Chronic obliterative arteriopathy of the inferior limbs
Chronic obliterative arteriopathy of the inferior limbs is arising from the development of atherosclerotic lesions which progressively obstruct the lumen of the arteries and creates a barrier to vascularization distal of the lower limbs. It is a marker of atherosclerotic general affection: arteritis patients present in 20-30% of cases significant carotid stenosis in 50% of coronary disease in 10% of cases of abdominal aortic aneurysm.
Chronic obliterative arteriopathy of the inferior limbs is a frequent condition; a quarter of the patients do not have any clinical symptom. Another third with symptoms is not presenting to the doctor, and do not receive treatment that could slow down the evolution of the disease and prevent its complications.
The population above 55 years the incidence of asymptomatic disease is 10% intermittent claudication is 5% and chronic critical ischemia is 1%. The incidence is lower in women (3.1 ratio), but the difference diminishes with age.
What are the stages of severity of the disease? One can distinguish four clinical stages according to chronic obliterative arteriopathy of the inferior limbs symptoms: stage I – asymptomatic, stage II – intermittent claudication (muscle pain during exercise), stage III – pain at rest and stage IV – trophic disorders (ulcer, gangrene).
What is ischemia? Ischemia means a reduction or stoppage of blood circulation in a region lying more or less of an organ or tissue. It will lead to a reduced supply of oxygen to the body, with a consequent suffering tissue. Acute ischemia is due to an acute obstruction of an artery due to local thrombosis of arterial emboli. It is manifested by the appearance of brutal intense pain at the level of a member who becomes cold and pale. It is a surgical emergency.
Critical ischemia corresponds to a stage of permanent ischemia which puts at stake the affected limb preservation. It is defined by a combination of clinical signs (rest pain that requires regular administration of analogue-switched, trophic disorders) and a significant decrease in the IPS. It corresponds to stages III and IV Leriche-Fontaine classification.
How the diagnosis and the evaluation of patients with chronic obliterative arteriopathy of the inferior limbs are made in order to start immediately medical and surgical treatment?
Systolic pressure index is a method of screening for peripheral artery disease.
2D and Doppler ultrasound can precisely locate the location of lower limb arterial lesions or intra-abdominal.
Lower limb arteriography provides a true “picture” of the arteries after a prior injection of a contrast agent. It directly visualizes the arteries and their branches, noting the vessels anatomy and their injuries; is an invasive method and is performed when you plan to perform an act of surgical or endoluminal revascularization. It is performed in specialized environment, with local anesthesia by puncture femoral and retrograde catheterization of the iliac shaft or humerus or radial puncture.
Therapeutic indications are made after an assessment of the severity of arteriopathy, topography of the arterial damage, atherosclerotic disease extension, the presence of risk factors, last but not least the way of life of the patient.