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[Pathophysiology and diagnosis for arteriosclerosis obliterans]
1Institute for Clinical Research, National Kanazawa Hospital, Kanazawa 920-8650.
Insights
Peripheral arterial disease (PAD) diagnosis and treatment focusing solely on leg circulation is insufficient. Comprehensive assessment of systemic atherosclerosis and risk factors is crucial for improving patient prognosis and survival.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Diagnostic Imaging
Context:
- Peripheral arterial disease (PAD) is conventionally treated by focusing on lower extremity circulation.
- This approach improves quality of life but not overall prognosis due to PAD's association with coronary and cerebrovascular diseases.
- Intermittent claudication, a common PAD symptom, arises from exercise-induced muscle ischemia due to arterial blockages.
Purpose:
- To highlight the limitations of conventional PAD diagnosis and treatment.
- To introduce advanced noninvasive diagnostic methods for evaluating intermittent claudication beyond the ankle-brachial pressure index (ABPI).
- To emphasize the importance of assessing systemic atherosclerosis and managing risk factors for improved PAD patient outcomes.
Summary:
- The study discusses limitations of traditional PAD management, advocating for a broader approach.
- It proposes advanced noninvasive techniques like plethysmography, thermography, laser Doppler flowmetry, and near-infrared spectroscopy (NIRS) as superior alternatives to ABPI for assessing intermittent claudication.
- Carotid artery atherosclerosis is identified as a marker for systemic disease, with smoking, systolic blood pressure, and Lp (a) as key risk factors.
Impact:
- Implementing advanced diagnostic tools and risk factor management can significantly improve the prognosis of patients with peripheral arterial disease.
- Shifting focus from isolated limb circulation to systemic atherosclerosis offers a more holistic and effective treatment strategy.
- Early identification and mitigation of risk factors like smoking and hypertension are vital for reducing cardiovascular and cerebrovascular events in PAD patients.
Abstract:
Patients with arteriosclerosis obliterans, or peripheral arterial disease have been conventionally diagnosed and treated from only the viewpoint of peripheral arterial circulation. These concepts may have improved the quality of life for patients, but could not contribute the prognosis of life, because peripheral arterial disease is associated with an increased risk of the coronary disease and cerebrovascular disease. Intermittent claudication, the most common symptom of peripheral arterial disease, results from flow-reducing lesions in the arteries of the lower extremity that cause exercise-induced muscle ischemia. In order to evaluate intermittent claudication, many kinds of noninvasive diagnostic studies, including ABPI (ankle brachial pressure index) and the measurement of claudication distance, et al have been proposed. We have used the recovery time of the ischemic reaction at foot sole, plethysmography, thermography, laser doppler flowmetry, or NIRS (near-infrared spectroscopy) after walking test, rather than ABPI. These examinations will be superior to ABPI to evaluate effects after ergotherapy or pharmacotherapy for patients with intermittent claudication. Carotid artery sclerosis may be a good marker of systemic atherosclerosis. By our assessment of risk factors, the progression of atherosclerotic change in carotid artery was strongly correlated with two risk factors, such as smoking and systolic blood pressure. In the cholesterol analysis, Lp (a) was only high risk factor for atherosclerotic change of carotid artery. Recent technical advances, adequate evaluation of systemic atherosclerosis, and reduction of risk factors should improve the prognosis of patients with peripheral arterial disease.