagnostic, 5-excellent image quality). Intra-class correlation coefficient (ICC) was calculated for inter-rater reliability. Diagnostic accuracy and interpretability were evaluated using CO2 DSA as a reference standard. 523 segments were evaluated in 28 patients (11 male, mean age: 71 ± 9 years). Median and interquartile range of subjective image quality parameters for QISS MRA were significantly better compared to CO2 DSA for all regions: (aortoiliac: 4 [4–5] vs. 3 [3–4]; femoropopliteal: 4 [4–5] vs. 4 [3–4]; tibioperoneal: 4 [3–5] vs. 3 [2–3]; all regions: 4 [4–5] vs. 3 [3–4], all p < 0.001). QISS MRA out-performed CO2 DSA regarding interpretability (98.3% vs. 86.0%, p < 0.001). Diagnostic accuracy parameters of QISS MRA for the detection of obstructive luminal stenosis (70%<) as compared to CO2 DSA were as follows: sensitivity 82.6%, specificity 96.9%, positive predictive value 89.1%, negative predictive value 94.8%. Regarding the degree of stenosis, interobserver variability for all regions was 0.97 for QISS MRA and 0.82 for CO2 DSA. QISS MRA proved to be superior to CO2 DSA regarding subjective image quality and interpretability for the imaging of chronic lower extremity PAD. Full article
(This article belongs to the Special Issue Claudication: The Artery and Beyond)
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