Faible performances diagnostiques de l'IPS cheville de repos par rapport au doppler artériel des membres inférieurs dans le diagnostic de l'AOMI chez le patient coronarien: à propos d'une série hospitalière / Weak diagnostic performance of resting ankle ABI compared with lower limb's arterial Doppler in the diagnosis of PAD in coronary patients: about a hospital serial study

Introduction. L'index de pression systolique (IPS) est considéré comme un outil indispensable, pour la prise en charge de l'artériopathie oblitérante des membres inférieurs (AOMI), cependant un complément d'exploration par les autres testes physiologiques, IPS au gros orteil et IPS effort s'impose afin de réduire le nombre des faux négatifs. Objectif. Démontrer le faible apport de l'IPS cheville de repos par rapport à l'échodoppler artériel des membres inférieurs dans le diagnostic de l'AOMI. Matériels et méthodes. Sur une série de 300 malades coronariens consécutifs durant l'année 2016 hospitalisés dans le service de cardiologie de l'hôpital universitaire de Constantine, un dépistage de l'AOMI a été réalisé par les investigations suivantes : Mesure de l'IPS à la cheville, compléter par la mesure de l'IPS a l'orteil si incompressibilité artérielle et par la mesure de l'IPS d'effort si l'IPS de repos est limite. Un échodoppler artériel des membres inférieurs a été réalisée par un échographe vividE9 General Electric pour l'ensemble de nos malades, en utilisant une sonde à balayage linéaire 12L, destinée à l'exploration vasculaire périphérique permettant d'obtenir un dépistage ciblé, Le traitement et l'exploitation des données ont fait appel au logiciel SPSS22. Résultats. Une sensibilité modérée de l'ordre de 50%, face à une spécificité élevée avoisinant 100% de l'IPS cheville de repos par rapport à l'échodoppler artériel des membres inférieurs. Sensibilité nettement améliorer après complément par les autres testes physiologiques qui sont la prise de l'IPS cheville effort et la mesure de l'index de pression systolique au gros orteil. Conclusion. L'examen vasculaire des membres inférieurs associe à la mesure de l'IPS cheville couplée aux autres testes physiologique (IPS au gros orteil et IPS effort) assurent une bonne sensibilité et spécificité diagnostiques de l'AOMI

Pattern of vascular diseases at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

BACKGROUND: Vascular diseases are evolving fast in sub-Saharan Africa, but its management is challenged by lack of expertise and infrastructure. In the light of the prevailing challenge, this study was done to see the pattern of vascular disease and its treatment in a tertiary referral hospital. METHODS: A prospective cross-sectional study was done over a period of one year (February 9, 2016 to February 8, 2017) at Tikur Anbessa specialized hospital (TASH) at Addis Ababa, Ethiopia. RESULTS: A total of 386 patients were seen at the surgical OPD. Of these, 78(20.2%) were admitted and operate on. The male to female ratio was 1.3:1. The mean age affected was 39 +/- 10 (Range 12-91 years). On the other hand, 132 (34.2%) patients came with PAD. Of them, 46(34.8%) presented with either frank Gangrene or pre-gangrene stage. The rest 86(65.1%) had claudication pain. The other diseases seen are Varicose Vein, 100(25.9%), Carotid body tumors, 60(15.4%), Aneurysmal diseases, 36(9.1%), Vascular malformations, 34(8.7%), and Vascular injuries, 22(5.6%). During the study period, 28(35.9%) PAD, 22(28.2%) trauma patients, 8(10.2%) Chemodectomas, 8(10.2%) aneurysms, 6(7.7%) hemangiomas, 4(5.1%) varicose vein and 2(2.6%) AV fistula patients were operated. CONCLUSION: The pattern of vascular disease in Ethiopia is becoming a challenge. The gap created due to limited vascular surgeons, poor infrastructure and absent supply chain system has significantly compromised the number and type of operated-on patients. These challenges result in preventable morbidity and mortality

Limb revascularization of peripheral artery disease in the developing countries: earliest 1-year experience from Northwestern Nigeria

Purpose: The purpose of the study is to present the preliminary audit and challenges of earliest cases of balloon angioplasty from Northwestern Nigeria. Materials and Methods: We present our first 25 cases of peripheral angioplasty in Northwestern Nigeria. The clinical diagnosis of peripheral artery disease was confirmed with Doppler ultrasound and angiography. Angioplasty was done either through femoral or brachial artery approaches. The patients were monitored for minimum of 6 months with serial clinical and Doppler ultrasound examinations. Results: Our patients consist of 19 males and 6 females. Their ages ranged from 20 to 80 years with a mean of 54 ± 17.5 years. There were 13 hypertensive and 15 diabetic patients while 5 patients have co-morbidities of diabetes and Hypertension. Although femoral antegrade route is the common access for angioplasty (14 out of 25), seven patients who were treated through the left brachial artery, six of them had either Type C or D aortoiliac disease in addition to distal lesions. At follow-up, 36% had limb amputation while one patient died a day after the procedure. Out of nine patients who had amputation, six are diabetic. Conclusion: Although more than half of them had improved blood flow with healing ischemic ulcers and reducing claudications, still substantial number of our patients often present late with severe peripheral artery disease. As a result, we had to resort to cumbersome arterial access and high amputation rate

