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v2","test-v2",[1849,1850,1851,1852,1853,1854,1855,1856,1857,1858],{"__typename":73,"id":72,"title":67,"slug":75},{"__typename":73,"id":84,"title":80,"slug":85},{"__typename":73,"id":93,"title":89,"slug":94},{"__typename":73,"id":102,"title":98,"slug":103},{"__typename":73,"id":111,"title":107,"slug":112},{"__typename":73,"id":131,"title":133,"slug":132},{"__typename":73,"id":588,"title":590,"slug":589},{"__typename":73,"id":579,"title":575,"slug":580},{"__typename":73,"id":598,"title":594,"slug":599},{"__typename":73,"id":607,"title":603,"slug":608},{"__typename":1860,"id":1861,"text":1862,"active":68,"link":18},"PromoBannerRecord","IZN2vWtySLe3lCbELb1Rfw","\u003Cp>Placerat tortor massa aenean diam elementum risus facilisis sed eget elementum vestibulum ut.\u003C\u002Fp>",[1864,1877,1893,1907,1924,1941,1951,1965,1979,1993,2007,2016,2029,2044,2057],{"id":1865,"__typename":1866,"_modelApiKey":1867,"title":148,"media":1868,"description":1870,"reference":1871,"category":1872},"Mc_O5HIMSxi-WJWg9zWgTQ","PageLinkRecord","page_link",{"alt":151,"url":152,"width":153,"height":154,"responsiveImage":1869},{"srcSet":156,"webpSrcSet":157,"sizes":158,"src":159,"width":160,"height":161,"aspectRatio":162,"alt":151,"title":151,"bgColor":163,"base64":164},"\u003Cp>\u003Cspan data-olk-copy-source=\"MessageBody\">Examens rapides, dossiers instantanés, plus de temps pour vos patients.\u003C\u002Fspan>\u003C\u002Fp>",{"id":167,"__typename":44,"_modelApiKey":45,"slug":168,"title":169},{"__typename":1873,"id":1874,"name":1875,"slug":1876},"SpecialityCategoryRecord","ThcnPekuQbCQz_fv8O3SxA","Doctor’s practice","doctor-s-practice",{"id":1878,"__typename":1866,"_modelApiKey":1867,"title":1879,"media":1880,"description":1890,"reference":1891,"category":1892},"UbP8NN0KTf6zMJRnBnBgvw","Médecine générale",{"alt":1881,"url":1882,"width":1883,"height":1883,"responsiveImage":1884},"MESI mTABLET for Primary care","https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1759468929-primary-care-1080-1080.png",4500,{"srcSet":1885,"webpSrcSet":1886,"sizes":158,"src":1887,"width":160,"height":160,"aspectRatio":76,"alt":1881,"title":1881,"bgColor":1888,"base64":1889},"https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1759468929-primary-care-1080-1080.png?auto=compress&crop=focalpoint&dpr=0.25&fit=crop&w=1080 270w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1759468929-primary-care-1080-1080.png?auto=compress&crop=focalpoint&dpr=0.5&fit=crop&w=1080 540w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1759468929-primary-care-1080-1080.png?auto=compress&crop=focalpoint&dpr=0.75&fit=crop&w=1080 810w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1759468929-primary-care-1080-1080.png?auto=compress&crop=focalpoint&fit=crop&w=1080 1080w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1759468929-primary-care-1080-1080.png?auto=compress&crop=focalpoint&dpr=1.5&fit=crop&w=1080 1620w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1759468929-primary-care-1080-1080.png?auto=compress&crop=focalpoint&dpr=2&fit=crop&w=1080 2160w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1759468929-primary-care-1080-1080.png?auto=compress&crop=focalpoint&dpr=3&fit=crop&w=1080 3240w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1759468929-primary-care-1080-1080.png?auto=compress&crop=focalpoint&dpr=4&fit=crop&w=1080 4320w","https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1759468929-primary-care-1080-1080.png?auto=compress&crop=focalpoint&dpr=0.25&fit=crop&fm=webp&w=1080 270w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1759468929-primary-care-1080-1080.png?auto=compress&crop=focalpoint&dpr=0.5&fit=crop&fm=webp&w=1080 540w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1759468929-primary-care-1080-1080.png?auto=compress&crop=focalpoint&dpr=0.75&fit=crop&fm=webp&w=1080 810w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1759468929-primary-care-1080-1080.png?auto=compress&crop=focalpoint&fit=crop&fm=webp&w=1080 1080w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1759468929-primary-care-1080-1080.png?auto=compress&crop=focalpoint&dpr=1.5&fit=crop&fm=webp&w=1080 1620w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1759468929-primary-care-1080-1080.png?auto=compress&crop=focalpoint&dpr=2&fit=crop&fm=webp&w=1080 2160w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1759468929-primary-care-1080-1080.png?auto=compress&crop=focalpoint&dpr=3&fit=crop&fm=webp&w=1080 