Publication:

Clinical study of peripheral arterial occlusive disease of lower extremities

Background Diagnosing PAD is important in order to implement appropriate therapies for preventing cardiovascular morbidity and mortality, improving functional impairment, and preventing further functional decline. The objective was to study the pattern of clinical presentation and etiology of peripheral arterial occlusive disease.

Methods This was a cross sectional observational study of 50 cases diagnosed with peripheral arterial disease of the lower extremities. History was taken as soon as the patient was admitted. A thorough clinical examination was carried out personally to find out and establish clinically first, the presence of vascular obstruction. Detailed vascular system examination was done as per the proforma provided.

Results TAO and atherosclerosis are the etiologies for ischemia in these cases, with atherosclerosis being more common of the two. All the cases of PAD presented with ischemic claudication and rest pain as common symptoms, while gangrene (80% of cases) and ischemic ulcer (20% of cases) were the other predominant symptoms. Doppler findings correlated with the disease presentation, TAO having a more infra-popliteal obstruction and atherosclerosis showing more proximal obstruction. All the cases were managed with some form of surgery and majority of them had limb loss. The level of amputation was below knee in 42% and above knee in 58% cases. Improvement of rest pain noted in 62.5% of cases, healing of ulcer in 50% of cases and improvement in claudication pain in 37.5% of patients who underwent lumbar sympathectomy.

Conclusions Post operatively most of the patients recovered uneventfully and some patients required secondary suturing of the surgical site. Three patients required a revision amputation at a higher level. At first month follow-up, many patients were ambulatory with the use of crutches.