ARTERITIS: A WOMEN'S ISSUE?

Obliterative arterial disease of the lower limbs (AOMI), sometimes referred to as "arteritis", corresponds to obstruction of the arteries in the legs, usually by atherosclerotic plaques. It is under-diagnosed and under-treated, particularly in women, with only one in 3 patients seeking medical advice before complications arise.

The main risk factor is smoking. But hypertension, diabetes, high cholesterol and contraception with synthetic estrogens are other avoidable risk factors for AOMI.

The most common sign is intermittent claudication, also known as arterial claudication. This is a typical cramp-like pain in the calf, sometimes in the arch of the foot, or in the buttock, which occurs selectively when walking, gives way when stopped after a few minutes and reappears for the same distance: the "walking distance".
If the AOMI is severe, pain may exist at rest, as the leg muscles are not sufficiently perfused by the arteries, even at rest. In the final stage, there may be very painful ulcers on the toes or hanging down the leg.
There are other, less typical symptoms, particularly in women, such as tingling in the legs on exertion, or pain in the buttocks that lead to misdiagnosis, often mistaken for osteoarthritis or sciatica.
The risk of undiagnosed arteritis is amputation when the arteries can no longer be revascularized and there is severe damage to the feet. This annual risk of amputation is nevertheless very low (< 1%).

On the other hand, more seriously, AOMI is an alarm signal of a diffuse disease, atheromatous vascular disease with a high risk of myocardial infarction or stroke sometimes fatal if screening is not done and no drug treatment put in place.

Examinations to confirm the diagnosis of AOMI, consist of measuring blood pressure at the ankles (what is known as the iankle systolic blood pressure index), performing a treadmill walking test to determine pain-free walking distance and a morphological and hemodynamic examination, doppler ultrasound. This vital exam visualizes where atheromatous stenoses in the arteries are and studies their impact on blood flow. In some cases, vascular physicians will complete the workup with angioscanner or angio MRI of the aorta and lower limbs.

Management is primarily medical, with imperative correction of risk factors:
The most important element is the total and definitive cessation of smoking and the discontinuation of any contraception containing synthetic estrogens.
It will also be prescribed atreatment to lower LDL cholesterol (statin), a treatment from the antihypertensive family (to have a blood pressure below 140 - 90 mm Hg) and a blood thinner (most often aspirin, called platelet antiaggregant). You'll also need to have good diabetic control (with medication if necessary). Walking rehabilitation is an important element in promoting the development of small arteries (collaterals) that will short-circuit the stenosis of the main artery. You need to walk "at the limit of your pain" for at least 3 months, and then review the situation with your vascular physician. In the event of persistent disability, revascularization may be envisaged, either by angioplasty with endovascular stenting, or surgery with arterial bypass to short-circuit the stenosis of the artery. Men have twice the chance of achieving ideal control of their risk factors, as optimal treatment is less often prescribed for women ...
The mission of Agir pour le Cœur des Femmes is to alert you to this arterial disease of the legs, AOMI, to anticipate by encouraging you to get tested if you have symptoms resembling those we have just described, and to act with a medical team who will propose a check-up and treatment adapted to your case. It is to be hoped that, by becoming more aware of the problem, women will benefit from better treatment of this arterial pathology, previously thought to be the preserve of men. AOMI is an environmental disease, and we can take effective action by modifying our lifestyle. AOMI is also a warning sign of the risk of cardio and cerebrovascular accidents, which we must not overlook.