[Quality standards for ultrasound assessment (CW-Doppler, Duplex US) of the lower limb arteries in vascular medicine. Report of the French Society for Vascular Medicine].

The quality standards of the French Society of Vascular Medicine for the ultrasound assessment of lower limb arteries in vascular medicine practice are based on the principle that these examinations have to meet two requirements: technical know-how (knowledge of devices and methodologies); medical know-how (level of examination matching the indication and purpose of the examination, interpretation and critical analysis of results). OBJECTIVES OF THE QUALITY STANDARDS: To describe an optimal level of examination adjusted to the indication or clinical hypothesis; to homogenize practices, methodologies, terminologies, results description and report; to provide good practice reference points and to promote a high quality process. THEMES OF THE QUALITY STANDARDS: The three levels of examination, indications and objectives for each level; the reference standard examination (level 2) and its variants according to indications; the minimal content of the exam report, the medical conclusion letter to the corresponding physician (synthesis, conclusion and management suggestions); commented glossary (anatomy, hemodynamics, signs and symptoms); technical basis.

[What are the guidelines for using a venous segment for an arterial bypass? General review].

Since the first femoropopliteal bypass, performed by J. Kunlin, in 1950, the saphenous vein has remained the material of choice for arterial bypass in a wide variety of localizations. Harvesting must be adapted to vein quality and the length necessary for the bypass.

Prevalence of unknown peripheral arterial disease in patients with coronary artery disease: data in primary care from the IPSILON study.

Background: Peripheral arterial disease (PAD) is a marker of increased risk of cardiovascular events and of poor prognosis in patients with coronary artery disease (CAD). The prevalence of unknown PAD among patients with CAD varies between studies according to the mode of diagnosis.

Aims: To evaluate the prevalence of unknown PAD, diagnosed using the ankle-brachial index (ABI), in patients from the IPSILON study with a CAD diagnosis; to assess the profile of these patients; and to determine predictors of PAD.

Prevalence of peripheral arterial disease in high-risk patients using ankle-brachial index in general practice: a cross-sectional study.

Aims: The deleterious nature of peripheral arterial disease (PAD) is compounded by a status of underdiagnosed and undertreated disease. We evaluated the prevalence and predictive factors of PAD in high-risk patients using the ankle-brachial index (ABI).

Methods: The ABI was measured by general practitioners in France (May 2005-February 2006) in 5679 adults aged 55 years or older and considered at high risk.

Peripheral arterial disease and isolated systolic hypertension: the ATTEST study.

Hypertension is a risk factor for cardiovascular (CV) diseases, either coronary artery disease (CAD), peripheral artery disease (PAD) or cerebrovascular disease (CVD). The relationships between those different localizations of CV disease and the haemodynamic features of hypertension have been poorly evaluated in the past. In the ATTEST study, a geographically representative panel of 3020 general practitioners recruited 8316 consecutive patients with CV diseases (PAD, CAD or CVD, alone or in association).

Peripheral arterial disease versus other localizations of vascular disease: the ATTEST study.

Objective: Despite the increased cardiovascular morbidity and mortality risk of patients with peripheral arterial disease, previous worldwide studies have documented undertreatment of cardiovascular risk factors in such patients.

Method: The ATTEST study was an observational cross-sectional epidemiologic study. Patients (n = 8475) were selected by 3020 general practitioners in France who were asked to include the first three patients with at least one site of proven atherothrombotic disease (peripheral arterial disease of the lower limbs for two patients and coronary artery disease or ischemic stroke for the third patient).

[Peripheral arterial disease: what management practices for general practitioners?].

Objective: The purpose of this study was to analyze the results of the ATTEST study in order to evaluate general medicine management practices for peripheral arterial disease (PAD). Our analysis was based on the guidelines for good practice which recommend measurement of the systolic pressure index (SPI), search for other localizations of atherothrombosis, treatment of risk factors including smoking, walking exercises, and long-term prescription of anti-platelets.

Methods: ATTEST is a cross-sectional multicentric observational epidemiologic study conducted in metropolitan France.

Carotid stenting with cerebral protection: first clinical experience using the PercuSurge GuardWire system.

Purpose: To study the feasibility and safety of carotid angioplasty and stenting using a new cerebral protection device that temporarily occludes the distal internal carotid artery (ICA).

Methods: Forty-eight high-risk patients (39 men, mean age 69.1 +/- 8 years, range 54 to 86) with 53 ICA stenoses underwent percutaneous angioplasty and stenting via the femoral approach under cerebral protection afforded by a 0.

Reproducibility in ultrasonic characterization of carotid plaques.

Background And Purpose: Echolucent carotid plaques compared with echogenic plaques could carry a significant risk of transient ischemic attacks and strokes, but the reproducibility of new ultrasonic methods has not yet been proved. The objective was to evaluate interobserver and intraobserver agreement in characterizing the carotid plaques studied by both B mode imaging and color Doppler imaging, which is the only ultrasonic method available for recognizing anechoic lesions.

