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Updated: Sep 21, 2026
Assessing Therapeutic Angiogenesis in a Murine Model of Hindlimb Ischemia
Published on: June 8, 2019
[Clinico-pathological aspects of the lower limb ischemia in chronic arterial occlusive disease]
1Second Department of Surgery, Tokyo Medical and Dental University.
Insights
Arteriosclerosis obliterans and Buerger's disease cause chronic lower limb ischemia due to arterial blockages. Understanding these conditions and their severity is crucial for effective treatment and preventing amputation.
Area of Science:
- Vascular Medicine
- Cardiovascular Surgery
- Vascular Surgery
Context:
- Arteriosclerosis obliterans (ASO) and Buerger's disease are leading causes of chronic lower limb ischemia.
- ASO involves atherosclerotic blockages in major arteries (aorta to femoral), while Buerger's disease affects smaller arteries with panarteritis.
- Both conditions can lead to severe leg ischemia due to thrombotic occlusions and disease progression.
Purpose:
- To differentiate between Arteriosclerosis obliterans and Buerger's disease.
- To explain the pathophysiology of chronic lower limb ischemia, including microcirculatory dysfunction.
- To outline diagnostic methods and severity assessment for chronic arterial occlusive diseases.
Summary:
- Chronic lower limb ischemia stems from arterial occlusive diseases like ASO and Buerger's disease.
- Pathological processes include atherosclerotic stenosis, non-specific panarteritis, and thrombotic occlusions.
- Microcirculatory changes involve white blood cell and platelet activation, leading to vasoconstriction and endothelial injury.
Impact:
- Highlights the importance of Fontaine's classification for grading ischemia severity and guiding treatment.
- Introduces the concept of chronic critical limb ischemia, emphasizing the need for prompt revascularization.
- Provides an overview of diagnostic tools and assessment strategies for chronic arterial occlusive conditions.
Abstract:
Arteriosclerosis obliterans (ASO) and Buerger's disease are representative arterial occlusive disease which causes chronic lower limb ischemia. In ASO, ischemia is produced by atherosclerotic stenosis and/or occlusion of major arterial trees mainly from the abdominal aorta to the femoral arteries, and in Buerger's disease, smaller arteries distal to the calf and the elbow are generally affected by non-specific panarteritis. Thrombotic occlusion at the affected vessels and proximal and/or distal progression of the secondary thrombosis often deteriorate leg ischemia. In chronic limb ischemia, microcirculation distal to affected vessels is also deteriorated by activation of white blood cells and platelets which induce vasoconstriction, injury of intimal cells, platelet aggregation, increased permeability, etc. Fontaine's classification of chronic limb ischemia based on clinical signs and symptoms is useful for grading severity of ischemia and selecting an optimal treatment. Recently, the concept of chronic critical limb ischemia is advocated, which is a condition that the limb amputation will be inevitable without restoration of blood flow. Diagnostic modalities for chronic arterial occlusion and assessment for severity of ischemia are outlined.
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