Revascularisation pour Ischémie critique du membre inférieur

Abstract

Revascularization for critical leg ischemia
Prospective study about 20 cases in Dakar
Introduction: Critical leg ischemia is used among all
patients who present either a chronic rest pain, or ulcers or
a gangrene of the foot evolving since more than two weeks,
in connection with an objective peripheral arterial disease
(PAD).
We report the case of 20 patients undergoing a revascularization for critical leg ischemia by studying the epidemiologic, clinical, paraclinic, therapeutic aspects 

Material and Methods: It is a prospective study concerning 20 patients between April 2006 and August 2007. The
average age was 74 years (53-97 years), the sex ratio of 0,
33 in favours of the women (75%). The average duration of
symptoms was 3, 7 months (15 days 12 months). The pain
(75%) and toe necrosis were the principal reason for
consultation.
The average ankle pressure was of 37, 7 mmHg (0-60
mmHg) and 65% had a pressure lower than 50 mmHg. The
average ankle brachial index (ABI) was 0, 20 (0-0, 6). Duplex
Doppler objectified a prevalence of distal lesions with a distribution appreciably equal to the two lower limbs.
Angiography objectified on the aortoiliaque level lesions
classified as TASC A, TASC C and TASC D in 5% each one; on
the femoropopliteal level, 70% were TASC B, 10% TASC D
and 5% TASC C. The remainder patients had an isolated distal lesion. We performed, a femoropopliteal bypass by great
sapheneous vein (30%), femoropopliteal bypass by prosthesis (30%), a femoroinfrapopliteal bypass (15%) and an
endarteriectomy with or without a patch in 25%).
Results: Hospital mortality was 10% (2 patients) of
which a myocardial infarction and a sepsis. Secondary mortality after overall 7 months (1-15 month) was represented
by 4 deaths including 3 by stroke and 1 by a sepsis. The average time of pain relief was 7 days for 29 days of hospitalization. The average time of complete wound healing was
180 days. Permeability patency rate, limb salvage rate and
survival rate at 6 months were respectively 58%, 46%,
76%.
Conclusion: Critical leg ischemia is the ultimate phase of
the occlusive arterial disease. The objective of treatment is
to reduce the rate of amputation which remains high.