Atherosclerosis (peripheral arterial disease) is the build-up of plaque in arteries other than the coronary arteries. So it is a group of diseases with a common cause, but with different symptoms and locations. Peripheral arterial disease may affect up to 15% of the population. What are the causes and symptoms of this type of atherosclerosis? How is the treatment going?

Atherosclerosis of peripheral arteries( peripheral arterial disease ) is another, next to ischemic heart disease, the result of atherosclerosis - the most common disease of the vascular system developing secretly for many years. Atherosclerosis can affect all arteries of the body - most often the lower limbs, causing pain while walking, less often in the neck.

Peripheral vascular disease is often the underlying cause of strokes and acute limb ischemia - very serious conditions.

The disease is suspected on the basis of symptoms and simple tests - e.g. ultrasound, in more advanced cases it is sometimes necessary to perform computed tomography and angiography.

The basis of treatment is the reduction of risk factors for the development of atherosclerosis, then pharmacological treatment, and if it is not effective - surgical treatment.

How does atherosclerosis develop?

Atherosclerosis is most often associated with heart disease, but it may affect all arteries of the body and develop in a similar way. The starting point is damage to the endothelium, i.e. the inner, delicate layer of the artery.

It occurs as a result of blood flow disorders or an ongoing inflammatory reaction. As a result, deposits composed of many substances and cells, including fat, are deposited in the vessel wall - these are plaques.

Under favorable conditions, they enlarge over time, it also happens that they burst, which leads to the detachment of their fragments and the formation of blood clots.

The development of atherosclerosis leads to a narrowing of the vessel's lumen, which in turn limits blood flow and hypoxia - initially only during its increased demand, and then, as the plaque size grows, also at rest.

The final stage of the disease is the complete closure of the vessel, which may result from such a large development of atherosclerotic plaque or itsdamage.

The second mechanism is related to the so-called unstable plaques, which break easily, while platelets recognize the broken vessel as a rupture and begin to attach at this point. At some point, the process gets out of control, the artery is closed and ischemia occurs.

Peripheral atherosclerosis - risk factors

The risk factors for peripheral arteriosclerosis are the same as those for a heart attack, since the same mechanism is responsible for both diseases. The best known are:

  • hyperlipidemia, or excess cholesterol, especially "bad" - LDL
  • smoking
  • diabetes
  • hypertension
  • obesity
  • lack of physical activity and poor diet

We can modify all these factors and significantly reduce the risk of disease development through a he althy lifestyle. There are also a few that are beyond our control:

  • age and gender (men and the elderly are more at risk)
  • history of heart attacks in the family

It has been proven that the process of atherosclerotic plaque deposition begins before the age of 30, first of all involving the aorta, it depends on our lifestyle how quickly this process will progress when it takes other vessels and causes ailments.

Atherosclerosis of peripheral arteries - symptoms

Symptoms of peripheral arteriosclerosis can be very diverse, in all cases they result from reduced blood supply, and hence hypoxia and nutrient deficiency. Ailments depend on the location of the disease, its severity and which organ does not receive enough blood.

The most common locations are:

  • Lower extremity artery disease

Lower extremity artery disease is by far the most common. It may apply to each person, but also to all sections of the vessels in the limb. The most common symptom is the so-called intermittent claudication, which is pain in the lower limbs while walking, causing the necessity to stop, which brings relief.

Which part hurts - thigh, lower leg, buttocks - depends on the location of atherosclerotic lesions. In the most advanced cases, there is pain at rest, initially at night and then all the time.

Long-term ischemia leads to muscle atrophy, limb hair growth, and difficulties in wound healing. Less common symptoms include cold feet, cramps, tingling in the limbs, and the so-called restless leg syndrome.

In the studyIn medical examinations, it is found that the heart rate is weakened or even absent in the vessels affected by atherosclerosis, as well as vascular murmurs.

Severe ischemia can cause non-healing wounds and necrosis that may lead to limb amputation.

The acute condition caused by atherosclerosis of the lower limbs isacute limb ischemia . It occurs, like a heart attack, as a result of damage to the atherosclerotic plaque and coagulation inside the vessel.

The result is a complete lack of blood supply, resulting in

  • severe continuous pain
  • fade
  • tingling
  • sensory disturbance
  • and finally limb paralysis

Acute limb ischemia requires immediate medical intervention, but unfortunately it often ends in amputation.

  • Upper limb artery disease

Upper limb artery disease is a relatively rare localization. It mainly includes the subclavian artery, which is the main vessel supplying the entire upper limb. Symptoms include pain initially during exercise and then also at rest.

As in the case of the lower limbs, atherosclerosis can also lead to acute limb ischemia.

Another condition that may appear in the course of subclavian atherosclerosis is the subclavian steal syndrome, which is the flow of blood through the vessels in the wrong direction: the vertebral artery, leading to the brain, and instead of flowing towards the head, it is redirected to the hand.

