Fabrice Schneider’s research while affiliated with Unité Inserm U1077 and other places

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Publications (40)


A prospective observational study to evaluate a possible relationship between vitamin K antagonist therapy and risk of peripheral arterial disease in patients with type 2 diabetes
  • Article

May 2024

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15 Reads

Diabetes Obesity and Metabolism

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Aim The use of vitamin K antagonists (VKAs) may increase the risk of peripheral arterial disease (PAD) because vitamin K is a strong inhibitor of medial arterial calcification. Type 2 diabetes (T2D) exposes patients to an increased risk of PAD. We examined how the use of VKAs modulates the risk of incident PAD in people with T2D. Materials and Methods SURDIAGENE is a French cohort including 1468 patients with T2D with a prospective follow‐up from 2002 to 2015. The primary outcome of the current analysis was the first occurrence of PAD, a composite of lower‐limb amputation (LLA) or lower‐limb revascularization. LLA and lower‐limb revascularization were considered individually as secondary outcomes. Results During a 7‐year median follow‐up, PAD occurred in 147 (10%) of the 1468 participants. The use of VKAs was not significantly associated with the risk of PAD [multivariable adjusted hazard ratio (HR) 1.42, 95% confidence interval (CI), 0.88‐2.31]. During the study period, LLA and lower‐limb revascularization occurred in 82 (6%) and 105 (7%) participants, respectively. The use of VKAs was significantly associated with increased risk of LLA [multivariable adjusted HR 1.90 (95% CI, 1.04‐3.47)], but not lower‐limb revascularization [multivariable adjusted HR 1.08 (95% CI, 0.59‐1.97)]. Conclusions In this prospective study, we did not observe any excess risk of PAD requiring lower‐limb revascularization in people with type 2 diabetes using VKAs. However, our data suggest a high risk of LLA in VKA users. Further studies are required to confirm this observation.



Infra-inguinal Endovascular Revascularisation and Bypass Surgery for Chronic Limb-Threatening Ischaemia: a Retrospective European Multicentre Cohort Study with Propensity Score Matching

June 2023

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45 Reads

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8 Citations

European Journal of Vascular and Endovascular Surgery

Objective: The aim of this study was to compare the long term efficacy of lower limb bypass with that of endovascular treatment (EVT) in patients with chronic limb-threatening ischaemia (CLTI). Methods: This retrospective, multicentre study evaluated the outcomes of patients with CLTI who underwent first-time infra-inguinal bypass or EVT. The primary outcome was to compare amputation-free survival (AFS) rates between the two propensity score-matched groups. The secondary outcome was to compare wound healing within the first 6 months. Major adverse events were compared according to the type of revascularisation. Results: Overall, 793 patients fulfilled the eligibility criteria, of whom 236 propensity score-matched pairs were analysed. Mean follow up was 52 months. The 236 bypass procedures included 190 autogenous bypass grafts (80.5%), 151 (64.0%) of which were infrapopliteal. Among the 236 EVT procedures, the target lesion was the femoropopliteal segment in 81 patients (34.3%), the femoropopliteal and infrapopliteal segments in 101 patients (42.8%), and the infrapopliteal segment in 54 patients (22.9%). AFS was significantly better in the bypass group at 5 years (60.5 ± 3.6%) compared with the EVT group (35.3 ± 3.6%) (p < .001). Major amputation occurred in 61 patients (25.8%) in the bypass group and 85 patients (36.0%) in the EVT group (HR 0.66, 95% CI 0.47 - 0.92; p = .014). The probability of healing was significantly better in the bypass group at 6 months compared with the EVT group (p = .003). The median length of stay was shorter for the EVT group (4 days) than for the bypass group (8 days) (p = .001). Urgent re-intervention and re-admission rates were high and did not differ significantly between the groups. Conclusion: This study showed that lower limb bypass surgery offered a significantly higher probability of AFS and wound healing compared with EVT in patients with CLTI.


