Category: Vascular

What Are The Clinical Advantages Of The Atys Systoe?

The Atys SysToe is a ground breaking device designed for the rapid and automatic assessment of toe or finger systolic pressures. Here are some of its key clinical advantages:

  1. Ease of Use: The SysToe is user-independent, meaning it can be operated easily by healthcare professionals without extensive training
  2. Accuracy and Reliability: Utilizing infrared photoplethysmography (PPG) and a patented algorithm, the SysToe provides accurate and reproducible measurements, even in patients with conditions like diabetes or chronic renal failure
  3. Versatility: It can measure pressures as low as 20 mmHg and is suitable for use in various settings, including vascular labs, diabetic units, and general practice
  4. Clinical Validation: The device has been clinically validated, showing good agreement with traditional methods like laser Doppler. It is particularly useful for patients with calcified arteries where other methods might fail
  5. Comprehensive Assessment: The SysToe can calculate the toe brachial index (TBI) or finger brachial index (FBI) when brachial pressure is known, aiding in the diagnosis and monitoring of peripheral arterial disease (PAD) and critical limb ischemia (CLI)
  6. Patient Comfort: The automatic inflation and deflation of the occlusion cuffs ensure a comfortable experience for patients
    These features make the Atys SysToe an invaluable tool for healthcare providers, enhancing the diagnosis and management of vascular conditions with efficiency and precision.

Why Is There A Need For The Systoe Toe Pressure Measurement System?

Clinical situation

Peripheral arterial disease (PAD) is when the arteries, in this case, to the legs, become fully or partially blocked. This blockage most commonly occurs due to atherosclerotic (cholesterol) plaques.

Arterial blood brings oxygen and nutrients to the muscles of the legs, and when blocked may result in pain in the legs, also called intermittent claudication. Intermittent claudication is typically described as pain in the patient’s calf after walking a distance that goes away when the patient rests.

In advanced peripheral arterial disease, the patient may have pain in the legs at rest, and may develop leg ulcers and gangrene.

When a patient is first seen and suspected of having PAD, the underlying diagnosis is usually not difficult if a proper history and physical examination is performed.

For this purpose the Ankle brachial index (ankle systolic pressure/brachial systolic pressure) is usually measured.

Why is there a need for the Systoe?

Limitations of Ankle Brachial Index (ABI)

In the case of diabetic patients, old patients and renal failure patients, medial calcification (deposit of calcium on the middle part of the artery wall) of the tibial/peroneal arteries may prevent the measurement of the ABI pressure.

ABI measurement is impossible in

  • 15 %  of diabetic patients at the time of the diagnosis.
  • 20 % of the diabetic patient present a PAD
  • 30 % after 15 years

Weitz et al. Circulation. 1996; 94: 3026-3049

As the toe arteries are affected by medial calcification later than the leg arteries, the toe systolic pressure can be measured to circumvent the problem of medial calcification of the tibial/peroneal arteries. Toe pressures are a clinical indicator. For clinical purposes a normal Toe brachial Index (TBI = toe systolic pressure/brachial systolic pressure) is considered to be higher than 0.7

For any value less than that, the patient will be found to have some occlusive disease proximal to the recording site.

A major advantage of TBI is its use following the progress of disease and after any form of intervention.

The Atys SysToe can also be used in the following circumstances

  • Triage patients before referral to vascular specialist
  • Opportunistic Screening and follow up after intervention
  • Wound and Ulcer healing

The Atys SysToe is a fully automatic clinically validated device that gives consistent readings which are not operator dependent. Using the SysToe clinicians can quickly determine whether a patient does or doesn’t have PAD without necessarily referring to a specialist Ultrasound Dept saving time and money

Hokanson Cuff Changes Are Ahead.

Hokanson whose range of vascular instruments, cuffs and accessories are distributed in the UK and Ireland by PMS Instruments recently announced some changes to their cuffs. All cuffs manufactured after 31st August 2017 will now be supplied with male bayonet connectors.

Hokanson vascular cuffs have been the standard in vascular laboratories and clinics throughout the world for over 40 years and as they have been using “leur” type connectors for many years why the change now?

As ever the idea is to make medical devices safer and in the case of “small bore connectors” which includes blood pressure and vascular cuffs minimize medical device tubing misconnections.

Small-bore connectors are parts used to connect medical devices such as tubing, syringes, IV lines and other accessories that deliver fluids and gases for patient care. Although thankfully rare, tubes using standard luer connectors but with different functions have in the past been mismatched and connected incorrectly.

In the USA the FDA provide several examples of this happening on their website including the case of a blood pressure cuff which was accidentally connected to an IV catheter.