  • Carotid atherosclerosis

Atherosclerosis of the carotid arteries - these include the vessels that supply blood to the brain. In many cases, even a severe stenosis can be asymptomatic because the brain is supplied with blood from several sources. The symptoms of this disease can be various:

  • dizziness
  • headaches
  • tinnitus
  • sometimes visual disturbances
  • paresis
  • sensory disturbance
  • gait disturbance

The most serious consequence of carotid atherosclerosis is a stroke, the risk of which increases significantly in people with these symptoms.

  • Renal atherosclerosis

Atherosclerosis of the renal arteries is rare, the result of this disease is a reduction in blood supply to the kidneys, which impairs their work and negatively affects the secretion of hormones (e.g. renin). As a result, arterial hypertension - the so-called renovascular hypertension - and kidney failure may develop.

Narrowing of the mesenteric arteries, or vesselssupplying the intestines. The most common symptom is abdominal pain, which initially occurs after a meal, leading to weight loss, less common symptoms include vomiting, diarrhea, constipation, and lower gastrointestinal bleeding.

Peripheral atherosclerosis - diagnosis

The choice of additional tests in the case of suspected disease depends on the suspected location of the lesions. People with peripheral arterial disease are usually already diagnosed with ischemic heart disease, which increases the likelihood of developing atherosclerosis elsewhere.

In addition, it is helpful to identify the presence of the risk factors described previously. For this purpose, laboratory tests are performed - lipid profile (assessment of blood cholesterol content) and glycemia, which allows for the diagnosis of diabetes or the assessment of its control.

More specific tests are mainly imaging diagnostics:

  • ultrasonography (USG)
  • Doppler tests
  • computed tomography - usually with contrast
  • angiography
  • in rare cases, magnetic resonance imaging

This group of imaging tests is performed by a specialist doctor - usually a vascular surgeon.

  • USGis only available for superficial vessels. It allows the assessment of the presence of atherosclerotic plaque, its size, and in Doppler examination - possible flow limitation. In the ultrasound of the carotid arteries, a specific parameter is assessed - the thickness of the intima-media complex, which tells about the risk of atherosclerosis in the entire body.
  • Assessment of blood flow in the arteries of the lower extremities can be done using the so-calledankle-brachial index . It is the quotient of the systolic blood pressure measured in the upper and lower limbs. Its measurement uses a continuous wave Doppler detector and a pressure gauge, it is a simple test, sometimes performed as a so-called screening test.
  • Suspicion of peripheral arterial disease can be confirmed usingcontrast-computed tomography . This test is performed for the region where atherosclerosis is suspected: lower limbs, abdominal cavity, head and neck. It is the most accurate test that allows not only to confirm the diagnosis, but also to accurately assess the level of changes and their severity. Computed tomography is used to plan the operation of diseased vessels.
  • Angiographyis an invasive examination that uses X-rays and a contrast agent. It allows you to accurately assess the vessels, the location of lesions and even their diameter. This research is performedusually in patients undergoing percutaneous interventions, such as ballooning and stenting.

Peripheral atherosclerosis - treatment

Symptoms of peripheral arterial disease can be very bothersome, especially intermittent claudication, significantly reducing the quality of life and mobility of the sick.

The most important procedure in the case of atherosclerosis - regardless of location, is the reduction of risk factors: quitting smoking, weight loss in overweight people, which can be achieved by increasing physical activity and introducing an appropriate diet.

In addition, attention should be paid to the proper management and control of diabetes and high blood pressure.

The influence of blood cholesterol is also significant, so in addition to a proper diet, sometimes drugs that reduce cholesterol - the so-called statins - are introduced.

In addition, antiplatelet drugs are sometimes used in the treatment of peripheral arteriosclerosis. The family doctor most often decides about the pharmacotherapy of hypercholesterolaemia (excess cholesterol).

If pharmacological treatment is unsuccessful, treatment may be necessary.

Nowadays we have endovascular methods, such procedures are performed similarly to stenting of coronary arteries. After puncture of the femoral artery, a balloon is inserted and the narrowed areas are widened, and then a stent is implanted in this place, which restores proper blood flow.

If such treatment is not possible, a classic procedure consisting in restoring the stenosis site - removal of atherosclerotic plaques or suturing a bypass - bypassing the narrowed vessel can be performed.

Treatment of peripheral arterial disease is initially performed by family doctors, but also by angiologists, i.e. vascular disease specialists and, of course, vascular surgeons.

Endovascular procedures are performed by vascular surgeons, less often interventional radiologists, classic procedures are of course the domain of surgeons.

ProbeAbout the authorBow. Maciej GrymuzaA graduate of the Faculty of Medicine at the Medical University of K. Marcinkowski in Poznań. He graduated from university with an over good result. Currently, he is a doctor in the field of cardiology and a doctoral student. He is particularly interested in invasive cardiology and implantable devices (stimulators).

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Cardiology