Chronic arterial ischemia

What is it?

Chronic arterial ischemia is a disease of the arteries that occurs due to a slow and progressive decrease in blood flow in a territory of the body, generally in the lower extremities. It is a much more common disease in men than in women.

How is it produced?

In most cases the cause of this decrease in blood flow is the presence of atherosclerosis. Atherosclerosis is a disease of the arteries in which there is a narrowing of their caliber due to the accumulation of lipids and inflammatory cells forming what is known as atheroma plaque. These plaques cause a decrease in the lumen of the vessel so the amount of blood that circulates through them is less. Due to the decrease in blood flow, the contribution received by the muscle groups of the lower limbs is less during exercise (when walking). To replace it, a collateral circulation develops, so the disease does not appear until the obstruction of the lumen of the vessel is important (more than half). The factors that favor atherosclerosis are those that will facilitate the appearance of chronic arterial ischemia such as: tobacco, diabetes, increased cholesterol and lipids, obesity and sedentary lifestyle.

Symptoms

The predominant symptom is the appearance of pain in the extremities that appears when the patient walks and that increases progressively until it forces him to stop walking. This pain typically goes away with rest. This situation is known as intermittent claudication. The patient is able to walk a distance (usually only a few meters) until pain appears. The pain can appear earlier when the patient exerts an effort such as climbing stairs or a slope. In more advanced stages of the disease, pain may appear even during rest and present skin lesions (ulcers) due to poor irrigation. Poor circulation can lead to cold and pale skin and decreased body hair in that area.

How is it diagnosed?

The diagnosis is based mainly on the symptoms explained by the patient, the physical examination and a series of tests that allow confirming the poor state of the arterial system. In the examination of the affected limb, the color and temperature of the skin are evaluated (coldness and paleness appear when the limb is raised) and the arterial pulses in the extremities.

Complementary explorations

• Doppler ultrasound: allows you to see the morphology and diameter of the vessels and the state of the arterial circulation.
• Ankle / arm index: it is the most used non-invasive method. blood pressure measurements are made in the ankle and arm and the results allow estimating the degree of elasticity of the arteries.
• Angioresonance: it is performed especially when the symptoms and the results of the tests are doubtful.
• Arteriography: it is an invasive test. It allows locating the extension and location of the lesions in the vascular tree.

Treatment

The goal of medical treatment is to prevent the disease from progressing further. Treatment of risk factors is essential. It is recommended to give up tobacco, control cholesterol, blood pressure and diabetes. Perform scheduled physical exercise at least 30 minutes per session 3 times a week. Pharmacological treatment is based on the use of drugs that promote blood flow and prevent the growth of atheroma plaques and the appearance of thrombi. Antiplatelet agents such as acetylsalicylic acid and vasodilators such as pentoxifylline are used. Revascularization treatment aims to restore arterial blood flow. It can be performed by percutaneous angioplasty or by performing a bypass.

Angioplasty is a procedure by which the artery or arteries that are stenosed (narrow) are reopened by means of a balloon, a small metal mesh (stent) is usually placed to keep it open. In bypass surgery, a piece of healthy vein from another part of the body or made of synthetic material is placed that allows to bypass the obstructed arterial section and restore blood flow.

The most serious complication of chronic arterial ischemia is the total absence of flow in the limb and therefore the death (necrosis) of the tissues, the only solution for which is surgical amputation of the affected limb.

Prevention

Avoiding risk factors such as tobacco and obesity, as well as controlling diabetes, hypertension, and cholesterol will lower the risk of this disease.