What is peripheral arterial disease?

peripheral arterial disease (PAD) is a circulatory problem that consists obstruction of peripheral arteries (iliac, femoral, sottogenicolari, etc.) Caused by the presence of narrowing (stenosis) of various nature that reduce the cavity (lumen) of the same arteries .

Obstructions cause a reduction of blood flow in a specific area of ​​the body (usually the muscles of the lower limbs) with consequent symptoms (e.g. muscle pain or intermittent claudication when walking).

What are the causes of peripheral arterial disease?

L ‘ peripheral arterial disease is caused mainly atherosclerosis. However, it is also possible that the obstruction of the peripheral arteries is due to inflammatory processes affecting the wall of the same (arteritis), trauma, exposure to radiation, anatomical variants of ligaments and muscles.

What are the risk factors of peripheral arterial disease?

The main risk factors are:

  • Smoke
  • Diabetes mellitus
  • Obesity (body mass index> 30)
  • Arterial hypertension (> 140/90 mmHg)
  • Hypercholesterolaemia (total cholesterol> 240 mg / dl)
  • Age
  • Familiarity for lower limb obliterating arteriopathy
  • Hyperhomocysteinemia

The diagnosis

The Cardiological allows to suspect the presence of peripheral arterial disease when:

  • visually we observe areas of skin of different coloring, from red to bluish, with respect to the surrounding ones;
  • with palpation the reduction or absence of a pulse is appreciated (i.e. the pulsation of the femoral, popliteal, pedideal artery, etc.)
  • with auscultation there is a vascular murmur (noise), a sign of turbulent blood flow due to an arterial narrowing.

Arterial echo-color Doppler

It is a non-invasive investigation which, through ultrasound, defines the structure of the artery and thanks to the colordoppler, allows to detect accelerations of the blood flow which, above a certain limit, are indicative of a pathological arterial narrowing.

RM Angio (Magnetic Resonance Angio)

It is a non-invasive radiographic investigation that allows, thanks to the exploitation of magnetic fields, to define the anatomy of an arterial district and any restrictions.

Angio CT scan (Angio Computed Tomography)

It is a non-invasive radiographic investigation that allows, thanks to the injection of contrast medium, to define the anatomy of an arterial district with possible narrowings.

arteriography

It is an invasive examination performed under local anesthesia. Arteriography provides arterial access through direct puncture of the artery in the femoral, radial, humeral etc., followed by the advancement of a catheter up to the vicinity of the site to be visualized in which the contrast medium that is drawn is injected. arterial anatomy and any constrictions that will be displayed on the monitor in front of the operator.

The treatment

In consideration of the characteristics of the narrowing (seat, length, severity), the operator can choose to perform percutaneous peripheral angioplasty (PTA) or classical surgery

The therapeutic objectives of peripheral arterial disease are essentially two:

  • reduce symptoms and allow physical activity as acceptable as possible;
  • prevent the evolution of the pathological process (atherosclerotic, inflammatory etc) to other districts (carotid, renal, subclavian, etc.) than the one involved.

These goals can be achieved primarily with changes to your lifestyle such as:

Stop smoking

The products obtained from the combustion of tobacco can damage the arteries and favor the development of atherosclerotic plaques at the level of peripheral and non peripheral arteries. Stopping the smoking habit is critical to reducing the progression of peripheral arterial disease (AOP). If you are unable to stop, we recommend that you ask your doctor for drug support.

Physical exercise

Physical activity (eg walking) is of fundamental importance in the presence of peripheral arterial disease (AOP) as it allows the development of collateral circles that “bypass the blocked arterial segments and also train the muscle to use oxygen in more efficient way. There are specific exercise programs for patients with AOP which will however need to be discussed with your doctor.

Diet

Reduce the introduction of saturated fats, salt and sugars in the food. These measures help to reduce the concentration of cholesterol and sugars in the blood and to reduce blood pressure, all very important risk factors in the development of atherosclerotic plaques.

If the change in lifestyle is not sufficient to control the possible development of peripheral arterial narrowings, it is always possible to resort to pharmacological therapies. There are numerous pharmacological aids that can be indicated in patients with peripheral arterial disease. The main ones are: drugs that reduce blood coagulability (antiplatelet agents such as aspirin, ticlopidine, clopidogrel, cilostazol), which reduce blood pressure (calcium channel blockers, ACE inhibitors and sartanics) and which reduce cholesterol and triglyceride levels (statins , Omega3, ezetinibe, fibrates).

There are also a number of interventional procedures :

Peripheral percutaneous angioplasty (PTA)

It is a minimally invasive procedure performed under local anesthesia. The interventional cardiologist (or vascular surgeon or interventional radiologist) performs it by inserting a long, thin tube (catheter) into an artery, generally at the wrist (radial artery), groin (femoral artery) or arm ( humeral artery), which is advanced to near the narrow artery.

At this point, a contrast medium is injected to check the site and extent of the narrowing (arteriography). Subsequently, if the artery is subject to percutaneous treatment, a guide wire is advanced through the catheter and then inside the closed or narrowed artery beyond the obstruction. In this way it is possible to slide a special balloon over the guide wire which, once in position, is inflated for a short time in order to reopen the occluded artery. A metal mesh stent can then be implanted to keep the long-term critical point open.

In some cases, arterial obstruction is so severe in terms of narrowing and length or localization that PTA would not be associated with a good risk / benefit ratio. In these cases the AOP will be directed to surgical treatment through:

Thrombendoarterectomy (TEA)

It is an operation that requires surgical cutting and deep anesthesia. It consists in the “cleaning” by the vascular surgeon of the artery segment where the atherosclerotic plaques are located which will be removed.

By-pass

It is an operation that requires surgical cutting and deep anestia. It consists in the use of dacron or vein ducts that allow the vascular surgeon to create a bridge connection between the healthy artery segments upstream and downstream of the occluded or severely restricted one which is thus “bypassed”.

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