3240w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1759468929-primary-care-1080-1080.png?auto=compress&crop=focalpoint&dpr=4&fit=crop&fm=webp&w=1080 4320w","https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1759468929-primary-care-1080-1080.png?auto=compress&crop=focalpoint&fit=crop&w=1080","#9dbe4b","data:image\u002Fjpeg;base64,\u002F9j\u002F4AAQSkZJRgABAQAAAQABAAD\u002F2wCEAAoHBwgHBgoIEggTFhAVDiQaDg0ODhUNDw4OIR8ZGBYVIhUdHysjGikoKSEWJDUlKC0vMjIyGSI4PTcwPCsxMi8BCgsLDg0PHA0QHC8oFhwvLy8vLy8vLy8vLy8vLy8vLy8vLy8vLy8vLy8vLy8vLy8vLy8vLy8vLy8vLy8vLy8vL\u002F\u002FAABEIABgAGAMBIgACEQEDEQH\u002FxAAZAAEBAAMBAAAAAAAAAAAAAAAABAEFBwP\u002FxAAfEAABAwQDAQAAAAAAAAAAAAABAAIDBAURQRMUIRL\u002FxAAXAQADAQAAAAAAAAAAAAAAAAAAAQIE\u002F8QAGBEBAQEBAQAAAAAAAAAAAAAAAAECEhH\u002F2gAMAwEAAhEDEQA\u002FAOsz1DWVAGVjnY0l2dKK4QvFYPV6tpS6M+6UatU18V5jiuThlFLFZOW5uP1tEvaF9yrT3AFkVkmMZ0iLRrMJNRVEvfJyiIjmB\u002F\u002FZ","\u003Cp>Optimisez votre flux de travail quotidien et soignez plus de patients en moins de temps grâce au MESI mTABLET - des diagnostics intelligents conçus pour les établissements de soins primaires très occupés.\u003C\u002Fp>",{"id":221,"__typename":44,"_modelApiKey":45,"slug":222,"title":223},{"__typename":1873,"id":1874,"name":1875,"slug":1876},{"id":1894,"__typename":1866,"_modelApiKey":1867,"title":624,"media":1895,"description":1904,"reference":1905,"category":1906},"U7D5H1iEREmkDO6M8pKgFg",{"alt":1896,"url":1897,"width":1883,"height":1883,"responsiveImage":1898},"MESI mTABLET for Nurse practice","https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1759468929-nurse-practices-1080-1080.png",{"srcSet":1899,"webpSrcSet":1900,"sizes":158,"src":1901,"width":160,"height":160,"aspectRatio":76,"alt":1896,"title":1896,"bgColor":1902,"base64":1903},"https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1759468929-nurse-practices-1080-1080.png?auto=compress&crop=focalpoint&dpr=0.25&fit=crop&w=1080 270w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1759468929-nurse-practices-1080-1080.png?auto=compress&crop=focalpoint&dpr=0.5&fit=crop&w=1080 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hôpitaux et les cliniques sont confrontés à une dure réalité : plus de patients, moins de personnel et des outils fragmentés qui ralentissent la prise de décision. 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des orteils et des conditions environnementales",{"tag":2122,"attributes":2123,"content":18},"meta",{"property":2124,"content":2120},"og:title",{"tag":2122,"attributes":2126,"content":18},{"name":2127,"content":2120},"twitter:title",{"tag":2122,"attributes":2129,"content":18},{"name":2130,"content":2131},"description","Le MESI mTABLET fournit une évaluation médicale prédictive grâce à une large sélection de modules matériels, d'extensions logicielles et de différentes options d'intégration.",{"tag":2122,"attributes":2133,"content":18},{"property":2134,"content":2131},"og:description",{"tag":2122,"attributes":2136,"content":18},{"name":2137,"content":2131},"twitter:description",{"tag":2122,"attributes":2139,"content":18},{"property":2140,"content":2141},"og:image","https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1755862753-thumb-31.jpg?auto=format&fit=max&w=1200",{"tag":2122,"attributes":2143,"content":18},{"property":2144,"content":2145},"og:image:width","1200",{"tag":2122,"attributes":2147,"content":18},{"property":2148,"content":2149},"og:image:height","675",{"tag":2122,"attributes":2151,"content":18},{"property":2152,"content":2153},"og:image:alt","TBI measurement 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   Sawka AM, Carter SA. Effect of temperature on digital systolic pressures in lower limb in arterial disease. Circulation. 1992 Mar;85(3):1097-101. doi: 10.1161\u002F01.cir.85.3.1097. PMID: 1537107. https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F1537107\u002F\u003C\u002Fp>\n\u003Cp>2.    Settembre N, Kagayama T, Kauhanen P, et al. The influence of heating on toe pressure in patients with peripheral arterial disease. Scand J Surg. 2018;107(1):62-67. https:\u002F\u002Fwww.mendeley.com\u002Fcatalogue\u002F06df7306-1e4e-3403-83d3-5c30670227ce\u002F?utm_source=chatgpt.com\u003C\u002Fp>\n\u003Cp>3.    Törngren S, et al. The effect of cooling on toe systolic pressures in subjects with and without Raynaud's syndrome in the lower extremities. Int Angiol. 1991;10(3):120-4. https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F1893682\u002F\u003C\u002Fp>\n\u003Cp>4.    Törngren S, et al. The effect of body heating and cooling on the ankle and toe systolic pressures in arterial disease. Int Angiol. 