X-Ray Exposure Time in Dedicated Academic Simulation Programs Is Realistic To Patient Procedures
  • Article
  • Full-text available

January 2022

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47 Reads

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2 Citations

EJVES Vascular Forum

Objective To ascertain whether simulated endovascular procedures are comparable to real life operating room (OR) procedures, particularly with regards to irradiation time. Methods This was a retrospective study comparing simulation with clinical data. Fluoroscopic time and overall operation time were compared between simulated abdominal aortic endovascular repair (EVAR) and iliac procedures that were respectively performed from 2016 to 2019 and from 2015 to 2019, and clinical EVAR and iliac procedures performed in the OR between January 2018 and November 2021. Results Within the defined periods, 171 simulated procedures (91 EVAR, 80 iliac) and 199 clinical procedures (111 EVAR, 88 iliac) were performed. For both EVAR and iliac procedures, median total procedure time was much longer during real surgery (p < .001). However, median total radioscopy time remained equivalent, whether the procedure was real surgery or performed on the simulator, for iliac procedures (8.47 minutes in the OR, 8.35 minutes on the simulator, p = .61) as well as for EVAR procedures (14.80 minutes in the OR, 15.00 minutes on the simulator p = .474). Conclusion Simulated endovascular procedures are comparable with real life OR procedures, particularly with regards to irradiation time when integrated in a dedicated curriculum.

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Plasma concentrations of lipoproteins and risk of lower-limb peripheral artery disease in people with type 2 diabetes: the SURDIAGENE study

March 2021

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70 Reads

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19 Citations

Diabetologia

Aims/hypothesis The lipid profile has not been fully investigated in individuals with peripheral artery disease (PAD). We aimed to evaluate the relationship between plasma concentrations of lipoproteins and the prevalence of lower-limb PAD at baseline and its incidence during follow-up in people with type 2 diabetes. Methods Plasma concentrations of total cholesterol, HDL-cholesterol, triacylglycerol and apolipoprotein (Apo) A-I, ApoA-II, ApoB-100 and Apo(a) were measured at baseline using colorimetric or MS methods in the SURDIAGENE cohort. Total cholesterol/HDL-cholesterol ratio, non-HDL-cholesterol and LDL-cholesterol were estimated using computation formulas. Logistic and Cox proportional hazard regression models were fitted to estimate OR or HR, with related 95% CI, for baseline prevalence or incidence of major PAD (lower-limb amputation or requirement of revascularisation) during follow-up by increasing lipoprotein tertiles, after adjustment for key confounders. Results Among 1468 participants (women 42%, mean ± SD age 65 ± 11 years, duration of diabetes 14 ± 10 years at baseline), 129 (8.8%) had a baseline history of major PAD. Major PAD was less prevalent at baseline in the highest (vs lowest) tertile of HDL-cholesterol (OR 0.42 [95% CI 0.26, 0.71], p = 0.001) and ApoA-I (OR 0.39 [95% CI 0.23, 0.67], p = 0.0007), and more frequent in the highest tertile of total cholesterol/HDL-cholesterol ratio (OR 1.95 [95% CI 1.18, 3.24], p = 0.01). Among 1339 participants without a history of PAD at baseline, incident PAD occurred in 97 (7.2%) during a median (25th–75th percentile) duration of follow-up of 7.1 (4.4–10.7) years, corresponding to 9685 person-years and an incidence rate of 9.8 (95% CI 8.0, 12.0) per 1000 person-years. The risk of incident PAD was lower in the top (vs bottom) tertile of HDL-cholesterol (HR 0.54 [95% CI 0.30, 0.95], p = 0.03) or ApoA-I (HR 0.50 [95% CI 0.28, 0.86], p = 0.01) and higher in the top tertile of total cholesterol/HDL-cholesterol ratio (HR 2.81 [95% CI 1.61, 5.04], p = 0.0002) and non-HDL-cholesterol (HR 1.80 [95% CI 1.06, 3.12], p = 0.03). Conclusions/interpretation We reported independent associations between HDL-cholesterol, ApoA-I, total cholesterol/HDL-cholesterol ratio or non-HDL-cholesterol and the prevalence or the incidence of major PAD in people with type 2 diabetes. Our findings provide a picture of lipoprotein profile in people with type 2 diabetes. Graphical abstract