Comparison of Quality of Life in Patients with Peripheral Arterial Disease Caused by Atherosclerosis Obliterans or Buerger's Disease : Cardiovascular Topic

Objective: Buerger's disease and atherosclerosis obliterans (ASO) are two peripheral arterial diseases (PAD) that are frequently encountered. The aim of this study was to compare quality of life (QOL) in patients with Buerger's disease and ASO. Methods: We prospectively followed 86 patients who were admitted to our hospital due to ASO or Buerger's disease. Their ischaemia was evaluated according to the clinical category chronic limb ischaemia at the time of hospital admission and at six and 12 months. The QOL was measured at the time of hospital admission and at six and 12 months with the Short Form Health Status Survey (SF-36) and Vascular Quality of Life Questionnaire (VASCUQOL). Results: A total of 86 patients with ASO or Buerger's disease (47 and 39; respectively) were included in the study. Pain parameters from both SF-36 and VASCUQOL scores were lower in patients with Buerger's disease at the time of hospital admission and at six months. The impairment in QOL was found to be proportional to the extent of chronic limb ischaemia. Conversely; when patients with critical limb ischaemia were evaluated; no difference was observed between those with ASO or Buerger's disease in terms of QOL. Amputations were found to have a negative effect on quality of life. Conclusion: Buerger's disease had a more pronounced negative effect on QOL than ASO; particularly in terms of pain score. When critical limb ischaemia was considered; ASO and Buerger's disease impaired quality of life at the same rate

Artériopathie oblitérante asymptomatique des membres inférieurs chez un groupe de patients avec des facteurs de risque cardiovasculaire à Yaoundé

INTRODUCTION. L'artériopathie oblitérante des membres inférieurs (AOMI) évolue chez près de 70% des malades de manière asymptomatique. Le but de notre étude était de décrire les aspects épidémiologiques, cliniques et diagnostiques de l'AOMI chez un groupe de patients consultant à l'Hôpital Général de Yaoundé. METHODOLOGIE. Il s'agit d'une étude transversale, descriptive qui s'est déroulée d'Octobre 2012 à Avril 2013 dans l'unité de Cardiologie de l'Hôpital général de Yaoundé. Nous avons recruté 42 sujets ayant au moins un facteur de risque cardiovasculaire majeur. Pour chaque sujet, nous avons collecté des données cliniques, anthropométriques. Puis nous avons mesuré l'Indice des pressions systoliques(IPS) et l'épaisseur intima média (EIM) fémorale. RESULTATS. La moyenne d'âge des sujets était de 54,3 ± 10,3 ans avec un sex-ratio (H/F) de 3,2. Une AOMI (IPS < 0,90) a été retrouvée chez 16,7% des sujets, tandis que 7,1% avaient un IPS > 1,30. L'EIM fémorale moyenne était de 0,82 ± 0,19 mm et 26,2% des sujets avaient une EIM augmentée (> 1 mm). CONCLUSION. L'AOMI asymptomatique est fréquente chez les patients présentant plusieurs facteurs de risque cardiovasculaire à Yaoundé

The prevalence of peripheral arterial disease in diabetic subjects in south-west Nigeria

Background: Peripheral arterial disease (PAD) is rarely sought for and generally underdiagnosed even in diabetics in developing countries like Nigeria. PAD is easily detected and diagnosed by the ankle-brachial index; a simple and reliable test. Objectives: To determine the prevalence of PAD in diabetic subjects aged 50-89 years and the value of ankle-brachial index measurement in the detection of PAD. Method: A cross-sectional descriptive study of 219 diabetic subjects aged 50-89 years was carried out. The participants were administered a pre-tested questionnaire and measurement of ankle-brachial index (ABI) was done. The ankle-brachial index 0.90 was considered equivalent to peripheral arterial disease. Results: The overall prevalence of PAD was 52.5. The prevalence of symptomatic PAD was 28.7whilst that of asymptomatic PAD was 71.3. There were a number of associations with PAD which included; age (p 0.05); sex (p 0.05); and marital status (p 0.05). The use of the ankle-brachial index in the detection of PAD was clearly more reliable than the clinical methods like history of intermittent claudication and absence or presence of pedal pulses. Conclusion: The prevalence of PAD is relatively high in diabetic subjects in the southwestern region of Nigeria. Notable is the fact that a higher proportion was asymptomatic. Also the use of ABI is of great value in the detection of PAD as evidenced by a clearly more objective assessment of PAD compared to both intermittent claudication and absent pedal pulses