Peripheral vascular disease of lower extremities

Peripheral vascular disease (PVD) of lower extremities is an atherothrombotic syndrome accompanied by a progressive narrowing of arteries of lower extremities. It is an important indicator of diffuse arterial involvement. The disease may be asymptomatic or symptomatic. Principle risk factors for PVD of lower extremities are advanced age, smoking, and diabetes mellitus. Further risk factors are hypertension, dyslipidemia, male sex, high plasmatic levels of homocystein, fibrinogen and glucose, history of myocardial infarction, TIA, stroke and heart failure. A classical example of PVD of lower extremities in a so far asymptomatic patient is a presentation with intermittent claudications. A critical limb ischemia describes chronic ischemic pain of a lower extremity at rest, ulcerations or gangrene of peripheral parts of a lower extremity. An acute limb ischemia is an urgent situation caused by a sudden occlusion of an artery by a thrombosis, embolus or a mechanical cause. Diagnosis of PVD of lower extremities is based on a history, presence of symptoms, and on ultrasound examination (pencil continuous Doppler, colour duplex ultrasonography). The primary goal of PVD treatment is to decrease cardiovascular morbidity and mortality by an aggressive intervention of risk factors. It is also necessary to prescribe an antiplatelet agent and provide a symptomatic relief pharmacologically and by intervention. The basic pharmacologic treatment is the use of antiplatelet agents (aspirin or clopidogrel), vasodilatant naftidrofuryl and statins. Regular exercise can prolong claudication intervals by up to 150%. If the effect of conservative therapy is insufficient or in the case of disease progression if the anatomical finding is suitable, we indicate an intervention – either endovascular (PTA) or surgical. In acute arterial occlusions it is possible to use a thrombolytic treatment, percutaneous aspirational thrombembolectomy (PAT) or mechanical thrombectomy.

Keywords: peripheral vascular disease of lower extremities, risk factors, clinical picture, treatment, ankle brachial index, colour duplex sonography