Lower Limb Arterial Disease, Lumbar Spinal Stenosis, PAD - Peripheral Arterial Disease
Conditions
Brief summary
The goal of this interventional study is to evaluate the rate of existing lower limb peripheral artery disease (PAD) in patients with surgically lumbar spinal stenosis (LSS). PAD and LSS can present similar symptoms and it can be difficult to diagnose PAD using conventional methods, depending on the location of the arterial disease. The main questions it aims to answer are : * What's the prevalence of PAD in LSS patients? * Which exam among routine tools is the most accurate to diagnose PAD in this population? Around their surgery for LSS (a few weeks before or after), participants will be included in a vascular medicine service. After checking of eligibility criteria, they will undergo a contrast-enhanced CT scan for the diagnosis of PAD and various routine diagnostic tests: Doppler ultrasound, treadmill tests, pressure index, pulse palpation.
Detailed description
Lumbar spinal stenosis (LSS) is a debilitating degenerative condition in older people associated with lower back pain, pain in the lower limbs and a reduced quality of life. LSS can be treated surgically, but the results are mixed: 35% of patients report low satisfaction one year after surgery. The symptoms of LSC in the lower limbs can mimic those associated with peripheral arterial disease (PAD). The prevalence of PAD in the LSC population varies between 4.1% and 67.8% depending on the diagnostic tests used and the populations studied. Thus, the precise analysis of the prevalence of PAD and the sensitivity and specificity of PAD diagnostic tests in this population remain to be determined. These analyses would help to optimise PAD diagnostic tools, while possibly providing an explanation for the post-operative persistence of functional discomfort in CLE patients. Furthermore, a better understanding of the vascular system in the CLE population offers hope for optimising patient care, both from a medical and a medico-economic point of view. The experimental visit takes place as soon as possible after receipt of the biological assessment and within a maximum period of 3 months. During this visit, specific research examinations will be performed, including stress tests (stress TcPO2 according to the modified Strandness protocol and stress TcPO2 according to the Gardner-Skinner increasing load protocol), as well as an injected scan of the aorta of the lower limbs. The pseudonymised CT scan will be sent to the sponsor for blind review. A follow-up telephone call will be made between 7 and 10 days after the CT scan to detect the occurrence of any adverse events. The study will then be completed for the participant.
Interventions
DIAGNOSTIC_TESTcontrast-enhanced CT scan
contrast-enhanced CT scan
Sponsors
Rennes University Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Presenting with a lumbar spinal stenosis with surgical indication, either unoperated or operated on less than 3 months ago * Affiliated with a social security scheme * Having received oral and written information about the protocol and having signed a written consent form to participate in this research.
Exclusion criteria
* emergency surgical care * Contraindication to contrast enhanced CT scan * Stroke or myocardial infarction (MI) within the last 3 months * Known severe or poorly tolerated arrhythmia * Known severe or symptomatic left ventricular outflow obstruction * Decompensated heart failure * History within the last 3 months of venous thromboembolic disease, myopericarditis, endocarditis, aortic dissection or intracardiac thrombus * Severe uncontrolled hypertension (BP \> 200/110 mmHg) * Inability to walk on the treadmill * Major lower limb amputation * Adult subject to legal protection
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of patients with PAD identified during the contrast enhanced CT scan | 3 months | Number of patients with PAD identified during the contrast enhanced CT scan. PAD will be defined by the presence of at least one arterial stenosis ≥ 50% on the arterial axes located from the abdominal aorta to the origin of the tibiofibular arterial trunk, as determined by CT scan of the aorta and lower limbs in accordance with the recommendations. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Efficiency of diagnosis test "pulse" | 3 months | determination of the sensitivity and specificity, positive predictive value and negative predictive value of the diagnostic test "pulse" : the absence of distal pulses will be considered pathological |
| Efficiency of diagnosis test "systolic pressure index" | 3 months | determination of the sensitivity and specificity, positive predictive value and negative predictive value of the diagnostic test "systolic pressure index" : A resting systolic pressure index ≤ 0.90 will be considered pathological in accordance with the recommendations. |
| Efficiency of diagnosis test "toe systolic pressure index" | 3 months | determination of the sensitivity and specificity, positive predictive value and negative predictive value of the diagnostic test "toe systolic pressure index" : A resting toe systolic pressure index ≤ 0.70 will be considered pathological in accordance with the recommendations. |
| Efficiency of diagnosis test "Aorto-iliac and lower limb Doppler ultrasound" | 3 months | determination of the sensitivity and specificity, positive predictive value and negative predictive value of the diagnostic test "Aorto-iliac and lower limb Doppler ultrasound " : velocimetric criteria for stenosis and Saint-Bonnet B and CD, E and 0 Doppler curves considered pathological (i.e. AOMI) in accordance with recommendations . |
| Efficiency of diagnosis test "exercise oxymetry" | 3 months | determination of the sensitivity and specificity, positive predictive value and negative predictive value of the diagnostic test "exercise oxymetry " : Delta from rest oxygen pressure (DROP) ≤ -15 mmHg will be considered pathological (i.e. AOMI) in accordance with the recommendations. . |
Countries
France
Contacts
CONTACTMarie-Laure Gervais
STUDY_CHAIRMarjolaine Talbot
Groupement des Hôpitaux de l'Institut Catholique de Lille
Outcome results
None listed