Peripheral arterial disease of the lower extremities
What is it?
It is represented by formation of atherosclerotic plaques in the femoral-popliteal segment, which cause lack of blood supply to the lower extremities, especially during exercise. This gradually makes it difficult to walk, leads to pain at rest (even at night) and the development of ulceration and necrosis in the lower extremities. People with other atherosclerotic diseases (myocardial infarction, angina pectoris, stroke, etc.) and/or the following risk factors are most at risk: smoking, diabetes, dyslipidaemia (hypercholesterolaemia, hypertriglyceridaemia), hyperhomocysteinaemia and some congenital diseases. Males are usually at greater risk than females and people over 50 years of age.
Which are the symptoms?
The disease is asymptomatic at first, but later a cramp-like pain in calves, sometimes associated with pain in hips and buttocks, develops. This pain is usually intermittent (claudication intermittens), associated with walking and physical activity, and may be accompanied by paresthesias (tingling of the skin). As the disease progresses, pain occurs even at rest, may interfere with night's rest, and hypothermia and cyanosis of the extremities (cold, blue fingers) may occur, up to development of peripheral ulcers and distal gangrene.
- cramp-like pain in calves
- pain in hips and buttocks
- hypothermia and cyanosis of extremities
- intermittent claudication
- peripheral ulcers
- distal gangrene
How is it diagnosed?
Patients with the symptoms described are at high risk of suspected steno-obstructive lower extremity pathology and should undergo imaging.
Suggested exams
How is it treated?
There are different types of treatment available. Medical treatment: therapy with antiplatelet drugs, which prevent platelets from binding to atherosclerotic plaques, exacerbating the disease; haemodilators, which make the blood more fluid and able to flow more easily in the affected vessels; vasodilators, which increase peripheral vascularisation. Correction of the patient's individual risk factors, abstinence from smoking and appropriate physical activity are essential. Early stage of the disease may have good outcomes. Surgical treatment: involves replacing (bypassing) a blocked artery with a synthetic or biological prosthesis (saphenous vein). Some cases may involve cleaning the arteries alone (endoarterectomy) by removing atherosclerotic plaques from the inside. Endovascular treatment is only possible in cases of segmental stenosis, not occlusion. Arteriography is carried out percutaneously (without incisions), and the arteries are dilated at stenosis (narrowing) regions, possibly by implanting one or more stents (small metal mesh tubes).
Suggested procedures
Where do we treat it?
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