Peripheral arterial occlusive disease - Arteriology

Peripheral arterial occlusive disease

In the extended context, the term peripheral occlusive arterial disease can affect the carotid, vertebral, mesenteric arteries (in the intestine), renal arteries, arteries of the upper limbs and also the lower limbs with reduced vascular blood flow.

Causes of peripheral arterial distress

The appearance of the disease is mostly due to atherosclerosis, the symptoms being due to the phenomenon of narrowing of the arterial caliber by the presence of atheroma plaques (fat deposits inside the vessel) but also to cardiac embolism (thrombi forming in the heart) or thrombosis arterial aneurysm (thrombi that occur in vascular dilatations such as aortic aneurysms).

Symptoms of the disease

The anamnesis in the clinical examination is very important in establishing the diagnosis of peripheral arterial disease, many patients even those in an advanced stage of the disease is asymptomatic or with atypical manifestations of the disease.

The main symptoms are:

  • Walking discomfort is represented by pain in the leg, in  the thigh or buttocks, including muscle cramps that improve at rest;
  • Pain in the lower limb or leg associated with the vertical or horizontal sloping position (legs hanging at the edge of the bed);
  • Association of effort  with pain in the upper limbs;
  • Abdominal pain after eating, associated with weight loss;
  • Erectile dysfunction.

Self-assessment

In the presence of symptoms specific to a transient ischemic accident (headache, confusion, asymmetry of the facial muscles, decreased visual acuity, difficulty verbal expression) the patient must access a specialized neurological consultation due to the risk of developing in the near future a complete ischemic stroke, which could lead to the irreversible neuronal lesion. Carotid stenosis is the most common cause of an ischemic cerebral event.

Abdominal cramps and colic that occur after eating are due to occlusion of the visceral arteries and should worry the patient when accompanied by nausea, vomiting, diarrhea, malabsorption (food nutrients are not assimilated properly) or unintentional weight loss.

Intermittent claudication is the most typical symptom in the case of arterial disease of the lower limbs, the patient complaining of pain when walking, the condition being even more serious as the discomfort occurs at short distances. The presence of resting pain accompanied by skin changes (cyanosis of the fingers) or ulcers of the lower limbs are indicators of the severity of the peripheral occlusive disease.

Treatment

Hygienic-dietary treatment for patients with peripheral arterial disease aims to reduce body weight and blood sugar levels by controlling food intake, increasing daily physical activity (30 minutes a day of exercise) and quitting smoking.

The medicinal preparations used in peripheral arterial occlusive disease are mainly addressed to chronic diseases that favour the evolution of the atherosclerotic process and include:

  • Antihypertensives - calcium channel blockers, angiotensin receptor blockers, angiotensin-converting enzyme inhibitors to control high blood pressure;
  • Fibrates and statins to improve the patient's lipid profile (decreased LDL, triglycerides, increased HDL);
  • Hypoglycemic agents to control blood glucose in diabetics;
  • Low-dose antiplatelet agents reduce the risk of endovascular thrombus formation.

The endovascular approach of the disease has the role of revascularizing the hypoperfused territory (resumption of blood flow in the narrowed vessel), with or without the use of stent graft in angioplasty.

Conventional surgical treatment is considered in case of failure of endovascular procedures or in patients with severe occlusions that require bypass (divert blood flow by creating new vascular ducts) or vascular reconstruction.