What are the main risk factors?
Atherosclerosis is a pathology that presents several risk factors. These can be distinguished in two categories: editable and non-editable. Among the first ones we can include diabetes, hypertension, hypercholesterolemia, hyperomocysteinemia and cigarette smoking. Among the non-modifiable risk factors we recognize: genetic factors, familiarity, gender (the male is most affected) and age.
Are there protective factors?
An active lifestyle, a balanced diet, intake of modest amounts of red wine, and regular physical activity are correlated with a lower incidence of the disease.
How many people are affected by this disease?
Peripheral arterial disease affects about 3% of the population aged 55 to 65 and about 6% between 65 and 75 years.
How does it affect the disease?
Atherosclerosis is responsible for the formation of plaque in the arteries which cause a narrowing of the vessel inside, until it is completely occluded. The most frequently affected sites are the arteries of the lower limbs.
What are the signs and what are the symptoms?
In the early stages, the disease is asymptomatic and can be diagnosed only by the evaluation performed by an experienced physician. The symptom that characterizes it, or a cramping-like, violent muscle pain, occurs during the march that prevents the affected person from continuing the journey. This pain ceases only with rest, then re-emerges with the same characteristics as the resumption of the stroke (this is why it is called “claudicatio intermittens”). This pain is due to an increase in oxygen demand that can not be met due to reduced blood supply to the lower limbs caused by stenosis / occlusions in the arteries. Beings may be affected by the gluteus, thigh or calf muscles depending on the location of the disease.In the last stage, the pain appears to rest mostly during sleep. Also, there may be a reduction in the temperature of the affected limb (hypothermia) and the presence of blue fingers (cyanosis), up to the appearance of ulcers and gangrene that form the clinical picture defined as “critical ischemia”.
What are the instrumental examinations needed for proper diagnosis?
Recalling that any instrumental diagnostic research should always be preceded by a specialist visit, the following examinations are available to the specialist to diagnose the disease and to plan for any surgical intervention:
- ABI test (measures the difference in arterial pressure at arm and ankle level).
- TcPO2 (used to accurately measure the amount of oxygen present in the tissue being tested).
- EcocolorDoppler (useful for assessing severity, location of lesions, and therapeutic planning).
- Angio-TC and Angio-Rm (useful for any surgical intervention planning).
- Angiography (invasive examination is almost always considered when an endovascular treatment is required).
What treatments are available today?
For the first stages, when you have no symptoms or when the patient’s quality of life is not compromised:
- Control of risk factors.
- Regular physical activity.
- Pharmacological therapy (medications that make blood more fluid, able to prevent plaque formation in the arteries, which can improve muscle metabolism).
- Vascular Biophysical Therapy. In advanced stages, an interventionist approach is needed to improve the patient’s quality of life and in the presence of “critical ischemia” to save the limb from amputation:
- Endovascular treatment (considered mininvasive as no surgical incision is required(
- Surgical treatment (generally considered when the disease is very extensive)