Atherosclerosis of the lower extremity vessels is a pathology caused by dysfunction of the distal part of the abdominal aorta and the vessels that supply the pelvic area and legs. The main danger of this condition is the sharp restriction of the artery's lumen, leading to reduced blood flow that nourishes the tissues.

This condition predominantly affects men aged 50 to 60 years and women aged 60 to 70 years. Currently, about 10% of the population over 60 years old face this problem.

Etiology

The primary factor influencing the development of atherosclerosis in the leg vessels is the accumulation of lipid (fatty) plaques on the arterial walls. These fatty deposits, primarily composed of cholesterol, form growths that narrow the vessel lumen. This impairs their conductance, potentially leading to complete blockage of the artery's lumen.

Atherosclerosis of the lower extremity vessels is a systemic disease resulting from disrupted fat and carbohydrate metabolism. It affects not only the vessels of the lower extremities but also the entire circulatory system of the body.

Symptomatology

Early forms of atherosclerotic changes are asymptomatic, showing no internal or external signs. The emergence and intensification of symptoms depend on the degree of vessel narrowing and the impairment of conductance.

Experts agree that the severity of the arterial pathological process does not always manifest with vivid symptoms. The absence of symptoms or their mildness does not necessarily indicate the absence of lipid deposits. Plaques can form over several years without manifesting. The severity of symptoms depends on the rate of vascular dysfunction and their ability to compensate. Symptoms become prominent when the arterial lumen is narrowed by 70-80%.

The first sign of severe pathology is intermittent claudication. Additionally, symptoms can include:

• Pain in the calves, and in severe cases, pain spreading to the thighs and buttocks
• Sensation of numbness in the legs, which feel cold to the touch
• Pale, dry skin with hair loss, peeling, and atrophic changes
• Walking difficulties, requiring frequent stops to continue moving. During rest, blood flow normalizes
• Pain in the lower extremities, calf cramps, aches, and other joint problems.

Diagnostic Methods

To accurately diagnose the pathology, a comprehensive examination by a specialist in vascular surgery is conducted. Based on the patient's medical history and complaints, the presence or absence of the disease can be determined.

To confirm or refute suspicions, the specialist prescribes a series of both laboratory and instrumental studies:

• Laboratory tests of blood and urine
• Measurement of C-reactive protein (CRP) levels to detect inflammation
• Blood sugar level determination
• Lipid profile to measure cholesterol and triglyceride levels
• Hemoglobin level assessment
• Creatinine measurement to assess kidney load

Instrumental examinations help diagnose the condition and determine the severity of the pathological process. Key procedures include:

• Duplex ultrasound scanning to determine the degree of arterial narrowing and blood flow capability
• Ankle-brachial index measurement to assess blood pressure
• Treadmill test to determine the exercise capacity that does not cause pain in the legs
• Angiographic examination using contrast materials to identify possible arterial defects
• MRI to determine the size of lipid deposits
• Following angiography, therapeutic measures are immediately initiated, including vessel plastic surgery.

Therapy and Recommendations

Major therapeutic methods include bypass surgery, which redirects blood flow around the affected area using a special shunt. Often, one of the limb arteries is used for the bypass. In rare cases, artificial prosthetics are used, leaving the affected vessel in place.

For correcting the pathological process, vascular prosthetics using femoropopliteal or tibial bypass grafting can be employed. In prosthetics, the affected artery is completely removed and replaced with an artificial prosthesis or an autologous vessel. This method is more challenging than bypass surgery and is thus less commonly used.

Vascular surgeons can also use techniques such as aortic stenting or balloon angioplasty to correct atherosclerotic processes. These techniques involve widening the narrowed vessel using a stent or balloon expansion. This method is effective only for partial vein involvement.