Particularities of peripheral arterial disease managed in vascular surgery in the French West Indies.
BACKGROUND
Epidemiology of peripheral arterial disease is currently unknown in French West Indies (Antilles).


OBJECTIVE
The aim of this study is to present peripheral arterial disease (PAD) occurring in the French West Indian subjects through the analysis of our database of vascular surgery. The study population included 754 patients (mean age 73 +/- 10 years), mostly from African descents. The main clinical presentation was critical limb ischemia (66%, including tissue loss in 48% of cases), followed by claudication (20%). The lesions affected the infragenicular arteries in 86% of cases, including 24% isolated to this level as well as 51% combined to femoro-popliteal lesions and only 7% of cases affecting the aorto-iliac level.


RESULTS
Ankle-brachial index was at 0.57 +/- 0.13 and 0.34 +/- 0.22 (p<0.001) in patients with claudication and critical limb ischemia (CLI), respectively. The severity scores were significantly higher in claudicants with aorto-iliac disease and CLI patients with infragenicular lesions. Except for hypertension (85%) and obesity (19%), the other risk factors were differently distributed between the 2 groups. While in the CLI group, patients were older, with higher rates of female sex, diabetes (62% vs. 48%, p<0.001) and severe renal failure, claudicants were significantly younger, with higher rates of smokers among men (75% vs. 51%, p<0.001) and moderate dyslipidemia (52% vs. 36%, p<0.001). The association with carotid stenosis (12%) and ischemic heart disease (18%) were quite uncommon. Renal disease (glomerular filtration rate<60 ml/mn/1.73 m2) was present in 61% of cases.


CONCLUSIONS
This study highlights clear differences regarding the presentation, localization and associations of PAD in the West Indies subjects managed in vascular surgery, especially with a severe infragenicular disease, even in claudicants. This study suggests the effect of a different distribution of risk factors as well as other ethnic and socio-economic factors.
Deneuville
M
M
Service de chirurgie vasculaire et thoracique, CHU de Pointe-à-Pitre-Abymes, France. m.deneuville@chu-guadeloupe.fr
Pierrot
J M
JM
N'guyen
R
R
D000368:Aged; D000369:Aged, 80 and over; D000842:Ankle / Q000098:blood supply; D001018:Aortic Diseases / Q000150:complications / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D001794:Blood Pressure; D001916:Brachial Artery / Q000503:physiopathology; D016638:Critical Illness; D005121:Extremities / Q000098:blood supply*; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D019430:Guadeloupe / Q000453:epidemiology; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D007383:Intermittent Claudication / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D007511:Ischemia / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D011150:Popliteal Artery / Q000601:surgery; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data