1992;11(4):289-97. https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F1495138\u002F\u003C\u002Fp>\n\u003Cp>5.    Balasubramanian V, et al. Thermographic patterns of the upper and lower limbs: baseline data. Int J Vasc Med. 2014;2014:1-8. https:\u002F\u002Fpmc.ncbi.nlm.nih.gov\u002Farticles\u002FPMC4310239\u002F\u003C\u002Fp>\n\u003Cp>6.    Bhamidipaty, V., Dean, A., Yap, S., Firth, J., Barron, M., Allard, B., & Chan, S. (2014). Second Toe Systolic Pressure Measurements are Valid Substitutes for First Toe Systolic Pressure Measurements in Diabetic Patients: A Prospective Study. European Journal of Vascular and Endovascular Surgery, 49(1), 77-82. https:\u002F\u002Fdoi.org\u002F10.1016\u002Fj.ejvs.2014.09.011 \u003C\u002Fp>\n\u003Cp>7.    Johnston KW, Hosang MY, Andrews DF. Reproducibility of noninvasive vascular laboratory measurements of the peripheral circulation. J Vasc Surg. 1987 Aug;6(2):147-51. doi: 10.1067\u002Fmva.1987.avs0060147. PMID: 2956433. https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F2956433\u002F\u003C\u002Fp>\n\u003Cp>8.    Cloete, N., & Cowie, C. (2009). Reproducibility of toe pressure measurements. Journal for Vascular Ultrasound, 33(3), 129–132. https:\u002F\u002Fdoi.org\u002F10.1177\u002F154431670903300301 \u003C\u002Fp>\n\u003Cp>9.    Tehan, P., Fox, M., & Mill, J. L. (2021). Measurement of toe systolic pressures: A technique paper. Wound Practice and Research, 29(3), 148–153. https:\u002F\u002Fdoi.org\u002F10.33235\u002Fwpr.29.3.148-153\u003C\u002Fp>",[2210],{"_modelApiKey":74,"__typename":73,"id":131,"slug":132,"title":133},{"schema":2212,"document":2213},"dast",{"type":2214,"children":2215},"root",[2216,2222,2229,2233,2243,2248,2253,2257,2261,2265,2269,2273,2277,2282,2286,2290,2294,2299,2303,2307,2312,2316,2320,2324,2329,2334,2338,2343,2347,2354,2361,2368,2373,2390,2395,2402,2416,2421,2428,2435,2449,2456,2470,2476,2496,2502,2528,2534,2551,2557,2565,2569,2571],{"type":2217,"children":2218},"paragraph",[2219],{"type":2220,"value":2221},"span","La mesure précise de l’indice de pression systolique à l’orteil (IPSO) est cruciale pour diagnostiquer l’artériopathie oblitérante des membres inférieurs (AOMI), en particulier chez les patients pour lesquels les mesures de l’indice de pression systolique (IPS) sont non concluantes en raison de facteurs tels que la calcification artérielle, les artères non compressibles ou les variations anatomiques. L’IPSO montre une meilleure sensibilité dans ces populations « difficiles », mais il est techniquement plus complexe : des recherches émergentes soulignent que la température des orteils, influencée à la fois par les conditions environnementales et par le réchauffement localisé, affecte significativement la fiabilité de ces mesures.",{"type":2223,"level":467,"children":2224},"heading",[2225],{"type":2220,"marks":2226,"value":2228},[2227],"strong","Pourquoi la température est importante dans les évaluations de l’IPSO",{"type":2217,"children":2230},[2231],{"type":2220,"value":2232},"L’IPSO est calculé en divisant la pression systolique mesurée à l’orteil par la pression systolique mesurée au bras. Comme les orteils sont plus sensibles que les bras à la vasoconstriction ou à la vasodilatation induite par la température, les variations environnementales ou physiologiques de température peuvent fausser les résultats.",{"type":2217,"children":2234},[2235,2237,2241],{"type":2220,"value":2236},"Une étude publiée dans ",{"type":2220,"marks":2238,"value":2240},[2239],"emphasis","Circulation",{"type":2220,"value":2242},"1 a montré que les pressions moyennes à l’orteil à 10 °C étaient significativement plus basses que celles mesurées à 30 °C ou dans des conditions habituelles. Les pressions augmentaient progressivement avec des températures allant de 27 °C à 39 °C, puis atteignaient un plateau autour de 36 °C à 39 °C. Cela suggère que des températures basses au niveau des orteils peuvent entraîner des lectures faussement basses de la pression systolique à l’orteil, soulignant la nécessité d’un réchauffement pour obtenir des évaluations précises.",{"type":2223,"level":467,"children":2244},[2245],{"type":2220,"marks":2246,"value":2247},[2227],"Données issues des études cliniques",{"type":2223,"level":749,"children":2249},[2250],{"type":2220,"marks":2251,"value":2252},[2227],"1. Réchauffer les orteils : améliorer la précision",{"type":2217,"children":2254},[2255],{"type":2220,"value":2256},"Une étude de 2017² portant sur l’influence