3 Arterial vascular disease in the leg

Lower extremity arterial disease

Most patients with Lower Extremity Artery Disease (LEAD) are asymptomatic. Walking capacity must be assessed to detect clinically masked LEAD.

The clinical signs vary broadly. Atypical symptoms are frequent. Even asymptomatic patients with LEAD are at high risk of Cardiovascular (CV) Events and must benefit from most CV preventive strategies, especially strict control of risk factors.

Antithrombotic therapies are indicated in patients with symptomatic LEAD. There is no proven benefit for their use in asymptomatic patients. Ankle-brachial index is indicated as first-line test for screening and diagnosis of LEAD [1]. This test can be done with the help of SOT company’s 8-channel ABI device.

3 common arterial diseases in the vessels of the lower limbs are:

  • Peripheral Artery Disease (PAD)
  • Raynaud Syndrome
  • Buerger Disease

Peripheral Artery Disease (PAD)

Peripheral artery disease is a common condition in which narrowed arteries reduce blood flow to the arms or legs. In peripheral artery disease (PAD), the legs or arms — usually the legs — don’t receive enough blood flow to keep up with demand.

This may cause leg pain when walking (claudication) and other symptoms. Peripheral artery disease is usually a sign of a buildup of fatty deposits in the arteries (atherosclerosis). Atherosclerosis causes narrowing of the arteries that can reduce blood flow in the legs and, sometimes, the arms [2].

Peripheral Artery Disease

Symptoms

Many people with peripheral artery disease have mild or no symptoms. Some people have leg pain when walking (claudication).

Claudication symptoms include muscle pain or cramping in the legs or arms that begins during exercise and ends with rest. The pain is most commonly felt in the calf. The pain ranges from mild to severe. Severe leg pain may make it hard to walk or do other types of physical activity.

Other peripheral artery disease symptoms may include:

  • Coldness in the lower leg or foot, especially when compared with the other side
  • Leg numbness or weakness
  • No pulse or a weak pulse in the legs or feet
  • Painful cramping in one or both of the hips, thighs or calf muscles after certain activities, such as walking or climbing stairs
  • Shiny skin on the legs
  • Skin color changes on the legs
  • Slower growth of the toenails
  • Sores on the toes, feet or legs that won’t heal
  • Pain when using the arms, such as aching and cramping when knitting, writing or doing other manual tasks
  • Erectile dysfunction
  • Hair loss or slower hair growth on the legs
    If peripheral artery disease gets worse, pain may occur during rest or when lying down. The pain may interrupt sleep. Hanging the legs over the edge of the bed or walking may temporarily relieve the pain.

Risk factors

Smoking or having diabetes greatly increases the risk of developing peripheral artery disease. Other things that increase the risk of peripheral artery disease include:

  • A family history of peripheral artery disease, heart disease or stroke
  • High blood pressure
  • High cholesterol
  • High levels of an amino acid called homocysteine, which increase the risk for coronary artery disease
  • Increasing age, especially after 65 (or after 50 if you have risk factors for atherosclerosis)
  • Obesity (a body mass index over 30)

Raynaud Syndrome

Raynaud’s disease causes some areas of your body — such as your fingers and toes — to feel numb and cold in response to cold temperatures or stress. In Raynaud’s disease, smaller arteries that supply blood to your skin become narrow, limiting blood flow to affected areas (vasospasm).

Women are more likely than men to have Raynaud’s disease, also known as Raynaud’s or Raynaud’s phenomenon or syndrome. It appears to be more common in people who live in colder climates [3].Raynaud Disease in hand

Signs and symptoms of Raynaud’s disease include:

  • Cold fingers or toes
  • Color changes in your skin in response to cold or stress
  • Numb, prickly feeling or stinging pain upon warming or stress relief

During an attack of Raynaud’s, affected areas of your skin usually first turn white. Then, they often turn blue and feel cold and numb. As you warm and your circulation improves, the affected areas may turn red, throb, tingle or swell.

Although Raynaud’s most commonly affects your fingers and toes, it can also affect other areas of your body, such as your nose, lips, ears and even nipples. After you warm up, the return of normal blood flow to the area can take 15 minutes.

 

Buerger Disease

Buerger’s disease is a rare disease of the arteries and veins in the arms and legs. In Buerger’s disease — also called thromboangiitis obliterans — your blood vessels become inflamed, swell and can become blocked with blood clots (thrombi) [4].

This eventually damages or destroys skin tissues and may lead to infection and gangrene. Buerger’s disease usually first shows in your hands and feet and may eventually affect larger areas of your arms and legs.

Virtually everyone diagnosed with Buerger’s disease smokes cigarettes or uses other forms of tobacco, such as chewing tobacco. Quitting all forms of tobacco is the only way to stop Buerger’s disease. For those who don’t quit, amputation of all or part of a limb is sometimes necessary.

buerger disease

Buerger’s disease symptoms include:

  • Tingling or numbness in the hands or feet.
  • Pale, reddish or blue-tinted hands or feet.
  • Pain that may come and go in your legs and feet or in your arms and hands. This pain may occur when you use your hands or feet and eases when you stop that activity (claudication), or when you’re at rest.
  • Inflammation along a vein just below the skin’s surface (due to a blood clot in the vein).
  • Fingers and toes that turn pale when exposed to cold (Raynaud’s phenomenon).
  • Painful open sores on your fingers and toes.

 

 

[1] Lower extremity artery disease ESC Publications

[2] Peripheral artery disease (PAD) Symptoms and Risk factors

[3] Raynaud’s disease Symptomes

[4] Buerger’s disease Symptoms

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