Relationship Between Diabetic Retinopathy Stages and Risk of Major Lower-Extremity Arterial Disease in Patients With Type 2 Diabetes

November 2020

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33 Reads

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18 Citations

Diabetes Care

Objective: We evaluated the association between diabetic retinopathy stages and lower-extremity arterial disease (LEAD), its prognostic value, and the influence of potential contributors to this relationship in a prospective cohort of patients with type 2 diabetes. Research design and methods: Diabetic retinopathy was staged at baseline as absent, nonproliferative, or proliferative. A Cox regression model was fitted in order to compute the hazard ratio (HR) (95% CI) for major LEAD (lower-limb amputation or revascularization) during follow-up by baseline retinopathy stages. The retinopathy-LEAD association was assessed in subgroups by age, sex, diabetes duration, HbA1c, systolic blood pressure, diabetic kidney disease, smoking, and macrovascular disease at baseline. The performance of retinopathy in stratifying LEAD risk was assessed by using the C statistic, integrated discrimination improvement (IDI), and net reclassification improvement (NRI). Results: Among 1,320 participants without a history of LEAD at baseline, 94 (7.1%) developed a major LEAD during a 7.1-year median follow-up (incidence rate 9.6 per 1,000 person-years [95% CI 7.8-11.7]). The LEAD incidence rate (per 1,000 person-years) increased as retinopathy worsened: it was 5.5 (95% CI 3.9-7.8) in participants in whom retinopathy was absent, 14.6 (11.1-19.3) in those with nonproliferative retinopathy, and 20.1 (11.1-36.3) in those with proliferative retinopathy. Nonproliferative retinopathy (adjusted HR 2.31 [95% CI 1.43-3.81], P = 0.0006) and proliferative retinopathy (3.14 [1.40-6.15], P = 0.007) remained associated with major LEAD. No heterogeneity was observed across subgroups. Retinopathy enhanced the C statistic (+0.023 [95% CI 0.003-0.044], P = 0.02), IDI (0.209 [0.130-0.321], P < 0.001), and NRI (0.562 [0.382-0.799], P < 0.001) values for risk of LEAD, beyond traditional risk factors. Conclusions: An independent dose-response relationship was identified between diabetic retinopathy stages and major LEAD. Retinopathy yielded incremental prognostic information for stratifying risk of LEAD, suggesting its usefulness as a predictor of LEAD.



Delayed severe median nerve palsy due to undiagnosed brachial pseudoaneurysm

May 2020

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19 Reads

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1 Citation

VASA

Post-catheterization pseudoaneurysms are a well-known complication of many endovascular procedures at the site of arterial puncture. However, long-term neurological complications due to undiagnosed compression are rare. A 60-year-old man presented to our unit for round, non-pulsatile, painless swelling in the inner side of his upper arm. Clinical examination showed finger paralysis, associated with amyotrophy of the forearm. Large brachial pseudoaneurysm with median nerve compression was diagnosed. The patient underwent autologous vein bypass, with poor 6-month neurological recovery. Early diagnosis of pseudoaneurysms is paramount because, when associated with nerve compression, the longer the diagnostic delay, the poorer the neurological prognosis.


Multicentre Experience with the Chimney Technique for Abdominal Aortic Aneurysms in French University Hospitals