du réchauffement sur les pressions à l’orteil a examiné 46 patients atteints d’artériopathie des membres inférieurs (86 jambes) à l’aide d’un dispositif laser Doppler et a montré que le réchauffement des orteils augmentait significativement les pressions systoliques à l’orteil lorsque les orteils étaient chauffés à 40 °C. Lors de la mesure initiale, la pression systolique moyenne de base à l’orteil était de 58,5 mmHg et la température cutanée de l’orteil était de 24 °C (écart-type : 2,8). La température moyenne de la pièce pendant la mesure était de 22,7 °C.",{"type":2217,"children":2258},[2259],{"type":2220,"value":2260},"Ils ont ensuite réchauffé les orteils pendant 5 minutes. La température des orteils après réchauffement était de 27,8 °C (écart-type : 2,8). La mesure moyenne de la pression systolique à l’orteil est montée à 62 mmHg. Mais lorsque les orteils étaient chauffés à 40 °C, la variation de la pression à l’orteil montait à 71 mmHg.",{"type":2217,"children":2262},[2263],{"type":2220,"value":2264},"Une variation individuelle des différences a également été observée. Des variations entre les réponses au réchauffement étaient présentes après le premier réchauffement et allaient de −34 mmHg (la pression à l’orteil diminuant de 74 à 40 mmHg) à +91 mmHg (la pression à l’orteil augmentant de 14 à 104 mmHg). Après le premier réchauffement, la pression à l’orteil diminuait ou restait identique lors de la deuxième mesure dans un total de 40 jambes (46,5 %).",{"type":2217,"children":2266},[2267],{"type":2220,"value":2268},"Mais lorsque les orteils étaient chauffés à 40 °C, la variation de la pression à l’orteil par rapport à la valeur de base allait de −28 à +103 mmHg. Après le deuxième réchauffement, la pression à l’orteil était inchangée ou plus basse chez 22 patients (25,6 %), et cette proportion était identique chez les diabétiques et les non-diabétiques (25,6 % vs 25,5 %, respectivement), ainsi que dans les jambes symptomatiques versus asymptomatiques (20,0 % dans les jambes asymptomatiques, 20,9 % chez les patients claudicants et 33,3 % dans les jambes avec ischémie critique des membres).",{"type":2217,"children":2270},[2271],{"type":2220,"value":2272},"Les données de cette étude indiquent qu’il existe une réponse différente au réchauffement selon les situations cliniques et selon les comorbidités des patients. Ces résultats indiquent également que le réchauffement des orteils peut améliorer la précision des mesures de pression systolique à l’orteil en réduisant les effets de la vasoconstriction. Ils indiquent également qu’un réchauffement excessif des orteils peut faussement élever les résultats de pression à l’orteil.",{"type":2217,"children":2274},[2275],{"type":2220,"value":2276},"Par conséquent, les mesures de pression à l’orteil font partie d’une évaluation globale : la pression à l’orteil seule ou le résultat de l’IPSO seul ne peuvent pas fournir une vision fiable de l’état du patient.",{"type":2223,"level":749,"children":2278},[2279],{"type":2220,"marks":2280,"value":2281},[2227],"2. Refroidissement des orteils : un risque de sous-estimation",{"type":2217,"children":2283},[2284],{"type":2220,"value":2285},"Des recherches³ ont montré que le refroidissement des orteils réduit significativement les pressions systoliques chez des patients sains. Elles ont comparé les résultats avec ceux de patients atteints du syndrome de Raynaud. Les résultats ont montré que, chez les patients atteints du syndrome de Raynaud, le refroidissement corporel entraînait une diminution moyenne de la pression à l’orteil de 58 mmHg, tandis que les patients sains du groupe contrôle présentaient une baisse de 24 mmHg. L’application d’un refroidissement local des orteils de 30 °C à 10 °C entraînait une diminution de plus de 40 mmHg dans les deux groupes.",{"type":2217,"children":2287},[2288],{"type":2220,"value":2289},"Ces résultats soulignent l’importance de maintenir une température adéquate des orteils pendant les évaluations afin d’éviter de sous-estimer les pressions systoliques à l’orteil.",{"type":2217,"children":2291},[2292],{"type":2220,"value":2293},"De plus, dans une étude⁴ portant sur l’effet du réchauffement et du refroidissement corporels sur les pressions systoliques à la cheville et à l’orteil dans l’artériopathie, les chercheurs ont constaté que des températures très basses au niveau des orteils, qu’elles soient dues à une exposition locale au froid ou à une réduction du flux sanguin liée au refroidissement systémique, entraînaient des pressions