[Diagnosis and non-invasive evaluation of a patient with obliterating arteriopathy of the lower limbs]

Abstract

Obliterating arteriopathy of the lower limbs (OALL) is a pathology that manifests itself late in the natural history of an atheromatous patient. It is largely a localised pathology but should be considered as a marker for more generalised disease, for which the prognosis is modified by cardiac and cerebrovascular complications. Measurement of the systolic blood pressure index at the ankles is indispensable for initial management, with measures inferior to 0.90 correlating with an arterial stenosis of more than 50%, even in the absence of symptoms. Although the diagnosis is above-all clinical, further investigations complete the initial management by estimating the severity of the lesions, identifying the threatening lesions, allowing an overview of the general disease and a follow-up of the patient. Undoubtedly, the Doppler ultrasound remains the first-line investigation of choice. Helical computerised tomography and angiography by magnetic resonance imaging complete the initial investigation when a revascularisation procedure is envisaged, their respective indications depending on the protocols of each Vascular Centre. The walking-on-a-rolling-carpet test allows evaluation of residual functional capacity of the patient at the stage of claudication. The discovery of OALL calls for at least coronary screening, whatever be the stage of severity, with one patient in four dying of a coronary complication in 5 years. Other vascular localisations should be screened for depending on the clinical symptomatology. The medico-economic value of an extensive systematic vascular work-up is, in effect, still only demonstrated for the stage of claudication.