April 2020

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74 Reads

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34 Citations

European Journal of Vascular and Endovascular Surgery

Objective The chimney technique (ChEVAR) allows for proximal landing zone extension for endovascular repair of complex aortic aneurysms. The aim of the present study was to assess ChEVAR national outcomes in French university hospital centres. Methods All centres were contacted and entered data into a computerised online database on a voluntary basis. Clinical and radiological data were collected on all consecutive ChEVAR patients operated on in 14 centres between 2008 and 2016. Patients were deemed unfit for open repair. Factors associated with early (30 day or in hospital) mortality and type 1 endoleak (Type I EL) were calculated using multivariable analysis. Results In total, 201 patients with 343 target vessels were treated. There were 94 juxtarenal (46.8%), 67 pararenal (33.3%), 10 Crawford type IV thoraco-abdominal (5%) aneurysms, and 30 (15.1%) proximal failures of prior repairs. The pre-operative diameter was 66.8 ± 16.7 mm and 28 (13.9%) ChEVAR were performed as an emergency, including six (2.9%) ruptures. There were 23 (11.7%) unplanned intra-operative procedures, mainly related to access issues. The rate of early deaths was 11.4% (n = 23). The elective mortality rate was 9.8% (n = 17). Nine patients (4.5%) presented with a stroke. The rate of early proximal Type I EL was 11.9%. Survival was 84.6%, 79.4%, 73.9%, 71.1% at 6, 12, 18, and 24 months, respectively. The primary patency of chimney stents was 97.4%, 96.7%, 95.2%, and 93.3% at 6, 12, 18, and 24 months, respectively. Performing unplanned intra-operative procedures (OR 3.7, 95% CI 1.3–10.9) was identified as the only independent predictor of post-operative death. A ChEVAR for juxtarenal aneurysm was independently associated with fewer post-operative Type I ELs (OR 0.17, 95% CI 0.05–0.58). Conclusion In this large national ChEVAR series, early results were concerning. The reasons may lie in heterogeneous practices between centres and ChEVAR use outside of current recommendations regarding oversizing rates, endograft types, and sealing zones. Future research should focus on improvements in pre-operative planning and intra-operative technical aspects.


Citations (19)


... Interpretation and generalisability: Our study outcomes align with the BEST-CLI trial and conflict with the findings of BASIL-2, the other major contemporaneously published lower limb CLTI trial [3,4]. Several other recent international retrospective studies have echoed improved wound healing and amputation-free survival in patients treated with infrainguinal bypass over endovascular intervention for CLTI patients [9,10]. The differences between the patient populations in BEST-CLI and BASIL 2 have been somewhat elucidated, although further collaboration between the principal investigators of each trial is expected to yield greater clarification on this. ...

Reference:

Contemporary Outcomes of Infrainguinal Vein Bypass Surgery for Chronic Limb-Threatening Ischaemia: A Two-Centre Cross-Sectional Study
Infra-inguinal Endovascular Revascularisation and Bypass Surgery for Chronic Limb-Threatening Ischaemia: a Retrospective European Multicentre Cohort Study with Propensity Score Matching
  • Citing Article
  • June 2023

European Journal of Vascular and Endovascular Surgery

... Unlike in the past, where only low-density lipoprotein was emphasized, both low-density lipoprotein and triglyceride abnormalities should now be considered [28]. For LEADDP, a recent study has shown that plasma concentrations of HDL-C, TC/HDL-C, and apolipoproteins are associated with the incidence of LEADDP [29]. Other studies have not found a link between lipid parameters and the incidence of LEADDP [23,30]. ...

Plasma concentrations of lipoproteins and risk of lower-limb peripheral artery disease in people with type 2 diabetes: the SURDIAGENE study

Diabetologia

... In addition, whether plasma proteomics can enhance the prediction of PAD risk in patients with T2D remains unclear. Previous PAD prediction models for patients with diabetes mostly relied on clinical variables (12)(13)(14)(15)(16), such as the recently developed cardiovascular disease (CVD) prediction model for patients with T2D, SCORE2-Diabetes, which included PAD as an extended end point (17). However, it remains unknown whether incorporating proteomics data into the existing clinical model could improve the accuracy of PAD prediction in people with T2D. ...

Relationship Between Diabetic Retinopathy Stages and Risk of Major Lower-Extremity Arterial Disease in Patients With Type 2 Diabetes
  • Citing Article
  • November 2020

Diabetes Care

... Other endovascular therapeutic options like off-the-shelf fenestrated or branched endovascular stent grafts are frequently not available, require dedicated endovascular experience, or might not be suitable according to the individual thoracoabdominal aortic configuration [27,28]. Therefore, the parallel graft EVAR technique with implantation of chimney or periscope parallel grafts for renovisceral organ perfusion can be considered as an important option for endovascular repair of complex ruptured aneurysms without delay [29][30][31][32]. ...

