Abstract
To determine the prevalence of Peripheral Arterial Disease (PAD) and associated risk factors in patients undergoing amputation at the Korle Bu Teaching Hospital (KBTH), Accra, Ghana. A cross- sectional study of all patients undergoing lower extremity amputation at the Department of Surgery, KBTH. A coded questionnaire was used to ascertain risk factors for PAD. The Edinburgh Claudication Questionnaire was used to determine symptomatic PAD and a 5 mmHz hand held Summit® Doppler together with an Accoson ® sphygmomanometer was used to determine PAD and its severity. Clinical diagnosis of symptomatic PAD was made using a symptom-based questionnaire and signs of PAD determined by measuring the ankle brachial pressure index (ABPI) by means of a handheld Doppler and sphygmomanometer. Risk factors were determined using the coded questionnaire and related to the occurrence and severity of PAD. The prevalence of PAD among recruited participants was 71%. Twenty-eight per cent of participants with PAD in the index limb also showed signs of PAD in the other limb. The diagnosis of PAD was made in 71%, using ABPI, and 13%, using ECQ. Twenty-seven per cent of patient with hypertension, seventeen per cent with diabetes and all patients with hypercholesterolemia were not on any form of medication. There is a high prevalence of PAD among patients undergoing lower extremity amputation at the KBTH. The majority of PAD patients presented with moderate to severe PAD. Instituting measures to identify and control risk factors of PAD may reduce this high burden. Not declared. Authors funded the study.
Highlights
Peripheral arterial disease (PAD) is an atherothrombotic syndrome marked by stenosis and occlusion of peripheral arterial beds
The prevalence of asymptomatic PAD ranges between 3-10% and that of symptomatic PAD is 3% for patients in their 40s and 6% for patients in their 60s
Ninety per cent (90%) of patients with asymptomatic PAD would be missed if a complaint of intermittent claudication was to be used in diagnosis.[17, 18]
Summary
Peripheral arterial disease (PAD) is an atherothrombotic syndrome marked by stenosis and occlusion of peripheral arterial beds. The target organs are the brain, heart, intestine, kidneys and the limbs, typically the lower extremities. It affects 12-14% of the general population and the prevalence is age dependent.[1,2,3] Within one year of presentation with severe leg ischemia, 30% of patients undergo a major amputation and 25% die of PAD.[4] Globally, a majority of patients are asymptomatic and undiagnosed until the disease has progressed to a late stage, requiring limb amputation. Successful treatment strategies of PAD include risk factor modification such as cessation of smoking and initiation of regular exercise, control of diabetes and hypercholesterolemia and www.ghanamedj.org Volume 51 Number 3 September 2017
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