Narrowing of the arteries in the legs is a silent threat that can be life-threatening. The disease often progresses slowly and chronically, causing patients to be less attentive to their symptoms. By the time they realize something is wrong, the condition may have worsened significantly, with over 70-80% artery blockage. This can lead to symptoms such as leg pain, difficult-to-heal wounds, and blackened tissue on the feet, which may necessitate amputation. In some acute cases, amputation may be required to save the patient’s life, resulting in disability. Importantly, this condition increases the risk of death from heart disease by 4-5 times and the risk of stroke by 2-3 times compared to those without the disease.
What Causes Arterial Narrowing?
The primary cause of the disease is atherosclerosis, which begins with fat deposits on the artery walls. This is followed by inflammation, leading to fibrous tissue formation and calcium buildup. Blood clots may also obstruct the arteries, thickening the artery walls and narrowing the arteries. This results in insufficient blood flow to the legs, causing symptoms of ischemia during physical activity.
Symptoms and Affected Areas
The symptoms of the disease depend on the location of the blockage and can be either acute or chronic. Symptoms may include leg pain, calf pain while walking or exercising, and severe pain that causes limping or occurs even at rest. Additional symptoms can include hair loss, muscle atrophy in the legs, hardened nails, cold feet, and slow-healing wounds on the feet or heels that may progress to necrosis. In acute cases, severe pain can occur, and toes or feet may turn black due to lack of blood flow.
Risk Factors for Atherosclerosis
This disease can affect both men and women, although it is more common in older adults with pre-existing coronary artery disease or cerebrovascular disease, as they share similar vascular abnormalities. Other risk factors include:
- Smoking
- Diabetes
- Hypertension
- High cholesterol levels
- Elevated homocysteine levels in the blood
Methods for Diagnosis and Assessment
When there are suspicious symptoms, the doctor will take a medical history and conduct a physical examination, including checking the pulse in the feet.
Assessment of Atherosclerosis Using ABI Measurement
The Ankle Brachial Index (ABI) is used to assess arterial health by measuring blood pressure at the ankle and comparing it to blood pressure in the same arm (right arm compared to right leg, and left arm compared to left leg).
If the ABI value is less than or equal to 0.9, it indicates potential issues with blood circulation in the lower extremities. The severity of the problem correlates with the measured value: lower values suggest more significant blockages in the peripheral arteries, which may occur at multiple sites. Additionally, the results can also provide insights into the condition of the blood vessels supplying the heart and brain. Therefore, if there are issues with the leg arteries, there is a higher likelihood of having problems with the arteries supplying the heart and brain, leading to conditions such as stroke, paralysis, and even death.
The ABI measurement should be performed by a physician or trained specialist, who will evaluate the pulse and determine if there are any issues. If problems are identified, the physician will immediately refer the patient for an ABI test. This measurement can be conducted using standard blood pressure equipment along with a stethoscope, or if the pulse is faint, a Doppler ultrasound device may be used.
Additionally, other diagnostic tests may be performed as necessary, such as vascular scans, laser examinations, computed tomography (CT) scans, contrast injections, and magnetic resonance imaging (MRI).
Therefore, individuals with diabetes should undergo early assessment of blood circulation in their lower extremities to receive appropriate care and guidance, which can help prevent wounds and the loss of toes, feet, or legs.