Multicentre Experience with the Chimney Technique for Abdominal Aortic Aneurysms in French University Hospitals
  • Citing Article
  • April 2020

European Journal of Vascular and Endovascular Surgery

... If, on the one hand, the evidence about CV and renal benefit of SGLT2i is clear and strong-in particular in patients affected by heart failure and regardless of the presence of T2D-on the other hand, data supporting their use in a PAD setting are more controversial due to an almost doubled amputation risk reported in the CANVAS trial with canagliflozin [56,122]. On the pathophysiological side, hypoperfusion to distal extremities induced by hypovolemia related to osmotic diuresis and glycosuria is the proposed and supposed mechanism underlying increased amputation risk during SGLT2i use, in a similar manner as other diuretics [159]. This safety concern was fueled by other observational studies in which SGLT2i use had an increased risk of lower-limb amputations, with most events occurring with canagliflozin [160,161]. ...

Lower limb events in individuals with type 2 diabetes: evidence for an increased risk associated with diuretic use

Diabetologia

... This hypothesis is further corroborated by a study investigating IMA as a biomarker of lower-extremity artery disease, a condition characterized by a significant pro-inflammatory and pro-oxidant state in T2DM patients. In this study, IMA concentrations were independently associated with the risk of peripheral revascularization or lower-limb amputation after 5.6 years of follow-up [93]. Appropriately designed prospective studies are warranted to investigate the capacity of IMA to predict diabetes complications and other adverse clinical outcomes in order to justify the use of this biomarker in routine practice. ...

Prognostic Values of Inflammatory and Redox Status Biomarkers on the Risk of Major Lower-Extremity Artery Disease in Individuals With Type 2 Diabetes
  • Citing Article
  • August 2018

Diabetes Care

... Studies that evaluate the biological mechanisms that could account for any such risk of SGLT2i's are also needed. For example, it is unclear whether any increased risk of amputation, should it be present, is due to the diuretic effect of SGLT2i's; some studies have suggested that diuretics may increase the risk of amputations in patients with type 2 diabetes [48] [49]. ...

Association of Diuretics Use and Amputations in Patients with Type 2 Diabetes—A Hypothesis Driven from Canvas Warning?
  • Citing Article
  • May 2018

Diabetes

... VORTEC was first introduced for renal revascularization during aortic reconstruction in aneurysm surgery, but recently also applied in hybrid aortic arch surgery or in femoral bypass. [5] We modified the original VORTEC where puncture is not required but with direct introduction of guidewire into target vessel and deployment of stent overlapping both sides of artery, reestablish blood flow (Fig. 7). [6] This modified VORTEC has a few advantages. ...

Use of VIABAHN Open Revascularisation TEChnique (VORTEC) for Iliofemoral Bypass

EJVES Short Reports

... In diabetic patients, atherosclerotic lesions were more common in lower extremity arteries than carotid arteries. Schneider et al. found that PAD but not carotid and/or coronary artery diseases was a relevant risk factor for both minor and major amputation [33]. Furthermore, PAD was closely associated with the occurrence of cardiovascular disease. ...

Influence of micro- and macro-vascular disease and Tumor Necrosis Factor Receptor 1 on the level of lower-extremity amputation in patients with type 2 diabetes

Cardiovascular Diabetology

... However, bypasses performed to the peroneal artery (which rely on collateralisation to the foot) are most effective when there is good collateralisation to the foot and a patent pedal arch is present. 99 Pedal arch patency also seems to be associated with improved wound healing and reduced risk of major amputation. 113 ...

Impact of angiosome- and non-angiosome-targeted peroneal bypass on limb salvage and healing in patients with chronic limb-threatening ischemia
  • Citing Article
  • July 2017

Journal of Vascular Surgery