[Use of the ankle-brachial index in the detection of peripheral arterial disease of the lower extremities in general medicine]

INTRODUCTION

Peripheral arterial disease of the lower extremities (PAD) is a serious condition, frequently under-evaluated. Long asymptomatic, it is easily detected by measuring the ankle-brachial index (ABI), a reference tool that is reliable, reproducible, simple and inexpensive. The objective of this thesis was to determine the rate of achievement of ABI in French Haute Autorité de santé indications, identify the associated factors and prioritize the obstacles to achieving ABI.

METHODS

Descriptive and analytical epidemiological study, with analysis of practices, prospectively addressed by postal questionnaire to a randomized sample of 220 general practitioners practicing in the European Metropolis of Lille between December 15, 2016 and February 15, 2017.

RESULTS

Our sample consisted of 92 GPs (42% participation). Among them, only 6 practiced ABI, notably for: intermittent claudication (n=5: 5%, IC95% [1; 10]), the existence of at least 2 cardiovascular risk factors (n=2: 2%, IC95% [0; 5]), diabetic patients over 40 years of age (n=2: 2%, IC95% [0; 5]), patients with diabetes (n=2: 2%, IC95% [0; 5]), patients with diabetes (n=2: 1%, IC95% [0; 5]), patients with diabetes (n=2: 1%, IC95% [0; 5]), and patients with diabetes (n=2: 1%, IC95% [0; 5]): 2%, CI95% [0; 5]), patients over 50 years of age with a history of diabetes or smoking (n=2: 2%, CI95% [0; 5]), or those with an unhealed lower extremity skin lesion (n=5: 5%, CI95% [1; 10]). The most frequently cited barriers were: the prescription of a routine echo-doppler (61%, 95% CI [51; 71]), lack of control (46%, 95% CI [36; 56]), time considered too long (17%, 95% CI [10; 25]), and equipment purchase or maintenance (19%, 95% CI [10.5; 26.4]).

CONCLUSION

ABI is few used in our sample, mainly due to delegation to angiologists.

[Study of practices: What do general practitioners first propose when faced with asymptomatic lower extremity peripheral artery disease?]

INTRODUCTION

Peripheral artery disease of lower limbs (PAD) can be discovered at an asymptomatic stage by the realization of systolic pressure indices. The 2006 recommendations of the French National Authority for Health on AOMI encourage the systematic prescription of antiplatelet agents; the 2012 recommendations on the proper use of antiplatelet agents no longer encourage it in the case of asymptomatic PAD. These two recommendations still coexist. Our objective was to determine the management of an asymptomatic PAD by general practitioners.

METHODS

Descriptive and analytical epidemiological study, with analysis of practices, prospectively addressed by postal questionnaire to a randomized sample of 220 GPs practicing in the European Metropolis of Lille between December 15, 2016 and February 15, 2017. The question was: "if an asymptomatic PAD is discovered in a 50-year-old patient who is otherwise in good general condition, what do you generally do?"

RESULTS

Our sample was 92 general practitioners (42% participation). Of these, only 6 were practicing HPIs. Before an asymptomatic PAD, management included an opinion from an angiologist (84%) and/or a cardiologist (75%) before the drug was prescribed (antiplatelet agent for 57%, statin for 33% and ACE inhibitor for 14%).

CONCLUSION

The extension assessment was carried out in more than 8 out of 10 cases. The use of antiplatelet antiaggregants was significant, which can be explained by the coexistence of divergent recommendations. The rapid clarification of recommendations is essential with the evolution of scientific data.