Peripheral arterial disease results from blockage of the arteries of the lower and upper extremities, most commonly caused by the growth of atherosclerotic plaques. These plaques form due to atherosclerosis, a process that occurs due to the accumulation of cholesterol in arterial walls and is associated with an inflammatory response.
It is a progressive process, which begins at an early age and progresses depending on genetic and lifestyle factors, specifically diet, smoking and level of physical activity. It is an important cause of cardiovascular pathology, being the origin of diseases that cause severe limitations or even death.
In 2019, peripheral artery disease affected around 56.4 million people between 40 and 70 years of age worldwide and around 70 million people over 70 years of age. This is a marker of cardiovascular risk, since it is usually associated with coronary and cerebrovascular diseases and, therefore, with a higher risk of suffering a heart attack or stroke.
Understanding the risk factors for the development of peripheral arterial disease is essential to be able to focus on prevention, timely diagnosis and effective treatment. Diabetes mellitus is one of them. As a risk factor for atherosclerosis, it contributes to the risk of peripheral arterial disease, which is a common cause of limitation in people with diabetes or even death. It is a disease that is increasing throughout the world and it is estimated that 1 in 10 people suffers from diabetes. According to data from the Portuguese Society of Diabetology, in 2021 the prevalence in the country was 14%, with an increase of 20% compared to the last 10 years. It was responsible for around 3% of deaths in 2020 and a major cause of amputation.
Peripheral arterial disease in people with diabetes is usually silent and the first signs only appear in advanced stages of the disease. Diabetes mellitus can also affect nerve fibers – diabetic neuropathy – causing a decrease or loss of sensation, which can lead to repeated trauma to the foot and the subsequent formation of wounds. Therefore, periodic evaluation of the feet by health professionals is essential to avoid progression to more complex injuries with risk of amputation.
As it is a disease that only shows very late signs and is associated with a high risk of complications, screening for peripheral arterial disease is recommended in patients with diabetes for more than 10 years, since the prevalence in this group is around 25 %. This screening will allow a more timely diagnosis, enabling an earlier start of treatment, reducing the rate of progression and the risk of complications, such as amputation. On the other hand, as peripheral arterial disease is related to other cardiovascular pathologies, early detection and appropriate treatment reduce the overall risk of death and complications such as heart attack or stroke.
Peripheral arterial disease has a variable presentation: in almost half of patients there are no signs, in another part it manifests as pain that appears after walking a certain distance and is relieved with rest, known as “intermittent claudication.” To a lesser extent, it is manifested by constant pain, even at rest, or by causing injuries to the extremities, which corresponds to a more severe form of the disease, called critical ischemia or, more recently, limb-threatening ischemia. This presentation requires urgent evaluation by a doctor.
However, it is known that most patients do not progress the disease to the stage of critical ischemia, if there is strict control of risk factors. An exception is people with diabetes, who more frequently present with a silent disease, with pain at rest and/or wounds in the lower limb – diabetic foot –, a more common form of presentation than lameness, hence the relevance of screening. in this group.
The presence of this disease can be confirmed through simple, non-invasive tests, such as measuring the ankle-brachial index or arterial echo-Doppler of the extremity. Treatment inevitably involves controlling risk factors, through the adoption of healthy lifestyles (such as a balanced diet, abstinence from smoking and regular exercise) and the introduction of medications. Surgical intervention to improve circulation in the limb is only considered when there is a risk of loss of the limb or the lameness continues to be very limiting, despite the measures taken. This can be performed using endovascular techniques (catheterization) and classic (open) surgery, depending on the patient’s risk and the characteristics of the disease.
Peripheral arterial disease is a growing pathology taking into account the habits of modern society and the global increase in diabetes mellitus. It requires a multidisciplinary approach, with doctors and health professionals from different areas, in which the control of risk factors, the adoption of a healthy lifestyle and pharmacological therapy are the basic treatment for all patients. It is these measures that are most related to an improvement in cardiovascular prognosis, with a reduction in the risk of complications and even death.
When associated with diabetes mellitus, this disease requires an earlier diagnosis, hence the recommendation for more regular screening and follow-up, also on a multidisciplinary basis, since it is correlated with a lower number of complications, including amputation. In the group of patients at risk of losing a limb or lameness that does not improve with the measures implemented, surgery should be considered, always taking into account the risk-benefit, and, if indicated, instituted as soon as possible.
Rita Soares Ferreira graduated in Medicine from the Faculty of Medicine of the University of Lisbon and completed her training in Angiology and Vascular Surgery at the Hospital de Santa Marta – ULS São José, where she currently maintains her healthcare activities. He is also a member of the Angiology and Vascular Surgery team at the CUF Tejo Hospital and the CUF Miraflores Clinic. He teaches at the NOVA School of Medicine.
Arterial is a section of the Observer dedicated exclusively to topics related to cerebrovascular diseases. It results from a partnership with Novartis and has the collaboration of the Association to Support Patients with Heart Failure, the Portuguese Cardiology Foundation, Portugal AVC, the Portuguese Stroke Society, the Portuguese Atherosclerosis Society and the Portuguese Society of Cardiology. It is completely independent editorial content.
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Source: Observadora
