Ischemic disease of the lower limbs

When your legs hurt…

What is ischemic disease of the lower limbs?

     Atherosclerosis is the most common cause of ischemic disease of the lower limbs (IDLL). It leads to the narrowing and eventual blockage of the lumen of the arteries. Behind the site of narrowing or blockage, ischemia occurs, resulting in a lack of blood flow and oxygen to the tissue.

    It is a long-term process in which fatty substances, primarily cholesterol, accumulate in the walls of the arteries, leading to the formation of an atherosclerotic plaque. A blood clot (thrombus) can form on the uneven surface of the plaque. Under unfavorable conditions, the plaque or thrombus can completely block the artery.

  What are the symptoms of ischemic disease of the lower limbs?

In the early stage, there are no symptoms at all. As the narrowing increases, pain in the muscles during walking occurs, forcing the patient to stop and rest (known as claudication or intermittent claudication). With further deterioration of blood flow, pain becomes persistent at rest or at night. Relief sometimes comes from hanging the limb over the edge of the bed. The most severe manifestation is severe ischemia, where the oxygen supply is absolutely insufficient, potentially leading to tissue death in the limb and the development of gangrene.

The diagnosis is confirmed by ultrasound (sonographic) examination, possibly followed by angiography (AG) or CT angiography (imaging X-ray examination).

What are the risk factors for the development of ischemic disease of the lower limbs?

–  Smoking

–  Not enough movement

–  Obesity

–  High blood pressure

–  High cholesterol levels

–  Diabetes

How is ischemic disease of the lower limbs treated?

1. For newly developed minor issues, conservative treatment is initiated. This includes medication, leg exercises through walking, and an overall change in lifestyle. Medication aims to limit the formation of blood clots, known as antiplatelet therapy. Additionally, in certain stages, vasodilatory treatment is administered, which involves drugs that dilate the arteries. Concurrently, medications are used to lower blood lipid levels, and blood pressure and blood sugar levels are monitored.
2. If symptoms do not improve, interventional treatment is employed. One option is angioplasty, where a thin catheter is inserted into the affected artery, and a balloon at its tip expands the narrowed section. Sometimes, a supporting material, known as a stent, is also placed in the expanded segment of the artery.
3. Another option is surgery, where a bypass is typically created. This involves bypassing the narrowed section, either using an artificial vascular graft (vascular prosthesis) or utilizing the patient’s own vein.
4. In the advanced stages of the disease, where tissue death has occurred, it is necessary to amputate these affected parts.

An essential part of treatment is an immediate change in lifestyle. Without the patient’s effort, the disease can rapidly worsen despite otherwise successful treatment.