Peripheral arterial disease (PAD) is one of the main manifestations of atherosclerotic disease, affecting the arterial tree from the aortic termination to the arteries of the foot [4]. Its frequency was 1.9% in our study. A frequency of 0.85% was observed by Cissé [6]. However, high frequencies have been observed in several African studies: 14.8% by Aboyans et al. [7], 16.7% by Menanga et al. [8], and 22.2% by Touani [9]. In this study, the average age was 52 years. The most affected age group was 61 years and older, accounting for 55.8% of cases. Several studies have shown that PAD is an age-dependent and rare condition before the age of 50. Its prevalence increases exponentially from age 60 onward, reaching 20% after age 80 [4]. In the Framingham study, the annual incidence increased with age, from 0.4 per thousand men aged 35 - 45 years to 6 per thousand men over 65 years [1][10]. Similarly, Le Hello [11] demonstrated in her study that the prevalence of PAD is high in subjects over 70 years of age. A male predominance was observed in our study, at 63%, which corroborates data from the African literature [6][8][9]. However, in high-income countries, the prevalence is similar in women and men [4]. However, other studies have noted a female predominance [12]. In our context, this proportion could be explained by factors such as the advanced age of most patients, which, combined with a sedentary lifestyle, increases the risk of peripheral arterial disease.

Peripheral artery disease (PAD) has significant morbidity and mortality due to its dual potential: local, affecting the circulation of the lower limbs, and systemic, affecting other coronary, carotid, or aortic arterial territories. During its progression, PAD often remains asymptomatic for a long time, leading to an underestimation and undertreatment of the disease [12]. The main risk factors are smoking, diabetes, hypercholesterolemia, and, to a lesser extent, hypertension [11]. In our study, the risk factors were dominated by diabetes (46.2%), hypertension (3.2%), and comorbidity (hypertension + diabetes) (23.1%). Diabetes is a powerful and independent risk factor for the development of PAD. This association is even stronger when studying severe forms of the disease, particularly critical limb ischemia and the risk of amputation [13][14]. In a study of 2146 asymptomatic patients at high vascular risk, hospitalized in cardiology, diabetology, geriatrics, internal medicine, and neurology departments, the prevalence of PAD was estimated at 41.1% [15]. Rada et al. [12] reported that 48.3% of subjects had diabetes, and 68% had hypertension, of which 58.3% were well controlled. This higher rate of hypertension may be explained by the fact that their study took place in a cardiology and vascular disease department. In Cameroon, 11.9% of patients were reported to have diabetes and 95.2% to have hypertension [8]. This high rate of hypertension can be explained by the high proportion of elderly subjects in our study.

In this study, 19.2% of patients were smokers. Rada et al. found 9.5% of patients were smokers in their study. Smoking was present in 33.8% of cases, the majority of whom were men (98.4%). Smoking was either current (64.4%), quit within the last 3 years (29.6%), or a past habit (24%) [12]. All studies agree that smoking is probably the most significant risk factor for PAD; overall, smoking increases the risk of PAD by 2 to 3 times [16][17]. In a French multicenter study, COPART, three-quarters of patients hospitalized for PAD were or had been smokers.

In this study, the clinical findings were dominated by gangrene (50%). Diakité [18] found 48.9% trophic disorders and 8.5% cyanotic discoloration of the toes. Cissé [6] reported 5.6% of gangrene. The annual incidence of critical ischemia is estimated at 0.35% in the United States [19] and 0.02% in England [20]. This result could be explained by the fact that the disease is often diagnosed late, with treatment beginning at an advanced stage, exposing patients to a high risk of complications and limb loss.

In our study, the involvement was diffuse in 41.3% of cases, affecting the anterior tibial artery in 12.5% of cases, followed by the superficial femoral artery in 11.5% of cases. These lesions were proximal in 19.2% of cases and distal in 39.4% of cases. In the series by Diakité [18], this involvement was diffuse in 29.8% of cases, superficial femoral in 14.9% of cases, and anterior tibial in 12.9% of cases. Benoit [21] found stenosis in 48.05% of cases of superficial femoral artery stenosis, 36.36% of anterior tibial artery stenosis, and 23.37% of cases of dorsalis pedis artery stenosis. These results highlight a preferential diffuse and distal location of arterial lesions in the context of lower limb arterial disease (LLAD). Diabetic arteriopathies are characterized by lesions, often multifocal and bilateral, whose location, preferably distal, is considered one of the most distinctive features of the condition. The rarity of aortoiliac involvement and the predominance of leg involvement have been documented by arteriography by several authors [22]. Distal arterial involvement was present in 100% of cases and severe in 75% of cases, according to the morphological abnormalities of the Doppler curves [21]. The involvement was stenotic in 71.2% of cases and occlusive in 28.8% of cases, due to atherosclerotic plaques (55.8%). Cissé [6], in his study, noted 72.2% of stenoses caused by atherosclerotic plaques in 94% of cases. These considerable rates of stenosis in African studies may be due to limited access to early care, with late detection favoring more advanced forms of the disease. We noted the presence of collateral circulation in 35.6% of cases; this collateral circulation was effective with distal recanalization in 12.5%. Diakité [18] found ineffective collateral circulation in 53.8%. Soft tissue necrosis was observed in 22% of cases, leading to amputation. Benoit [21] found 12.8% soft tissue necrosis. Amputation is indicated in the following cases:

- Irreversible tissue damage.

- Of chronic permanent ischemia without possible revascularization, which does not respond favorably to medical treatment or whose general repercussions pose a life-threatening risk to the patient [1].

These results show, on the one hand, the high frequency of infrapopliteal lesions, often associated with severe forms of AOMI, and, on the other hand, the advanced nature of the disease, which can worsen the functional prognosis.