title: [Peripheral arterial disease of the lower limbs at Antananarivo University Hospital (Madagascar)].
abstract: OBJECTIVE
  To analyze problems in the management of reversible peripheral arterial disease (PAD) to assess the local technical feasibility of revascularization surgery.
  
  
  METHODS
  This observational study of lower-limb PAD in the vascular surgery department at Antananarivo University Hospital covered the 3-year period from January 2009 to January 2012. Cases of non-atherosclerotic PAD and those with incomplete records were excluded from this study. The characteristics studied were time until specialist management began, clinical presentation, diagnostic tools used, surgical treatment, course, and prognosis in the medium term.
  
  
  RESULTS
  Of the 43 files examined, we selected 29 cases. The time from initial symptoms until management by specialists ranged from 90 to 730 days; for most patients it was between 366 and 730 days. More than half the patients had stage IV PAD according to the classification of Leriche and Fontaine, and the general health status of 31% was impaired. Doppler ultrasound was readily accessible, but computerized tomographic angiography was possible for only 31% of the patients requiring revascularization. Revascularization surgery could be performed for 48.2%, while initial amputation was required for 51.7%. Outcomes of revascularization surgery after 12 months included death for 6.9% of patients, failure of bypass surgery for 6.9%, and a limb salvage rate of 85.7%.
  
  
  CONCLUSIONS
  Despite the lack of technical equipment, conventional surgery can still save limbs for patients at the reversible stage.
authors.affiliation: Service de chirurgie générale et vasculaire, CHU Hujra, BP 4150 Antananarivo 101, Madagascar.
authors.forename: T
authors.initials: T
authors.lastname: Rajaonanahary
authors.affiliation: Service de chirurgie générale et vasculaire, CHU Hujra, BP 4150 Antananarivo 101, Madagascar.
authors.forename: F
authors.initials: F
authors.lastname: Raherinantenaina
authors.affiliation: Service de chirurgie générale et vasculaire, CHU Hujra, BP 4150 Antananarivo 101, Madagascar.
authors.forename: M
authors.initials: M
authors.lastname: Rakotonaivo
authors.affiliation: Service de chirurgie générale et vasculaire, CHU Hujra, BP 4150 Antananarivo 101, Madagascar.
authors.forename: H
authors.initials: H
authors.lastname: Rakoto Ratsimba
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006785:Hospitals, University; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008270:Madagascar; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000601:surgery*; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000379:methods
keywords: Madagascar; lower limb; peripheral arterial disease; surgery