Surgical Management of Peripheral Arterial Disease in Cameroon: A Case Series and Review of the Literature

Abstract

Background: Peripheral arterial disease (PAD) is an increasingly recognized manifestation of atherosclerotic cardiovascular disease in sub-Saharan Africa (SSA). However, the condition remains frequently underdiagnosed, and many patients present at advanced stages with chronic limb-threatening ischemia (CLTI). This study aimed to describe the surgical management of PAD in Cameroon and to compare our findings with previously reported African and low- and middle-income country (LMIC) series. Methods: We conducted a retrospective case series of patients treated surgically for peripheral arterial disease between March 2025 and February 2026 at the Division of Thoracic and Cardiovascular Surgery at the Yaoundé General Hospital in Cameroon. Demographic characteristics, cardiovascular risk factors, clinical presentation, and surgical procedures were analyzed. A narrative review of the literature on PAD management in SSA and LMICs was also performed. Results: Thirty-two patients (n = 32) underwent surgical treatment for PAD. The mean age was 69 ± 5 years (range: 65 – 75), and all patients were male. Hypertension was present in 23 patients (71.8%), smoking in 15 (46.8%), and diabetes mellitus in 8 (25.0%). Most patients presented with advanced CLTI, including Rutherford stage 5 in 8 patients (25.0%) and stage 6 in 14 patients (43.7%). Twenty-four patients (n = 24, 75.0%) required amputation, including 16 major amputations and 8 minor amputations, whereas only 8 patients (25.0%) underwent limb revascularization procedures with femoro-popliteal bypass. Limb salvage was achieved in 7 of the 8 revascularized patients (87.5%). Similar patterns have been reported in several African studies, where late presentation and limited access to vascular surgery contribute to high amputation rates. Conclusion : In our setting, most patients with PAD present at advanced stages when revascularization is no longer feasible. Strengthening early diagnosis and expanding vascular surgical services are essential to reduce the burden of limb loss in sub-Saharan Africa.