Estudio epidemiológico de la enfermedad arterial periférica en pacientes de consultas externas y de hospitalización de la sección de medicina interna del Hospital Perpetuo Socorro del Área de Salud de Badajoz

Abstract

Peripheral arterial disease (PAD) is a manifestation of the arteriosclerosis, a systemic disease that can affect all the territories of the arterial tree. The natural history is generally benign. There are few patients who will eventually develop serious complications in the lower limbs. The rate of amputations in symptomatic patients is low. The EAP is underdiagnosed since the majority of patients are asymptomatic. In recent years, various Guides of clinical practice in the management of cardiovascular risk and in particular in the management of diabetic patients recommended the early detection of this entity. There are various reasons, but the main are a marker of existence of atherosclerotic disease in other vascular territory. The aforementioned guides communicate the indications of early detection. The clinical history and physical examination with the application of the questionnaire of Edinburgh does not allow a correct diagnosis of EAP, therefore, special mention is made of the index test Ankle-Arm (ITB), simple method, cheap, with a high sensitivity and specificity. The combination of both tools (a good history with application of Edinburgh questionnaire more the realization of the ITB) increases the chances of a correct diagnosis of the PAD. The statistics on the incidence and prevalence of this disease are variables. In our environment, data are scarce about the PED, so it is one of the objectives of this study, in line with the Health Plan of Extremadura and the Comprehensive Plan of Cardiovascular Diseases. Objectives: To describe the epidemiological characteristics of the PAD in a sample of patients in an Internal Medicine Service. Provide data of the PAD in Extremadura. With the data obtained attempting to disseminate and promote the screening of the PAD among health professionals. Material and methods: Study of basic descriptive statistics in a sample of 96 patients. It was considered diagnosis of PAD an ITB<0.9. The questionnaire Edinburgh was used to identify symptomatic forms. Evaluated the associated risk factors and cardiovascular risk was calculated for each subject. Results: We present a sample of 96 patients. The predominance of the male sex (60% are men and 40% women) with a mean age of 75 years. The Association of comorbidity is important, the HTA with a 72%, the HLP with 60%, obesity with a 57%, DM with a 52%, IRC with a 36% , COPD with a 40% and obesity with a 57% are the CVRF more frequently associated. The comorbidity is similar in men and women, except in the previous diagnosis of EAP and in COPD clearly more frequent in men and obesity, arterial hypertension and diabetes mellitus in women. The 11% of patients had already suffered a stroke and a 25% CI. With the same number and percentage 21 patients (21.6%), we found the IC and the FA. Only 7 of them were previously diagnosed of PAD. In the sample only 3 patients (3.1%) had been amputees. The degree of control of the CVRF is bad so were poorly controlled 45 per cent of hypertensive patients, 46% of diabetics and 54% of s individuals with hyperlipidemia. A 22 % of the sample had two CVRF poorly controlled and a 41% the three analyzed. The number of drugs for the control of the CVRF individually was 1, so that before the control treatment is optimized a 59.3 % of the sample. Almost half of the sample had a history of smoking clearly more frequent in males (76%). The sample submitted is of high cardiovascular risk, 68% had a score above 5%. All the CVRF or co-morbid conditions are more frequent in high risk patients. Only 44 patients a 45.8% had had clinical manifestations of PAD and only 7 individuals (7.2%), all men, had been screening of PAD with earlier. Have been diagnosed "de novo" 50 cases, slightly more than 50% of the studied patients. The treatment of the PAD, was very low, only 6 percent of the patients had treatment antiaggregant and 19% oral anticoagulation. 40% of the same presents an ITB normal. The ITB pathological considering less than 0.9 is recorded in a 48% of the sample and a pathological ITB global (< 0.9 or > 1.3) amounts to 61%. The ITB normal is more frequent in low risk patients, can be seen statistically significant difference in patients.