Hand Acceleration Time Assessment With Ultrasound Doppler

Study Overview
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Brief Summary
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Chronic upper limb ischemia syndrome is uncommon compared to lower limb ischemia, with several potential causes (e.g., arteriosclerosis, compressive syndromes, arteritis, connective tissue diseases, trauma, and thrombosis). Many patients with upper limb ischemia remain asymptomatic due to arterial collateral vascularization. Given the wide variety of potential causes for upper limb ischemia, the diagnosis may require different technical approaches. Doppler ultrasound is a non-invasive, accessible, non-radiating technique that provides direct arterial imaging, yielding valuable information on arterial anatomy and hemodynamics. Some authors have described the reliability of the arterial duplex ultrasound for lower limb assessment using the pedal acceleration time (PAT). The PAT provides real-time hemodynamic physiological information on the entire limb. The acceleration time (AT) is an ultrasound parameter which measures the time elapsed (in milliseconds, ms) from the beginning of the arterial Doppler waveform until the systolic peak, evaluating the morphology of the arterial waveform in real time. In a healthy individual, this time should be short (between 40 - 100 milliseconds), displaying a triphasic waveform with a systolic acceleration, a sudden diastolic fall, and a subsequent anterograde flow at the end of diastole. A more damped wave suggests proximal stenosis and the acceleration time has been correlated to different degrees of foot ischemia. Notably, the AT parameter has also been studied in other territories, such as the carotid and pulmonary arteries, coronary arteries, and the aorta. Hand acceleration time (HAT) has also been described very recently as a potential tool to assess hemodialysis access-induced ischemia, cardiogenic shock, and subclavian iatrogenic ischemic lesion. However, the HAT has not yet been properly characterized or validated. Our working hypothesis is that the HAT is a useful diagnostic tool for chronic upper limb ischemia.

Official Title
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Hemodynamic Assessment of the Hand Arterial Perfusion Through the Ultrasound-Doppler Hand Acceleration Time (HAT) Technique: A Descriptive Study

Conditions
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Upper Limb Ischemia, Vascular Disease

Intervention / Treatment
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* Diagnostic Test: Hand Doppler Ultrasound


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria (healthy volunteers): Healthy adult volunteers (≥ 18 years of age). No evidence of upper limb arterial disease. Who sign the written informed consent. Exclusion Criteria (healthy volunteers): Healthy volunteers unable (at the investigator discretion) to understand or comply with any study-related procedure. Healthy volunteers who refuse to participate. Those presenting cardiovascular risk factors (e.g., hypertension, diabetes mellitus, dyslipidemia). Inclusion Criteria (upper limb ischemia patients): Adult patients (≥ 18 years of age) with a known diagnosis of chronic upper limb ischemia. Who sign the written informed consent. Exclusion Criteria (upper limb ischemia patients): Patients unable (at the investigator discretion) to understand or comply with any study-related procedure. Patients who refuse to participate.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Healthy Volunteers<br>Lack of upper limb arterial disease. | Diagnostic Test: Hand Doppler Ultrasound<br>* Hand Doppler Ultrasound to assess the Hand Acceleration Time (HAT)<br>|
| Patients with Chronic Upper Limb Ischemia<br>Known diagnosis of chronic upper limb ischemia. | Diagnostic Test: Hand Doppler Ultrasound<br>* Hand Doppler Ultrasound to assess the Hand Acceleration Time (HAT)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Median (range) hand acceleration time measured by Doppler ultrasound | The hand acceleration time will be measured at the following arteries: Distal radial artery Distal ulnar artery Princeps pollicis artery Index finger radial artery Second common palmar digital artery Fourth common palmar digital artery | Day 1 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Median (range) age of the participants. |  | Day 1 | 
| Number (percentage) of male/female participants. |  | Day 1 | 
| Number (percentage) of patients presenting cardiovascular risk factors of interest. | Cardiovascular risk factors of interest are smoking habits, arterial hypertension, diabetes mellitus, and dyslipidemia). | Day 1 | 
| Number (percentage) of patients with past medical history of interest. | A past medical history of interest is defined as ischemic cardiopathy, heart failure, and chronic obstructive pulmonary disease. | Day 1 | 
| Presence (Yes/No) of distal pulses in the upper limb. |  | Day 1 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Hand acceleration time, Upper limb ischemia, Vascular disease