systoliques à l’orteil nettement réduites, voire impossibles à mesurer. La cause probable est une augmentation du tonus vasculaire ou une modification de l’élasticité de la paroi artérielle à basse température. Il est à noter que les membres présentant les températures d’orteil les plus basses pendant le refroidissement présentaient les pressions les plus basses. Cette sensibilité à la température introduit une variabilité significative dans les mesures de pression systolique à l’orteil, dépassant les limites normales de reproductibilité et soulignant la nécessité de contrôler ou de normaliser la température des orteils pour des évaluations vasculaires précises.",{"type":2223,"level":749,"children":2295},[2296],{"type":2220,"marks":2297,"value":2298},[2227],"3. Thermorégulation du pied et mesures au deuxième orteil",{"type":2217,"children":2300},[2301],{"type":2220,"value":2302},"Une étude⁵ sur les profils thermographiques des membres supérieurs et inférieurs a révélé que l’hallux (gros orteil) est constamment plus chaud que les autres orteils, avec une diminution progressive de la température du deuxième au quatrième orteil. Ce profil est attribué à l’anatomie vasculaire du pied.",{"type":2217,"children":2304},[2305],{"type":2220,"value":2306},"Mais si un patient a subi une amputation du gros orteil ou du premier orteil, il est également possible de mesurer la pression systolique à l’orteil sur le deuxième orteil. Lorsque des chercheurs ont étudié si la mesure de la pression systolique au deuxième orteil constituait un substitut valable aux mesures de pression systolique au premier orteil chez les patients diabétiques, ils ont constaté que les mesures de pression systolique au deuxième orteil étaient interchangeables avec celles du premier orteil. Les pressions au deuxième orteil peuvent être utilisées chez les patients diabétiques dont les pressions au premier orteil ne peuvent pas être évaluées.⁶",{"type":2223,"level":749,"children":2308},[2309],{"type":2220,"marks":2310,"value":2311},[2227],"4. Reproductibilité des mesures vasculaires non invasives de la circulation périphérique",{"type":2217,"children":2313},[2314],{"type":2220,"value":2315},"Les études portant sur la reproductibilité des mesures vasculaires non invasives de la circulation périphérique⁷ ont montré que les mesures de l’indice de pression systolique sont très fiables. Ces études ont également confirmé qu’une variation de l’indice de pression cheville-bras supérieure à 14 % indique généralement un changement pathologique cliniquement significatif.",{"type":2217,"children":2317},[2318],{"type":2220,"value":2319},"Dans le même temps, la recherche a également évalué la reproductibilité des mesures de pression à l’orteil⁸ et a constaté que la variabilité de l’IPSO est plus importante, rapportée comme allant de la même variabilité que celle de l’IPS jusqu’à environ deux fois celle de l’IPS. La variabilité plus élevée de l’IPSO peut être due à une plus grande susceptibilité des artères digitales à la vasoréactivité.",{"type":2217,"children":2321},[2322],{"type":2220,"value":2323},"Pour mettre cela en perspective, plusieurs facteurs peuvent influencer la précision des lectures de pression à l’orteil. Il s’agit non seulement de la température de l’orteil et de la température ambiante, ainsi que du site précis de mesure, mais aussi de la personne qui réalise la mesure. Les différences de technique entre professionnels de santé peuvent affecter significativement les résultats.",{"type":2217,"children":2325},[2326],{"type":2220,"marks":2327,"value":2328},[2227],"En conclusion, la mesure de la pression à l’orteil est une procédure très sensible, influencée par de multiples variables. Pour que les résultats soient constamment fiables, une approche globale et standardisée doit être adoptée, idéalement dans des conditions soigneusement contrôlées.",{"type":2223,"level":467,"children":2330},[2331],{"type":2220,"marks":2332,"value":2333},[2227],"Protocole de mesure",{"type":2217,"children":2335},[2336],{"type":2220,"value":2337},"Pour conclure cette vue d’ensemble, la nécessité d’un protocole standardisé et bien établi pour mesurer les pressions systoliques à l’orteil est claire. Cette nécessité est encore soulignée dans une étude récente⁹, dans laquelle les auteurs ont mis en avant l’importance d’utiliser une méthodologie cohérente afin d’assurer à la fois l’exactitude et la reproductibilité. L’article décrit les principales étapes procédurales et considérations cliniques, renforçant l’idée qu’une