Peripheral Arterial Disease
Introduction
The intermittent claudication or otherwise peripheral arterial disease is the inability to walk due to pain in the calves or the buttocks of the patient. It is a common condition in which blood flow to the hands and feet is reduced due to the narrowing of the arteries. In the general public the condition is characteristically called "shop window disease", as the patient looks for an excuse to stop at a shop window due to the pain/burning they feel while walking mainly in the calves or also in the buttocks.
The peripheral arterial disease is usually a sign of accumulation of fats in the arteries (atherosclerosis). Atherosclerosis causes narrowing of the arteries that can reduce blood flow to the legs and, sometimes, to the arms. The sypmtoms of claudication include muscle pain or cramps in the legs or arms, with the pain being more frequently felt in the calves. The pain ranges from mild to severe. The intense pain in the legs can make walking or other types of physical activity difficult. The therapy of peripheral arterial disease includes among others exercise, healthy diet, as well as smoking cessation.
The timely early diagnosis of the disease
is very important
for the good outcome of the condition in both stages of the disease.
Understanding of Intermittent claudication
The appearance of the pain in the calves or the buttocks of the patient during walking is indicative of poor perfusion of the lower limbs due to occlusion of the arteries (peripheral arterial disease). This is also the main cause of intermittent claudication. The indication for the treatment of the condition is the appearance of pain at a distance of less than 200 meters (Fontaine stage IIb).
NOTE: In young patients intermittent claudication (particularly during exercise) is mainly due to compression of the popliteal artery behind the knee by the gastrocnemius muscle. This condition is called popliteal artery entrapment syndrome and requires treatment in order to prevent injury of the interior of the vessel or thrombosis of it.
Ποιες είναι οι επεμβατικές μέθοδοι χειρουργικής θεραπείας;
Therapeutic options for intermittent claudication (peripheral arterial disease)
Intermittent claudication is initially treated with the correction of the risk factors that lead to the occlusion of the vessels (smoking cessation, weight loss, cholesterol control, administration of antiplatelet agents etc.) and with the encouragement of the patient to walk as much as possible based on a special exercise program.
In case of no improvement of the symptoms the patient can undergo an intervention. revascularization of the lower limb. The method of revascularization can be performed either minimally invasively (endovascularly), or with the placement of a surgical bypass. With the Hybrid Clinic, interventions for the resolution of complex vascular surgery conditions are performed with great success and without complications.
Main criteria for which treatment is better are the length of the occlusion, the presence of intense calcifications, the clinical condition of the patient and clearly the specialization of the center in each technique.
In the case of minimally invasive (endovascular) surgery, revascularization is performed with special wires and balloons while in specific patients and types of occlusions there is the possibility of removal of the atherosclerotic plaque with special atherectomy devices (laser, rotational, directional atherectomy). The general rule in patients with intermittent claudication is to avoid as much as possible the placement of a stent in the leg due to the higher risk of restenosis (20-40% at one year) or "fracture" (breaking) of the stent from the movements of the knee (1-10%). To reduce this risk either balloons coated with special drugs that remain in the wall of the vessel and reduce the risk of restenosis are used (drug-coated balloons), or stents that release such drugs for a considerable period of time (drug-eluting stents).
NOTE: In the special case of popliteal artery entrapment, the only treatment is the surgical removal, either of the tendon, or of the muscle that causes the entrapment of the vessel. These specific young patients do not undergo the aforementioned treatments as they do not suffer from peripheral arterial disease.
The role of the vascular surgeon in the treatment of intermittent claudication
The The role of the vascular surgeon who masters equally well both techniques of revascularization of the leg (endovascular and bypass) is to decide for each patient separately which method suits them more and which is the most appropriate moment to intervene. In every case, the patient with intermittent claudication must walk frequently and long distances as peripheral arterial disease is an indication of generalized disease of the vessels including also the vessels of the heart (coronary artery disease). Get in Contact with our clinic to receive individualized diagnosis and treatment.
