Occlusion of Peripheral Arteries

Abstract

A group of 6,400 volunteers aged 15 to 64 employed in the pharmaceutical industry in Basle, Switzerland, were examined for occlusions of limb arteries. Each subject was given a screening examination including a cardiovascular history, palpation, and electronic recording of foot and wrist pulses. An additional, more detailed examination was done on 294 subjects with pathologic or doubtful screening findings. This included arteriography for 83 subjects. Occlusions of peripheral arteries were found in 99 extremities of 75 subjects. One sixth was located in arteries of the upper extremities; 14 per cent concerned the iliac, 49 per cent the femoral arteries, and 23 per cent the arteries of the lower leg. In the age group 15 to 39 years occlusions occurred as frequently in women as in men, while a male predominance of 1.6:1 was noted in the 40 to 64 age group. The prevalence rose progressively from 0.1 per cent below age 40 to 8 per cent in the 60 to 64-year-old men. Occlusions were not infrequent in young men; 1 per cent was noted in the age group 40 to 44. The history was not found reliable for detection of peripheral arterial occlusions. About two of three subjects with demonstrated occlusions failed to exhibit classical symptoms of reduced blood flow in skin or muscle. Conversely, approximately one of four men and one of three women with patent arteries complained of some discomfort in the legs suggestive of occlusions of peripheral arteries. Evidence of general arterial disease was already present in many subjects with peripheral arterial occlusions: 41 per cent had an occlusion in more than one extremity, 27 per cent presented symptoms of coronary heart disease, and 90 per cent had arteriographic evidence of atherosclerosis in nonoccluded arteries of pelvis and extremities. A similar sex ratio, age distribution, and the frequent concurrence of occlusions of peripheral arteries and coronary heart disease in the same subject strongly suggest a common process responsible for both diseases. A thorough examination of the readily accessible peripheral arteries by methods within the reach of most physicians may lead to the early detection of asymptomatic atherosclerotic disease, permitting the institution of preventive or therapeutic measures before the appearance of myocardial infarction, gangrene, or cerebral vascular accidents.