approche systématique est essentielle pour obtenir des résultats fiables et significatifs.",{"type":2217,"children":2339},[2340],{"type":2220,"marks":2341,"value":2342},[2227],"1. Conditions de test",{"type":2217,"children":2344},[2345],{"type":2220,"value":2346},"Pour garantir des mesures précises et reproductibles, plusieurs facteurs environnementaux et physiologiques doivent être contrôlés :",{"type":2217,"children":2348},[2349,2352],{"type":2220,"marks":2350,"value":2351},[2227],"Température de la pièce",{"type":2220,"value":2353}," : maintenir une température ambiante constante entre 22 et 24 °C. Les environnements froids peuvent induire une vasoconstriction, ce qui peut artificiellement abaisser les lectures de pression systolique à l’orteil.",{"type":2217,"children":2355},[2356,2359],{"type":2220,"marks":2357,"value":2358},[2227],"Positionnement du patient :",{"type":2220,"value":2360}," le patient doit être allongé en décubitus dorsal pendant quelques minutes avant le début du test et rester dans cette position pendant toute la procédure. Cela aide à stabiliser la pression artérielle et garantit que les orteils se trouvent au niveau du cœur.",{"type":2217,"children":2362},[2363,2366],{"type":2220,"marks":2364,"value":2365},[2227],"Restrictions avant le test",{"type":2220,"value":2367}," : Les patients doivent éviter de fumer, de consommer de la caféine et de faire de l’exercice pendant au moins 2 heures avant le test, car ces facteurs peuvent affecter le tonus vasculaire et le flux sanguin.",{"type":2217,"children":2369},[2370],{"type":2220,"marks":2371,"value":2372},[2227],"Limiter les interférences :",{"type":2374,"style":2375,"children":2376},"list","bulleted",[2377,2384],{"type":2378,"children":2379},"listItem",[2380],{"type":2217,"children":2381},[2382],{"type":2220,"value":2383},"Réduire les tremblements des membres, les mouvements brusques et l’hyperémie, car ces éléments peuvent perturber le signal de photopléthysmographie (PPG).",{"type":2378,"children":2385},[2386],{"type":2217,"children":2387},[2388],{"type":2220,"value":2389},"Tenir compte des affections vaso-neurales sous-jacentes (par exemple, phénomène de Raynaud) susceptibles d’influencer la pression systolique à l’orteil en raison d’une fonction vasculaire altérée.",{"type":2217,"children":2391},[2392],{"type":2220,"marks":2393,"value":2394},[2227],"2. Équipement nécessaire",{"type":2217,"children":2396},[2397,2400],{"type":2220,"marks":2398,"value":2399},[2227],"Dispositif PPG",{"type":2220,"value":2401}," : il s’agit de la modalité la plus couramment utilisée. Elle fonctionne à l’aide d’une lumière infrarouge permettant de détecter les variations du volume sanguin et de produire une courbe lisible.",{"type":2217,"children":2403},[2404,2407,2409,2414],{"type":2220,"marks":2405,"value":2406},[2227],"Brassards",{"type":2220,"value":2408}," : un dimensionnement approprié du brassard est essentiel. Des brassards de taille incorrecte peuvent produire des lectures faussement élevées ou basses. Le choix du brassard doit correspondre à environ 1,5 fois le diamètre du doigt ou de l’orteil évalué. Les brassards ",{"item":131,"type":2410,"children":2411},"itemLink",[2412],{"type":2220,"value":2413},"IPSO de la MESI mTABLET ",{"type":2220,"value":2415},"disposent d’un indicateur de taille et d’une zone OK pour aider à déterminer la taille de brassard appropriée pour l’orteil sélectionné.",{"type":2217,"children":2417},[2418],{"type":2220,"marks":2419,"value":2420},[2227],"3. Technique de mesure",{"type":2217,"children":2422},[2423,2426],{"type":2220,"marks":2424,"value":2425},[2227],"Hygiène et préparation",{"type":2220,"value":2427}," : suivre les protocoles d’hygiène standard. Le port de gants est recommandé, en particulier lors de la prise en charge de patients présentant des plaies ouvertes.",{"type":2217,"children":2429},[2430,2433],{"type":2220,"marks":2431,"value":2432},[2227],"Placement du brassard ",{"type":2220,"value":2434},":",{"type":2374,"style":2375,"children":2436},[2437,2443],{"type":2378,"children":2438},[2439],{"type":2217,"children":2440},[2441],{"type":2220,"value":2442},"Placer le brassard autour de la base de l’hallux, en s’assurant qu’il est bien positionné sans exercer de pression avant le gonflage.",{"type":2378,"children":2444},[2445],{"type":2217,"children":2446},[2447],{"type":2220,"value":2448},"Le positionner suffisamment fermement pour qu’il reste en place pendant la mesure.",{"type":2217,"children":2450},[2451,2454],{"type":2220,"marks":2452,"value":2453},[2227],"Placement