Outcome of management of peripheral arterial occlusive disease at KNH. a 10 year retrospective study (1993 - 2002)

Abstract

This is a retrospective study of the outcome of management of PAOD at KNH. It covered a 10 year period between January 1993 and November 2002. It was carried out by a review of medical records. A total of 80 patients with 100 involved limbs were studied. Twenty four patients were excluded from the study as their files could not be traced or lacked sufficient data for analysis. Ninety three lower limbs and seven upper limbs were involved. Twenty five patients had bilateral lower limb disease and one had bilateral upper limb disease. There were 61 (76.3%) males and 19 (23.8%) females giving a male: female ration of 3.2: 1. The mean age of the patients seen was 52.6 years with a range of 16 to 100 years. The disease was uniformly spread between the ages of 30 to 79 years in both males and females. The majority of patients (72.6%) had primary level of education and below. Central province had the highest number of patients by birth (56.3 %). Fifty percent of the patients were smokers while 15% were diabetics and 15% hypertensives. Gangrene and rest pain were the most frequent presenting features occurring in 63% and 59% of the cases respectively. Arteriography as a diagnostic modality was used in 80.6% of the cases. Amputation was the most common primary mode of management reflecting the late presentation of the disease at presentation. It was done in 26 (32.5%) cases as the sole procedure and in 6 (7.5%) cases in combination with other primary procedures. Conservative management formed the next common mode of management in 16 (20.0%) cases. Amputation also formed the commonest secondary mode of management following failure of a primary revascularization procedure or after failure of conservative management. There was a statistically significant higher rate of secondary procedures after graft surgery than after amputation. The rate of sepsis following primary amputation (46.2%) was statistically higher than following graft surgery (8.3)