Peripheral arterial disease is “a condition that affects the arteries responsible for blood supply (circulation) to the lower limbs (legs, thighs, feet) and pelvis,” says Sérgio Sampaio, vascular surgeon and assistant professor at the Faculty of Medicine. from the University of the Port. These vessels eventually become fragile and can even become clogged.

It is an “important and dangerous disease, but it is possible to avoid” a tragedy. If suspected, the most recommended specialist is a vascular surgeon.

Depending on the severity, the complaints will be different. In an early stage, the disease may not cause any symptoms and can only be detected by testing.

In more advanced situations, the vascular surgeon says that these signs may appear:

• Pain when walking (almost always in the calf, but sometimes in the hip/buttocks), after having traveled a certain distance (the shorter the distance, the more significant the problem). This symptom will be felt over shorter distances if the patient climbs a ramp or walks faster;
• Pain at rest (Mainly affecting the extremity of the limb), worsens when the patient is lying down or with the legs elevated. This symptom is usually accompanied by a cooling of the affected area and may lead the patient to seek relief and remove the affected limb from the bed;
• Appearance of areas of gangrene or ulcers. [morte de tecidos e lesões] that do not heal due to the inability of tissue regeneration due to lack of oxygenation.

“An attentive and experienced vascular surgeon will be able to easily make the diagnosis based on the data provided by the patient and on the physical examination, including palpation of the arterial pulses,” explains Sérgio Sampaio. But there are tests that are used to diagnose and characterize the disease, such as:

• hemodynamic examination – Allows the “irrigation pressure” to be quantified at different levels;
• Arterial echodoppler – Morphological and functional ultrasound, which characterizes the appearance of the arteries and quantifies/characterizes blood flow;
• CT angiography (computed tomography angiography) and magnetic resonance angiography (magnetic resonance angiography): exams that detail the anatomy of the disease;
• Angiography – “X-ray” of the arteries into which the contrast is injected. According to Sérgio Sampaio, this is the exam universally considered when there is already “a very specific intention to move towards treatment, something that will happen immediately, in the same act.”

This process that occurs in the walls of the arteries can disrupt normal blood flow. The inner surface of the arteries is altered, which can lead to complete blockage.

When blood circulation is not sufficient, there may be pain in the calves when walking (“intermittent claudication”) and when this becomes more severe, areas of dead tissue (necrosis) may appear, leading to amputation of the limb.

Medical treatment (medication), lifestyle changes and “surgical revascularization procedures (operations to improve the irrigation/circulation capacity of the areas affected by the problem).

“Medical treatment should always be proposed. Recommended medications almost always include an antiplatelet agent. [tipicamente a aspirina, mas não necessariamente] and a statin [fármaco geralmente usado para controlar o colesterol, mas com efeito direto na parede arterial]”says Sergio Sampaio. In addition, it is recommended to control risk factors and change lifestyle habits.

Surgery is not always indicated and, therefore, is assessed on a case-by-case basis. But in some cases, the advantages are obvious and can even preserve a limb that would otherwise end up amputated.

Tobacco, diabetes, high blood pressure and hypercholesterolemia. [valores elevadores de colesterol] They are the most important.

Not everyone runs the same risk, but individually, diabetes and tobacco “represent twice the impact on the probability of developing the disease than high blood pressure or high cholesterol levels.”

This disease affects men up to twice as often as women, especially before the age of 70. But as age advances, the difference between genders becomes smaller. “The disease becomes more likely with advancing age, as is the case with all forms of atherosclerosis,” says the doctor. More rarely, it can occur in younger people, usually in association with other health problems.

Avoid tobacco as much as possible, control diabetes, treat high blood pressure and consult with a specialist. If necessary, combat high cholesterol levels. In the latter case, Sérgio Sampaio reinforces that the medication, in addition to reducing cholesterol levels, stabilizes arterial lesions and, therefore, should be recommended even in patients with non-elevated cholesterol. An active lifestyle through regular walks is also recommended.

In a national study conducted in 2008 by the Portuguese Society of Angiology and Vascular Surgery, the prevalence of peripheral arterial disease in mainland Portugal was 5.9%, 6.6% in the Azores and 3.8% in Madeira. But, Sérgio Sampaio warns, these values ​​are far from identifying “the real prevalence of the problem.” Typical values ​​in developed countries range up to 10% from the age of 50 and around 20% above the age of 70.”