Occlusive arterial disease: a little-known disease of public
,
The peripheral arterial disease (PAD), a consequence of atherothrombosis
in 90% of cases, still remains a misunderstood disease public, stressed experts
who spoke at a press conference in Paris following the campaign to raise
awareness among general practitioners and the public.
To be taken seriously
Called "Steps for Life" (insofar as the PAD, when symptomatic,
is characterized by the occurrence of pain on walking), this campaign started
with firstly the organization a large open all at Versailles, in partnership
with the French Federation of Hiking and walking distribute posters and
information leaflets for patients in the GP and pharmacies.
The frequency of severe arterial disease is underestimated as often
clinically silent or hidden. Its prevalence (total number of cases per year)
increases with age and if 800,000 patients in France are met, the PAD actually
affect 2 to 2.5 million people and four men for every woman.
Only 34%, also under 65.
"The PAD is the result of a gradual narrowing of the arteries for
vascularization of the lower limbs. It most often results from a combination of
a slowly evolving process (atherosclerosis) and its complications (thrombosis =
migration a blood clot), responsible for cardiovascular events, "said Dr.
Jean-Pierre Laroche, vascular physician at Avignon."Any patient presenting
with PAD should be considered a polyvascular justify an assessment of
cardiovascular risk, including coronary and aortic stroke," said Dr.
Patrick Carpentier (CHU Grenoble). In fact, he says, 8-10% of patients with PAD
at the stage of claudication (pain on walking requiring discontinuation) are
holders of an aneurysm of the abdominal aorta in the infrarenal portion .
According to him, the prognosis of this disease is still severe with a
mortality rate of nearly 50% at 10 years in the absence of treatment of the
disease.
"All epidemiological studies show that the patient will die PAD is
almost never the location of the disease
atherothrombosis, but most often its cardiac (50% of cases),
cerebrovascular (10-15%) or promoted by tobacco (20-30%) cancer, the latter
being the major risk factor for 'PAD, "he points out.
Tobacco, guilty No. 1
Smoking is the risk factor most frequent PAD. According to a French
survey in general practice patients in 5708, 71% of patients with this
condition have smoked or smoke. Thus, the prevalence (total number of cases per
year) of arterial disease from 8% among non-smokers and 17% in moderate smokers
and 33% in heavy smokers.
Other risk factors include high cholesterol, obesity and diabetes.
"The diabetic PAD is more frequent and severe, with lesions most
often distal", informs Prof. Carpentier. Its prevalence is 3.4 times
higher in the diabetic and 5.7 times in women with diabetes compared to people
who are not human. Intermittent claudication is also twice as common in
diabetes and the risk of amputation multiplied by 10 or 15, he says.
Intermittent claudication: the most famous sign
The best known sign of PAD is intermittent claudication, which is pain
occurring when walking, usually in the calf. It occurs after a walk given to
each patient and disappears quickly to stop the effort. However, she returns at
regular intervals, which defines the scope of work for each patient.
Data examination with assessment of this parameter, the clinical
examination and measurement of the index of systolic pressure at the ankle (the
difference between raised blood pressure in the arm and that measured at the
ankle ) or IPS, which says a PAD for less than 0.90 result can usually classify
lesions according to levels of development and severity.
Three stages of PAD are described:
- Stage of ischemia effort (work) or asymptomatic but with lesions
documented or characterized by intermittent claudication in the effort:
- Stage of chronic ischemia: occurrence of rest pain or distal trophic
disorders;
- The final stage of chronic critical ischemia of the lower limbs (risk
of necrosis and amputation).
"But it was the screening of asymptomatic forms (corresponding to
two thirds of cases) is a major public health issue," warns Dr. Laroche.
In fact, patients without symptoms have minor occlusive lesions or very well
supplemented or are so sedentary they do not seek their legs, hence the
importance of routine screening when they have one or several risk factors.
Author: Mohammad
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