PERIPHERAL ARTERY DISEASE (PAD)

Introduction

Peripheral artery disease is a fairly common chronic condition with the progressive course and serious complications. The lumen of the arteries supplying blood to the tissues of the lower limbs, less often the upper limbs, is gradually reduced. A reduction of the amount of inflowing blood limits the supply of oxygen and nutrients to the tissues. The disease is likely to play an increasing social and economic role as societies continue to age.

Causes

The main causes of the disease include smoking, lipid metabolism disorders (hypercholesterolaemia) and diabetes. Ineffectively treated hypertension and stationary lifestyle also play a role.

Symptoms

The symptoms result from the limited blood flow to the soft tissues. The most common include intermittent claudication, i.e. post-workout muscle pain subsiding after rest. In chronic ischemia of the lower limbs, the symptom is measured by the distance of a leisurely walk after which the calf symptoms appear. In patients with atherosclerosis, hair loss, a feeling of cold and, in extreme forms, non-healing wounds are observed.

Diagnosis

A well-grounded suspicion of the disease can be made after checking pulse on the limbs and measuring the ankle-brachial index (ABI). Imaging examinations, such as ultrasound, conventional angiography, computed tomography angiography and magnetic resonance imaging are used to confirm and complement diagnosis.

Treatment

The treatment is multidirectional, it involves combating risk factors (giving up smoking, treating hyperlipidemia, hypertension and diabetes), using antiplatelet and vasodilating drugs, as well as implementing supervised training programs. Patients refractory to conservative treatment, with a claudication distance that prevents normal everyday functioning and those at risk of losing the limb, are qualified for invasive treatment. Classic surgical procedures involve a mechanical removal of the narrowed or blocked arteries or implantation of bypass grafts. Currently, thanks to the development of minimally invasive techniques, percutaneous procedures, such as restoring patency, balloon angioplasty and vascular stent implantation, play a dominant role.

Type of operation

The aim of endovascular restoration of the patency of the arteries is to force an atherosclerotic lesion using catheters and guides. This can be done from different accesses (puncture of the femoral artery is the most common) and in various directions. After the initial angioplasty with a high-pressure balloon (up to several atmospheres), a vascular stent is implanted at place of occlusion. This management ensures the long-term effect of the procedure, i.e. maintenance of the patency of the affected vessel.

As a rule, patients are discharged home the day after the procedure with the recommendation to take medications, change lifestyle and report for check-ups at the Regional Outpatient Clinic of Vascular Diseases.