Lecoq Simon, Hersant Jeanne, Feuilloy Mathieu, Parent Henri-François, Henni Samir, Abraham Pierre
Sports Medicine, University Hospital Angers, 49000 Angers, France.
Vascular Medicine, University Hospital Angers, 49000 Angers, France.
J Clin Med. 2022 Sep 22;11(19):5550. doi: 10.3390/jcm11195550.
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.
尽管下肢动脉疾病（LEAD）与腰椎管狭窄症（LSS）之间的关联预计较为常见，但仅有少数研究对其进行了分析。通过运动血氧测定法，我们在5197例主诉间歇性跛行并接受跑步机测试的不同患者中，确定了运动诱发的局部血流受损（缺血）情况。我们记录了身高、体重、年龄、性别、正在进行的治疗、心血管危险因素（糖尿病、高血压、当前吸烟习惯），以及疑似或已治疗的LSS和/或下肢血管重建病史。至少一侧静息时踝臂指数<0.90或>1.40被认为提示存在LEAD（ABI+）。缺血定义为运动血氧测定期间最小DROP值（运动时肢体变化减去静息时胸部变化）<-15 mmHg。我们使用逐步线性回归分析了无LSS病史患者中与运动诱发缺血相关的临床因素，并根据这些因素定义了一个评分。然后在有LSS病史的患者中对该评分进行测试。在4690例无（疑似、诊断或治疗）LSS病史的患者中，我们观察到ABI+、男性、抗血小板治疗、BMI<26.5 kg/m²、年龄≤64岁以及下肢动脉血管重建病史与缺血的存在相关。从这些因素得出的评分值与507例有LSS病史患者运动诱发缺血的概率相关。该评分可能有助于怀疑缺血的存在是腰椎管狭窄症病史患者步行障碍的一个因素。
