Treatment of arteriosclerosis obliterans of the lower limbs

April 2017

The HAS published in April 2006 recommendations on how to deal with chronic obliterating atherosclerotic arteriopathy of the lower limbs (CPOA).

These recommendations aim at dealing with patients suffering from this pathology in the best manner.

This disease leads to a reduction of the artery size of the lower limbs and to cardio-vascular risks.


Asymptomatic arteriopathy

Diagnosis


According to the HAS, a screening must be processed on all subjects having a cardio-vascular risk using:
  • Systolic pressure index (SPI),
  • Clinical evaluation.

Treatment

  • Non medicinal treatment:
    • Daily physical activity,
    • Therapeutical education.
  • Medicinal treatment :
    • Platelet aggregation inhibiting drug,
    • Statin,
    • Angiotensin converting enzyme inhibitor (ACE).
  • Others :
    • Giving up smoking,
    • Lose weight,
    • Glycaemia balance (in case of a diabetic patient);
    • Dyslipemia decrease (diet),
    • Decrease of the blood pressure (antihypertensive).

Intermittent claudication

  • At this status of CPOA, this effort ischaemia can appear to lower limbs through pure claudication with no symptoms at rest."

Treatment of symptomatic CPOA


HAS recommends the same treatments as for asymptomatic patients .

Dealing with claudication

  • A check-up is necessary :
    • Echo-doppler,
    • Walking test,
    • Angiography.
  • Medical treatment :
    • Walking,
    • Vascular readaptation,
    • Statins.
  • Other treatments:
    • Revascularisation,
    • Iliac or femoral endoprothesis,

Permanent chronic ischaemia

Treatment

  • Surgery and Endovascular Treatment :
    • Revascularisation,
    • Angiography.
  • Medicinal treatment :
    • Complementary revascularisation treatment,
      • Pain killers,
      • Control the general hemodynamic balance, the ventilation and nutrition status,
      • Prevent vein thrombosis disease (LMWH), eschars and retractions
    • Deep treatment,
    • Prostaglandines and vasodilators,
    • Platelet aggregation inhibiting drug,
    • Anti-vitamin K.

Acute ischaemia


An acute ischaemia is "a brutal alteration of the nutritional microcirculation perfusion of a limb threatening its immediate viability".
  • Surgical thrombectomy,
  • Thrombolysis in situ,
  • Thromboaspiration.


Following the removal of the obstruction, the patient must carry on the same treatment as in the case of arteriopathy.

CPOA and amputation


HAS recommends amputation in case of :
  • Irreversible damage to the tissues ,
  • Chronic and permanent ischaemia ,
    • Non possible revascularisation,
    • No positive reaction to the treatment,
    • Existence of a risk to the vital prognosis of the patient.


Its level is determined according to:
  • The extent of the ischaemia ,
  • Cicatrisation possibilities,
  • The functional preservation of the affected limb,
  • Bracing possibilities,
  • Readaptation possibilities of the patient.

CPOA and the elderly


CPOA is frequent among the elderly. It must be systematically checked when there is a risk of eschar:
  • Clinical examination of the foot
  • SPI measurment.

CPOA and diabete


HAS systematically advise SPI measurment and echo-dopler :
  • For diabetics aged over 40,
  • For people suffering from diabete for more than 20 years,
  • In case of cardio-vascular risks.

Sources


Dealing with chronic obliterating arteriopathy atherosclerotic of the lower limbs, HAS, avril 2006.

Photographic copyright: Jubalharshaw19 | Dreamstime.com

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Latest update on April 11, 2010 at 09:20 PM by owliance.en_ctrl_002.
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