Peripheral artery disease

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EPIDEMIOLOGY :

  • 2 at 3 % men, 1 at 2 %women after 60 years
  • asymptomatic : 10 at 12% + 65 years
  • Risk factors : Smoking, diabetes +++

TOBACCO :

—> Facteur de risque n=1 dans lAOMI retrouvé dans chez 90% patients with claudication < 75years

Incidence de lartérite / year 1000 in a Paris Prospective Study (Cardiovascular Prevention. P Ambrosi)

Facteurs de risque de progression de l’AOMI :

(TASK, J Vase Surg, 2000)

other etiologies :

1- Inflammatory diseases :

  • The thromboangiitis obliterans, or Buerger's disease.
  • La maladie de Takayasu.
  • collagenosis (the périarthrite noueuse (PAN), SLE (LED) and GCA).

2- Infectious causes :

  • syphilis.
  • La rickettsiose.

3- Disorders of blood viscosity :

  • polycythemia
  • thrombocytose

Identification du stade de l’AOMI :

  • Screening : palpation, IPS
  • Claudication
  • lschémie

Leriche and Fontaine classification :

  • According to the clinical severity (liée au niveau et au degré de l’arterial obstruction, and more or less significant development of collateral circulation)

Stade In : asymptomatologie, mais abolition dun ou plusieurs pou Is traduisant loblitération dun ou plusieurs tronc artériels

Stade II : ischémie musculaire à l’effort, manifesting as intermittent claudication walking., arterial blood flow at rest is sufficient.

Stade III : permanent tissue ischemia. Le débit au repos est » limite »

stage IV : advanced ischemia with trophic disorders and gangrene.

  • ischemia’effort asymptomatique : IPS < 0,9 ou abolition de pouls sans manifestations cliniques d’ischemia
  • permanent chronic ischemia : combination of rest pain or trophic disorders for at least 15 days with a systolic blood pressure less than 50 mmHg at the ankle or 30 mmHg à l’toe.

* L’ischémie aiguë dun membre correspond à une altération brutale de sa perfusion, involving immediate vitality.

—> hospitalization for 2 last

Diagnostic :

Field :

  • Profession, physical activity.
  • Alcohol poisoning often associated with tobacco.
  • Other cardiovascular risk factors

PAIN :

  • Douleur d’effort (muscle cramp),
  • limp intermittente (pain on walking) The walking distance for which a pain occurs, called "walking perimeter", est un indicateur de lévolutivité de la sévérité lésions.
  • Of rest pain.
  • Constant pain, often night.

– At a more advanced stage, there may be necrosis, leg ulcers

Systolic Pressure Index IPS :

0.9 < IPS <1.3 : normal hemodynamics
0.75 < IPS < 0.9 : arterial well compensated
0.4 < IPS < 0.75 : arterial moderately compensated
IPS < 0.4 : severe hemodynamic consequences

NATURAL HISTORY :

Prognosis depending on the location

*The locations proximal iliac artery have a general prognosis worse (2,5 at 3,5 times more d’évts CV)

*The distal lesions local more severe prognosis, more’amputations

Additional tests :

Échodoppler évaluer la sévérité des lésions et leur localisation en vue dun geste thérapeutique1.

arteriography : Reserved for patients in whom surgical revascularization is being considered.

Angioscanner et Angie Resonance

assessment of the lesions :

– Organic
– systematic ECG
– routine screening for carotid disease

Prise en charge thérapeutique d’un patient asymptomatique ou au stade d’ischemia’effort :

GOALS :

  • Prévenir le risque de complications cardio-vasculaires et daccidents thrombotiques.
  • Freiner ou stabiliser lévolution de la maladie athéromateuse (local extension and distance).
  • Get a functional improvement to increase the quality of life.

Lifestyle Changes :

  • Smoking.
  • Diabetes.
  • weight reduction.
  • Walk and exercise Systematics, daily > 30 mn

INTERVENTIONS MEDICAMENTEUSES :

  • Antiagrégants
  • Statins
  • IEC

Course Dr S. Bensalem – Faculty of Constantine