CHSJ

Curr Health Sci J, vol. 38, no. 1, 2012

Clinical and epidemiological study of occlusive peripheral arterial disease of the lower limbs

[Original Paper]

D. MANESCU(1), P. MANESCU(2), R. NEMES(2)


(1)Department of Surgery, Emergency County Hospital, Drobeta Turnu Severin;
(2)Department of Surgery, University of Medicine and Pharmacy of Craiova


Abstract:

Aim: study of risk factors for the disease, its clinical manifestations, and laboratory diagnostic elements (vascular functional explorations). Material and method: 50 consecutive patients operated in the Department of Surgery no. 1 of the Emergency County Clinical Hospital of Craiova who underwent retroperitoneoscopic lumbar sympathectomy (RLS) are analysed, the study group being a part of a total of 680 patients with occlusive peripheral arterial disease of the lower limbs (PAD), hospitalized and treated in our clinic between 2007 and 2011. Results: sex ratio = 1/7.9 in the group which includes all arterial diseases hospitalized (586 males and 74 females), sex ratio = 1/15.6 in patients who underwent sympathectomy (47 males and 3 females). The comorbidity evaluation highlighted the presence of high blood pressure (HBP)  in 50% of patients who underwent sympathectomy, which is within the range of data obtained on the entire group (52.5%). Chronic ischemic heart disease (20% in patients who underwent sympathectomy and 48.6% in patients of the entire group), acute myocardial infarction (16% in the RLS group and 11.4% in the PAD group) and ischemic stroke (8% in the RLS group and 4.8% in the PAD group) certify the plurifocality of arterial lesions. Diabetes was present in our study in 26% of patients with PAD and 18% of patients with RLS. Smoking was encountered in 72.6% of patients in the reference group and 70% of RLS patients. Twenty one cases had a history of disease of 1 year or less, while the remaining 29 cases have been suffering even for more than 6 years. The clinical picture was dominated by pain, present in all cases. We found no arterial pulsation in the posterior tibial and pedal arteries in 88% of the cases (44 patients). Changes of the hair and nails were present in 21 cases (42%), and in 28 cases (56%) we found hypotrophy of calf and crural muscles. Trophic lesions were present in a total of 24 patients (48%), assigned as stage IV patients. Oscillometric index values were below the normal range in all cases. Skin temperature values were close to normal values (26°C) in only 13 patients (26%); 27 patients (54%) had a distal systolic index (DSI) < 0.5, corresponding to a severe critical ischemia. Conclusions: The development of the disease is caused by the association of several pathogenic factors, the most important ones being age, smoking, diabetes, and HBP. Symptoms at onset were generally mild, insidious, with clinical distress extending over variable periods of time, with oscillating evolution but slowly progressing worsening trend. The clinical picture was dominated by pain. Changes of the skin, hair, nails, and muscles are common objective signs


Keywords: peripheral arterial disease , cardiovascular comorbidities , smoking, diabetes, pain, trophic ulcers, amputation



Corresponding: D. Manescu, MD, PhD Student, Department of Surgery, Emergency County Hospital, Drobeta Turnu Severin,, RomAnia; mail: dragosmanescu2005@yahoo.com


DOI 10.12865/CHSJ.38.01.06 - Download PDF
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