de la sonde PPG",{"type":2220,"value":2455}," :",{"type":2374,"style":2375,"children":2457},[2458,2464],{"type":2378,"children":2459},[2460],{"type":2217,"children":2461},[2462],{"type":2220,"value":2463},"Fixer la sonde sur la pulpe distale de l’hallux de manière à ce qu’elle soit bien au contact de la peau, afin d’éviter les interférences liées à la lumière ambiante.",{"type":2378,"children":2465},[2466],{"type":2217,"children":2467},[2468],{"type":2220,"value":2469},"Fixer la sonde à l’aide d’un ruban hypoallergénique et s’assurer que les câbles sont fixés pour éviter tout mouvement pendant le test.",{"type":2217,"children":2471},[2472,2475],{"type":2220,"marks":2473,"value":2474},[2227],"Sites alternatifs",{"type":2220,"value":2455},{"type":2374,"style":2375,"children":2477},[2478,2484,2490],{"type":2378,"children":2479},[2480],{"type":2217,"children":2481},[2482],{"type":2220,"value":2483},"Si l’hallux n’est pas disponible, le deuxième orteil peut être utilisé avec une fiabilité similaire.",{"type":2378,"children":2485},[2486],{"type":2217,"children":2487},[2488],{"type":2220,"value":2489},"Les autres orteils plus petits ne sont généralement pas recommandés en raison de la difficulté à obtenir un positionnement constant et du nombre limité de validations.",{"type":2378,"children":2491},[2492],{"type":2217,"children":2493},[2494],{"type":2220,"value":2495},"Dans ces situations, envisager d’autres évaluations vasculaires (par exemple, pressions à la cheville ou Doppler à onde continue) ou adresser le patient pour une imagerie ou une consultation spécialisée en médecine vasculaire.",{"type":2217,"children":2497},[2498,2501],{"type":2220,"marks":2499,"value":2500},[2227],"Acquisition du signal ",{"type":2220,"value":2434},{"type":2374,"style":2375,"children":2503},[2504,2510,2516,2522],{"type":2378,"children":2505},[2506],{"type":2217,"children":2507},[2508],{"type":2220,"value":2509},"Attendre qu’une courbe forte et cyclique apparaisse sur le moniteur avant de poursuivre. La courbe peut être interprétée qualitativement ; des signaux amortis, retardés ou diminués peuvent indiquer une sévérité croissante de l’artériopathie oblitérante des membres inférieurs (AOMI).",{"type":2378,"children":2511},[2512],{"type":2217,"children":2513},[2514],{"type":2220,"value":2515},"Gonfler progressivement le brassard. Éviter de gonfler au-delà de 250 mmHg afin de prévenir tout dommage au brassard - les courbes s’aplatissent généralement entre 150 et 200 mmHg, mais peuvent le faire à des pressions plus basses dans les membres sévèrement atteints.",{"type":2378,"children":2517},[2518],{"type":2217,"children":2519},[2520],{"type":2220,"value":2521},"Une fois que la courbe disparaît, gonfler de 20 mmHg supplémentaires.",{"type":2378,"children":2523},[2524],{"type":2217,"children":2525},[2526],{"type":2220,"value":2527},"Commencer le dégonflage lentement, à une vitesse de 2 à 5 mmHg par seconde.",{"type":2217,"children":2529},[2530,2533],{"type":2220,"marks":2531,"value":2532},[2227],"Identification de la pression systolique à l’orteil",{"type":2220,"value":2455},{"type":2374,"style":2375,"children":2535},[2536,2542],{"type":2378,"children":2537},[2538],{"type":2217,"children":2539},[2540],{"type":2220,"value":2541},"La première petite courbe cyclique régulière visible pendant le dégonflage indique que la pression artérielle a dépassé la pression du brassard - elle est enregistrée comme la pression systolique à l’orteil.",{"type":2378,"children":2543},[2544],{"type":2217,"children":2545},[2546,2549],{"type":2220,"marks":2547,"value":2548},[2239],"Remarque",{"type":2220,"value":2550}," : cette courbe initiale peut être petite et facilement manquée par des cliniciens peu expérimentés.",{"type":2217,"children":2552},[2553,2556],{"type":2220,"marks":2554,"value":2555},[2227],"Répétition des mesures",{"type":2220,"value":2455},{"type":2374,"style":2375,"children":2558},[2559],{"type":2378,"children":2560},[2561],{"type":2217,"children":2562},[2563],{"type":2220,"value":2564},"Si la mesure doit être répétée, attendre au moins 3 minutes avant de refaire le test afin d’éviter une réponse hyperémique, qui peut temporairement augmenter la pression systolique à l’orteil.",{"type":2217,"children":2566},[2567],{"type":2220,"value":2568},"Bien que la mesure des pressions à l’orteil soit un élément important de l’évaluation vasculaire, elle doit être intégrée dans une évaluation complète du membre. Idéalement, la prise en charge des plaies du pied et des soins vasculaires