Methods: Fifty-three carotid plaques greater than 40% in diameter were selected from four centers and simultaneously analyzed by 9 observers.

[Prevalence of anatomic renal artery stenosis in hypertensive patients with arteritis].

Atherosclerosis is a diffuse disease that can affect renal arteries. An important point for the management of hypertensive patients is the prevalence of anatomical renal stenosis when lower-limb peripheral vascular disease coexists with hypertension. From Sept 1, 1987, to Aug 31, 1990, 252 consecutive hypertensive adults with peripheral vascular disease were referred to our clinic.

[A new contribution of Doppler echography of renal arteries: follow-up studies of angioplasties. A retrospective study of 50 cases].

Objective: analysis of Doppler Duplex (DD) contribution to renal artery percutaneous angioplasty (ATL) follow-up.

Method: between 1983 and 1989, SO ATL were performed in 47 subjects with renovascular hypertension. Their average age was 50 +/- 12 years.

[Thrombosis of renal veins].

According to whether they are acute or progressive, complete or partial, uni- or bilateral, renal venous thromboses have quite various clinical expressions and biological consequences. The diagnosis is readily suggested by acute pain in the side with an increase in the size of one or both kidneys, associated with hematuria, proteinuria, or in case of renal failure, which is characteristic of acute bilateral thrombosis. On the other hand, chronic thrombosis of a renal vein is sometimes suggested only when complications such as pulmonary embolism occur.

[Ultrasonic tomography of the abdominal vessels].

For a long time echotomography just was interested in big vessels as precious anatomic guide, to delimit pancreas, to cut up liver or to situate ganglion or tumour. The improvement of technics, and particularly real time sonography coupled with continuous wave or pulsed doppler, have permitted to step over the next stage which is to recognize the proper lesions of the vessels. The probes available to perform abdominal vessels investigations have a frequency between 3 and 7.

[A method of venous study by real time ultrasonography associated with directional and continuous Doppler ultrasonography].

The authors propose a method of investigation of the superficial and deep venous axes of the limbs, neck, abdomen and pelvis by using successively directional and continuous wave Doppler and real time high resolution echotomography. The principle is to recognise normal and pathological venous flow by the Doppler technique and to detect the intrinsic (thrombus, agenesis) or extrinsic abnormalities causing local haemodynamic disturbances or distal emboli even in the absence of flow disturbance by echotomography. If the suggested protocol is strictly observed, the method allows diagnosis of the majority of pathologies, not only their haemodynamic consequences but also the underlying causes.

[Popliteal artery entrapment. Contribution of ultrasonography].

Ultrasounds contribute significantly to the diagnosis of popliteal artery entrapment. The haemodynamic data obtained by Doppler's velocimetry and the parietal and morphological data obtained by ultrasonography make it possible to proceed beyond a diagnosis of "presumption" based on clinical and arteriographic findings and to reach directly a positive diagnosis of entrapment, even in cases with arterial obstruction. Between December, 1979 and December, 1983, 12 cases of popliteal artery entrapment (5 of type I, 1 of type II and 6 of type III) were diagnosed by ultrasonic methods in 8 patients.

[Reimplantation of the subclavian artery into the common carotid artery].

Since 1973, transposition of the subclavian artery into the common carotid artery has been the technique of choice to treat prevertebral occlusive subclavian lesions. However, the haemodynamic results in the vertebral artery were far from perfect, as shown by immediate post-operative ultrasonic examinations. This has been corrected by a technical modification: the subclavian artery is severed flush with the vertebral artery lying obliquely downward and medially, which is equivalent to reimplanting a "double-barrelled" vessel (the vertebral and subclavian arteries) into the common carotid artery.

[Ultrasonic diagnosis of aneurysmal polydystrophies].

Two methods are available for establishing a positive diagnosis of aneurysmal polydystrophies: the use of hemodynamic data from Doppler recordings to obtain details of the degree of parietal elasticity and the effect of parietal lesions on circulatory rate, and the application of real time ultrasound imaging to visualize the structure of the wall, the contents of the lumen and the level and extent of variations in caliber.

[Venous graft versus carotid thromboendarterectomy (T.E.) (author's transl)].

497 cases of carotid stenosis were operated upon with 2 operative series: one with a venous graft technique and the other by thromboendarterectomy (T.E.).

[Plate thermography in post-operative monitoring (author's transl)].

The authors report the data obtained from plate thermography--a technique based on the liquid crystal principle--in more than 200 patients with arteritis. More specifically, the study compares the results of arteriography, Doppler effect velocimetry and plate thermography before and after surgery in two groups of patients with similar conditions (20 cases of aorto-bifemoral prosthesis and 10 cases of lumbar sympathectomy). The results were comparable in both groups, as well as in most of the 200 patients operated upon in the same unit for various arterial diseases of the lower limb.