[Anatomic and functional diagnosis in arterial occlusive disease]

Area of Science:

• Vascular Medicine
• Cardiovascular Surgery
• Radiology

Context:

• Peripheral arterial disease (PAD) is primarily caused by arteriosclerosis, with symptoms often appearing decades after disease onset.
• Hemodynamic effects of arterial narrowing depend on complex functional, morphological, and metabolic factors.
• Significant arterial narrowing (>70%) in leg arteries may not impair exercise capacity, highlighting asymptomatic PAD.

Purpose:

• To review the pathophysiology, causes, and clinical manifestations of peripheral arterial disease and acute peripheral vascular occlusion.
• To emphasize the diagnostic and therapeutic challenges posed by asymptomatic PAD and emergent vascular occlusions.
• To detail the common etiologies, including arteriosclerosis, thrombosis, and embolism, and their predilection sites.

Summary:

• Arteriosclerosis is the leading cause of PAD, manifesting clinically years after its insidious onset.
• Acute peripheral vascular occlusion, a medical emergency, often results from in-situ thrombosis or embolism, frequently impacting lower extremities.
• Emboli commonly lodge at arterial bifurcations in the lower extremities, with occlusion severity correlating to centrality.

Impact:

• Understanding PAD pathophysiology is crucial for timely diagnosis and intervention, especially in cases of acute occlusion.
• Recognizing asymptomatic PAD and its risk factors can prevent progression to critical limb ischemia.
• This review aids clinicians in managing PAD and acute vascular emergencies, improving patient outcomes.