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.