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Arterial occlusive disease (PAD)

Occlusive arterial disease of the lower limbs: definition
The arterial occlusive disease (PAD, also known as peripheral arterial disease), corresponds to the narrowing or occlusion of an artery in the thigh, leg or foot.

The reduced blood flow causes a downstream cellular asphyxia by lack of irrigation (ischemia). The local ischemia can lead to gangrene (tissue death) of all or part of the area poorly irrigated (leg, foot, toe).

Depending on circumstances, it may be sudden or chronic.

It almost always occurs in the context of atherosclerosis, known as atherosclerosis, that is to say an overall deterioration of blood vessels by one or more risk factors for cardiovascular disease: smoking, diabetes, hypertension, hypercholesterolemia, obesity, inactivity.

Risks and consequences of arterial
The PAD is significantly undervalued, under-diagnosed and under-treated (Beckman et al. Circulation, 2006). The study Ellipse (2008) found that almost half of hospitalized patients (42%) in various clinical departments have PAD ignored when the search index systolic pressure. Data from the U.S. NHANES study in the general population (Pande et al. Circulation, electronic publication June 20, 2011) shows a prevalence of PAD at 6% for more than 40 years.

Extrapolation to the population is difficult, but probably near the living conditions copying European American. An IPSOS survey for the Society of Vascular Medicine (Steps for Life, 2007) shows that 6% of 65 to 69 years have intermittent claudication, clinical signs of central PAD. According to the Haute Autorité de Santé (Recommendations 2006), 10 to 20% over 55 years old are asymptomatic PAD, ie silent.
The PAD is part of a generalized impairment of the vessel wall, atherosclerosis, it requires to find a breach of the brain and heart due to the risk of cerebrovascular accident (CVA), myocardial infarction or sudden death. It should be noted that the presence or absence of clinical signs (pain on walking, systolic pressure index above the threshold supported) does not change the complications and deaths (GetABI Study, 2007).
According to a study; having arteritis affecting the arteries high in the pelvis shows a three times higher risk of making a cardiovascular event compared with arteritis affecting the foot or leg. However, the distal arteritis (leg and / or foot) are at greater risk of amputation.

Causes and origins of arteritis of the lower limbs
The PAD is due to a deterioration of arterial walls mainly by plaque, a mass of fat (cholesterol) and inflammatory cells. The artery narrows and stiffens causing a drop in blood flow, so asphyxiation tissue oxygen downstream (especially toes). Blood clots form in the arteries easily damaged. They clog unexpectedly sharply, interrupting all traffic, thus causing acute ischemia very painful and dangerous (gangrene).

Many situations cause arteritis and worse: smoking (95% of patients with PAD consume more than one pack of cigarettes per day), diabetes, hypertension, high cholesterol and obesity. These are the cardiovascular risks common to all vascular diseases.

Signs and symptoms of PAD
The PAD has several evolutionary stages. At the very beginning of its development, the PAD is silent (asymptomatic). Then it occurs gradually walking by symptoms of calf cramps or pain in the leg (called ischemia "effort") appearing increasingly early when walking, this causes lameness special called intermittent claudication because it stops when you stop the effort.

Then the symptoms of pain at rest, lying and night. This worsening of disease signs asphyxia almost permanent tissue causing tissue death if nothing is done: leg ulcers and gangrene.

Gangrene is a total asphyxia and irreversible toes turn black, cold and insensitive. Gangrene required amputation.

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