est assurée au sein d’une équipe pluridisciplinaire de préservation du membre, où les évaluations telles que la pression systolique à l’orteil et l’IPSO s’inscrivent dans une approche coordonnée et globale du diagnostic et de la prise en charge. Toutefois, une telle prise en charge intégrée n’est pas toujours réalisable dans tous les environnements cliniques, ce qui souligne l’importance d’appliquer les protocoles de bonnes pratiques même dans des contextes plus limités.",{"item":2204,"type":2570},"block",{"type":2217,"children":2572},[2573],{"type":2220,"value":48},{"alt":2153,"url":2575,"width":2576,"height":2577,"responsiveImage":2578},"https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1755862753-thumb-31.jpg",3840,2160,{"srcSet":2579,"webpSrcSet":2580,"sizes":2581,"src":2582,"width":2583,"height":974,"aspectRatio":2584,"alt":2153,"title":2153,"bgColor":2585,"base64":2586},"https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1755862753-thumb-31.jpg?ar64=MjE6OQ&auto=compress&crop=focalpoint&dpr=0.25&fit=crop&w=1440 360w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1755862753-thumb-31.jpg?ar64=MjE6OQ&auto=compress&crop=focalpoint&dpr=0.5&fit=crop&w=1440 720w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1755862753-thumb-31.jpg?ar64=MjE6OQ&auto=compress&crop=focalpoint&dpr=0.75&fit=crop&w=1440 1080w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1755862753-thumb-31.jpg?ar64=MjE6OQ&auto=compress&crop=focalpoint&fit=crop&w=1440 1440w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1755862753-thumb-31.jpg?ar64=MjE6OQ&auto=compress&crop=focalpoint&dpr=1.5&fit=crop&w=1440 2160w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1755862753-thumb-31.jpg?ar64=MjE6OQ&auto=compress&crop=focalpoint&dpr=2&fit=crop&w=1440 2880w","https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1755862753-thumb-31.jpg?ar64=MjE6OQ&auto=compress&crop=focalpoint&dpr=0.25&fit=crop&fm=webp&w=1440 360w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1755862753-thumb-31.jpg?ar64=MjE6OQ&auto=compress&crop=focalpoint&dpr=0.5&fit=crop&fm=webp&w=1440 720w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1755862753-thumb-31.jpg?ar64=MjE6OQ&auto=compress&crop=focalpoint&dpr=0.75&fit=crop&fm=webp&w=1440 1080w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1755862753-thumb-31.jpg?ar64=MjE6OQ&auto=compress&crop=focalpoint&fit=crop&fm=webp&w=1440 1440w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1755862753-thumb-31.jpg?ar64=MjE6OQ&auto=compress&crop=focalpoint&dpr=1.5&fit=crop&fm=webp&w=1440 2160w,https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1755862753-thumb-31.jpg?ar64=MjE6OQ&auto=compress&crop=focalpoint&dpr=2&fit=crop&fm=webp&w=1440 2880w","(max-width: 1440px) 100vw, 1440px","https:\u002F\u002Fwww.datocms-assets.com\u002F160495\u002F1755862753-thumb-31.jpg?ar64=MjE6OQ&auto=compress&crop=focalpoint&fit=crop&w=1440",1440,2.3338735818476497,"#8cc540","data:image\u002Fjpeg;base64,\u002F9j\u002F4AAQSkZJRgABAQAAAQABAAD\u002F2wCEAAoHBwgHBgoNCAgVEQ0NDg8NDQ4QDhELFgUNFxUeGBYVFiEaHysjGh0oHRUWJDUlKC0vMjIyGSI4PTcwPCsxMi8BCgsLDg0KEBANHC8cIhwvLy8vLy8vLy8vLy8vLy8vLy8vLy8vLy8vLy8vLy8vLy8vLy8vLy8vLy8vLy8vLy8vL\u002F\u002FAABEIAAsAGAMBIgACEQEDEQH\u002FxAAZAAABBQAAAAAAAAAAAAAAAAAEAAECBQb\u002FxAAcEAACAgIDAAAAAAAAAAAAAAAAAQIDITEEERL\u002FxAAVAQEBAAAAAAAAAAAAAAAAAAACAP\u002FEABgRAAIDAAAAAAAAAAAAAAAAAAACARIT\u002F9oADAMBAAIRAxEAPwDL1cWEZYD6aI9gdTfssadoUqCHJuiMRCvbS2MVC0P\u002F2Q==",{"left":2094,"top":2094,"width":2095,"height":2095,"rotate":2094,"vFlip":68,"hFlip":68,"body":2588},"\u003Cg fill=\"none\">\u003Cg id=\"arrow-down\">\n\u003Cpath id=\"Vector\" d=\"M19.281 14.0306L12.531 20.7806C12.4614 20.8504 12.3787 20.9057 12.2876 20.9434C12.1966 20.9812 12.099 21.0006 12.0004 21.0006C11.9019 21.0006 11.8043 20.9812 11.7132 20.9434C11.6222 20.9057 11.5394 20.8504 11.4698 20.7806L4.71979 14.0306C4.57906 13.8899 4.5 13.699 4.5 13.5C4.5 13.301 4.57906 13.1101 4.71979 12.9694C4.86052 12.8286 5.05139 12.7496 5.25042 12.7496C5.44944 12.7496 5.64031 12.8286 5.78104 12.9694L11.2504 18.4397V3.75C11.2504 3.55109 11.3294 3.36032 11.4701 3.21967C11.6107 3.07902 11.8015 3 12.0004 3C12.1993 3 12.3901 3.07902 12.5307 3.21967C12.6714 3.36032 12.7504 3.55109 12.7504 3.75V18.4397L18.2198 12.9694C18.3605 12.8286 18.5514 12.7496 18.7504 12.7496C18.9494 12.7496 19.1403 12.8286 19.281 12.9694C19.4218 13.1101 19.5008 13.301 19.5008 13.5C19.5008 13.699 19.4218 13.8899 19.281 14.0306Z\" fill=\"currentColor\"\u002F>\n\u003C\u002Fg>\u003C\u002Fg>",1787202260509]