Profile of patients with Atherosclerotic Aortoiliac Occlusive Disease presenting to CMCH, Vellore: A Descriptive study

Sitaram, V (2007) Profile of patients with Atherosclerotic Aortoiliac Occlusive Disease presenting to CMCH, Vellore: A Descriptive study. Masters thesis, Christian Medical College, Vellore.


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AIM OF THE STUDY: To Evaluate the Epidemiology, Patient Profile, Vessel Involvement Pattern, and To Assess the Type of Treatment given and Outcome for Atherosclerotic Aortoiliac Occlusive (AOD) Disease in a Tertiary Care Hospital. OBJECTIVES: 1. To evaluate the general characteristics of the patients presenting with Atherosclerotic aortoiliac occlusive disease (AOD). 2. To evaluate the anatomical pattern of vessel involvement based on Angiogram or the arterial Doppler study, including multiple level occlusions. 3. To determine the type of treatment given, whether conservative (including Antiplatelet therapy and chemical sympathectomy), endovascular radiological intervention or open (surgical) reconstruction. 4. To evaluate the outcomes of these treatment modalities i.e., symptomatic relief as well as complication rates, in the view of underlying risk factors. METHODOLOGY: 1. 20 patients with aortoiliac disease diagnosed clinically and proven with arterial doppler and or an angiogram were studied prospectively for an year. Also, 360 patients with peripheral vascular disease visiting our hospital for past nine years were evaluated, and data collected for 91 patients with aortoiliac disease (total no.= 111). 2. Epidemiological evaluation, risk factors, disease severity, treatment options and outcome was studied and analyzed using the SSPS software for windows. 3. Frequency tables were drawn for each of the parameters using the statistical analysis and incidence of the variables in each category was calculated. 4. Using this basic data sheet, all the variables were cross tabulated and evaluated based on their strength of association. 5. Finally inferences were drawn and conclusion made based on the analysed data. RESULTS: The results of this study are based on, as mentioned in the methodology, 20 patients evaluated prospectively for one year and 91 patients evaluated retrospectively for the past 9 years, with a total of 111 patients, diagnosed to have atherosclerotic aortoiliac occlusive disease. CONCLUSIONS: This observational study has revealed following important conclusions 1. The previously known risk factors play vital role in pathogenesis and progression of the atherosclerotic vascular disease. The major factors found in this study were: 2. Modifiable: Tobacco consumption, Diabetes mellitus, Hypertension, Dyslipidaemia. Non-modifiable: Advancing age, Male gender. In order to stop the disease process and prevent further progression, these modifiable factors need to be aggressively identified and treated. Tobacco use, in any form, should be strongly discouraged. 3. Majority of the patients (64%) with Aortoiliac disease presented with critical ischemia and the rest (36%) complained only of claudication. 4. Ischemic heart disease was major comorbidity when other systems were affected by atherosclerosis. This was followed by impotence and almost equal number of patients had a cerebral vascular ischemic event. This observation further emphasizes the importance of strict risk factor control on a preventive basis. 5. The undernourishment was probably due to reduced food intake secondary to chronic pain and morbidity. Typical features of limb ischemia, namely trophic changes and coldness of the affected limb were seen in almost all the patients. 6. Ischemia was at critical level, as indicated by ABPI of < 0.3, in about half the patients. Majority of patients (91%) had ABPI of < 0.6. 7. Radiological evaluation correlated well with the clinical examination in determining the pattern of the vessel involvement. Most patients had block in the aortoiliac segment. A small proportion of the patients also had blocks at multiple levels. 8. Most of the patients had some form of intervention – operative or radiological revascularization. 9. About one third of the patients required only conservative treatment including antiplatelet therapy, which is very important in the management of any occlusive disease of the arteries. 10. About one third of the patient had tissue loss in form of amputation or debridement. This was at a higher rate in the patients with diabetes and who consume tobacco. These two factors also delayed the signs of ulcer healing. 11. Both surgical and radiological interventions, in the appropriately chosen patients, had comparable results with respect to post procedure palpable pulse, improvement in ABPI and in giving patients relief from the ischemic pain.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Atherosclerotic Aortoiliac Occlusive Disease ; Christian Medical College ; Vellore ; Descriptive study.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 04 May 2018 02:28
Last Modified: 04 May 2018 02:28

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