Etiological Aspects of Lower Extremity Peripheral Arterial Disease: Multicentric Prospective Study of 126 Cases

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<i>Introduction</i>: Atherosclerosis is the main cause of lower extremity peripheral arterial disease (PAD). However, there are other etiologies little reported. The objective of this work was to study the socio-demographic, clinical and etiological aspects of PAD. <i>Patients and study method</i>: This was a multicentre, descriptive, cross-sectional study conducted from January 1^st to October 30^th, 2021, in Thies and Dakar, Senegal. Any clinically suspected PAD was confirmed by arterial Doppler ultrasound and/or CT angiography. Clinical, biological and ultrasound data were used to establish the etiology and diagnosis criteria of OLIN for the diagnosis of thromboangiitis obliterans (TAO). <i>Results</i>: A total of 126 patients were collected, 31 (24.6%) in Thies and 95 (75.4%) in Dakar. There were 72 men (57.1%) and 54 women (42.9%), a male-to-female sex ratio of 1.3. The average age was 62.5 years 10.8 years. The majority of patients had a low socio-economic profile (52%). Etiologies were dominated by atheromatous disease (n= 120; 95.2%) and the cardiovascular risk factors were in order of frequency: physical inactivity (n=98; 77.8%), type 2 diabetes (n=78; 62%), hypertension (n= 69; 54.8%), smoking (n= 46; 36.5%) and dyslipidemia (n=29; 23%). Thromboangiitis obliterans (Buerger’s disease) was the second etiology found in 5 patients (3.96% of cases) and concerned only men who regularly used tobacco and cannabis. One case of ANCA-associated vasculitis was also found. In addition, there was a considerable delay in diagnosis with 117 patients (92.8%) at the critical ischemia stage at the time of diagnosis and amputation of varying magnitude in 110 patients (87.3%). This delay in diagnosis was at least due to insufficient screening, limited access to arterial Doppler echo and the lack of specialized services in vascular medicine, outside the capital Dakar. <i>Conclusion</i>: The most common etiology of lower extremity PAD was atherosclerosis. Obliterating thromboangiitis was not uncommon. Early detection of PAD and control of risk factors for atherosclerosis must be the rule.