The FDA, and the International Organization for Standardization (ISO), decided to take action and IEC 80369-5:2016 was published in March 2016 to provide specifications for the small-bore connectors used with blood pressure cuffs. Hokanson have standardised on a male bayonet connector.

The following cuffs will be affected.

Hokanson UDC/UPC cuffs, the DP and SC cuffs that currently come with a Luer connector will be changed to a bayonet connector. This includes the SC10, SC12, TMC7 and SC5.

Hokanson cuffs with D rapid version hoses (SC12D, SC12LD, etc.) will remain unchanged. CC thigh cuffs will come with the bayonet connectors, and that connector can be cut off for use with an E20 rapid cuff inflator Y-connector (as with the Luer).

We will be providing Permanent Conversion Kits as well as Adaptor Kits to ensure compatibility and allow you to use legacy leur connector cuffs. Conversion kits are for permanent conversion of cuffs already being used that will change them to the new standard bayonet connector. Adapter kits are for customers who want to use both Luer and bayonet connectors, until all cuffs in use have bayonet connectors.

There is no requirement requiring customers to remove or stop using products currently in use from the market.

SysToe – Putting your Patient’s Feet First

In this digital day and age, you might not be surprised to hear me ask if you’ve had your digital pressure taken recently? Of course, I mean your toe and finger pressure – simple to forget but important not to ignore.

Today, we’re specifically talking about Peripheral Arterial Disease (PAD), which is when the arteries to the legs get either completely or partially blocked, most commonly due to atherosclerotic (cholesterol) plaques. These blockages lead to intermittent claudication, a leg pain in the patient’s calf as a result of walking, which eases at rest. Many might consider this calf pain as fairly normal, and ignore the symptoms, especially if they felt normal again when resting. If Peripheral Arterial Disease is left unchecked, it may become more advanced, eventually leading to pain at rest, leg ulcers and even gangrene.

PAD has previously been diagnosed with a physical examination by a GP, who would compare blood pressure in the patient’s arm and ankle. A difference in the two readings would be a possible indication of PAD. Whilst this technique has been in use for over half a century, it comes with problems; most notably the need for operator training and that the patient can experience some discomfort throughout the process. We now have the ‘SysToe’ machine, meaning PAD can be quite easily diagnosed with a simple reading of the Toe Brachial Index (TBI). This reading can also be used following diagnosis to track disease and help aid recovery.

So why is the SysToe system so great?

The SysToe system is a fully automated clinically validated patented device. It is not operator dependent so gives reliable and repeatable measurements. This not only saves on NHS time and money, but also helps to create more accurate diagnosis than ever before. It’s the full automation which make the SysToe so great; once the cuff and the sensor are placed on the toe (an easy job for anyone to do), just press the START button for cuff inflation and deflation to take place at the data value displayed within three minutes.

For the quick assessment of lower limb arterial diseases, the SysToe is a must have piece of equipment. Fast measurements, accurate and reproducible results, time & money saving; can your surgery or clinic not afford to have one?

Transcranial Holter and Carotid Stenosis

The Atys Medical TCDx Transcranial Holter is a unique transcranial Doppler with an innovative motorised 1.5MHz Doppler probe. Traditional transcranial Doppler (TCD) requires the patient to be stationary during the recording period with a bulky and uncomfortable headframe that is prone to movement artefacts and loss of signal. The TCDx recorder is small, lightweight and battery operated allowing high resolution digital recording of up to 5 hours duration. Because of the temporal variability in embolization the longer monitoring length is preferable to ensure embolic episodes are not missed.

As the TCDx is portable the patient can engage in normal daily activities and the product can be used in an outpatient setting. An auto search algorithm and automatic self-adjusting probe restores vessel insonation if the signal quality gets weak. Post processing of the recorded TCD signal is automatic and fast using software for emboli detection. Each embolic event is tagged and the operator has full access to both the Doppler spectral signal and audiogram. The Doppler spectral signal is a representation of the Doppler signal in the frequency domain. The Audiogram is the representation of the same Doppler signal but in the time domain.

During set up real time display of the Doppler spectrum and the motorised probe ensures optimum signal quality and positioning on the acoustic window. In symptomatic carotid stenosis, the presence of emboli predicts future transient ischemic attack and stroke risk. Whether they have a similar predictive role in asymptomatic stenosis is under investigations and the TCD-x has been designed to help answer this question.

The applications of the TCD-x are not restricted to carotid plaques. They also include all unstable wall diseases, endocarditis and decompression illness. The TCD-x is also suitable for physiological studies as the time evolution of blood velocity can be analysed.