DEFINITION

Peripheral arterial occlusive disease is characterised by the progressive narrowing of the arteries until they are completely obstructed. The districts most affected are: the aorto-iliac district; femoropliteum and carotid artery.

FREQUENCY: About 20% of the general population aged 65 to 74 is affected and the male sex is more frequently affected.

CAUSES: The most frequent cause is atherosclerosis.

CLINICAL AND NATURAL EVOLUTION OF THE DISEASE

In the early stages, the disease limits gait, causing cramp-like pain when walking, at different locations depending on the arterial tract involved. Subsequently, if the disease progresses, the pain appears at rest (especially at night) until the appearance of trophic lesions (ranging from small lesions on the fingers, to gangrene), then it may progress until it causes the loss of function of the limb(s) affected by the disease. The evolution of the disease with the support of the patient’s medical and behavioural therapy can be stopped at an early stage, even the painful symptoms during walking (claudication) can improve not only with the help of these aids, but also and especially with intense and daily walking. Sometimes, despite all these measures, the evolution of the disease can be abruptly accelerated by acute intercurrent phenomena, such as thrombosis (occlusion) of the diseased artery (aorta, iliac and femoral vessels) or embolism (clots that can detach from irregular plaques or from peripheral aneurysms and/or the aorta that occlude smaller vessels). In both cases, the abrupt stoppage of blood flow downstream of the obstruction requires an emergency surgical/medical intervention (with drugs that dissolve the thrombus/embolus) in order to try to save the affected limb(s).

DIAGNOSIS: the diagnosis is based on the symptomatology characterised by the difficulty in walking, showing typically crampy pain in one or both of the lower limbs during walking and through diagnostic investigations such as: Doppler CW, echo colour Doppler, angiography.