2023-08-14 11:53:00
*Written by Jo Su-beom, Director of the Peripheral Vascular Center at Ewha Womans University Aortic Vascular Hospital (Professor of Radiology)
“Because my legs hurt, I can’t go around the whole neighborhood and I have to take a break in the middle.” These are the words that patients who complain of discomfort in their legs complain in unison in outpatient clinics. When you walk like this, your calves, thighs, or buttocks feel tight, and when you stop and rest, the symptoms subside are medically called intermittent claudication. This is a phenomenon that occurs because the leg muscles are not supplying blood as much as they need.
Intermittent claudication is due to atherosclerosis of the peripheral arteries that supply blood to the legs. Arterial stenosis, which occurs in peripheral arteries along with coronary arteries and cerebral arteries, is a very serious disease, but in the case of peripheral arteries, compared to the heart and brain, it does not determine life or death relatively immediately, so many patients do not think it is a big deal.
However, if left untreated, numbness in the legs or burning pain in the feet may occur even if the legs are not used gradually (severe lower extremity ischemia), the feet and legs are always cold, and ulcers may form on the skin, and if it gets worse Complete decay of the foot may necessitate amputation of the leg. In particular, in the case of diabetic foot caused by diabetes, tissue damage may progress to infection and necrosis, and amputation is unavoidable.
Head of Peripheral Vascular Center, Jo Soo-beom, Ewha Womans University Aortic Vascular Hospital
According to the HIRA, peripheral arterial stenosis is a very common disease with more than 200,000 patients in Korea, and the number is increasing every year due to aging. Smoking and diabetes are known to be the main causes of peripheral arterial stenosis, and the incidence increases especially when hyperlipidemia is present together. In addition, hypertension, a family history of cardiovascular disease, lack of exercise, and overweight have also been reported as risk factors.
There are several methods for diagnosing peripheral arterial stenosis. One test that can be easily performed in an outpatient setting is measuring the blood pressure in the ankle artery and comparing it with the blood pressure in the brachial artery (ankle-brachial index, ABI). If the ankle artery blood pressure is lower than the brachial artery blood pressure, it suggests that there is a high possibility that there is a narrowed part in the blood vessels going to the legs.
As a detailed examination, there is CT angiography, in which a drug called a contrast agent is administered intravenously and then CT is taken to check the condition of the blood vessels. Since this test allows you to see the lower extremity artery in detail in a 3D image, it is possible to accurately evaluate the area and degree of narrowing or blockage.
If CT is not possible, MRI angiography is performed using MRI or vascular ultrasonography is performed. Vascular ultrasonography is advantageous to patients with renal disease because it checks the state of blood vessels without using a contrast medium, but it is important that an experienced specialist perform it because there may be subjective opinions depending on the operator.
Finally, there is angiography, in which a thin tube called a catheter is inserted into the lower extremity artery and a contrast agent is injected into the blood vessel to be directly examined to check the state of the blood vessel. Although this test is the most accurate test for evaluating the patient’s blood vessels, it is mainly used when a procedure is performed consecutively because a thin tube must be inserted.
If the severity of the symptoms is not severe, it can be treated with lifestyle changes and medications. As a lifestyle to prevent the progression of the disease, low-fat diet, regular exercise, smoking cessation, and cleanliness of the legs and feet are necessary. Among them, smoking cessation is the most important. Drugs to prevent progression of the disease and improve symptoms include blood cholesterol lowering drugs, blood pressure regulators, and vasodilators.
However, if it is not curable with medication, surgery or surgery should be considered. It may differ depending on the condition of the blood vessels, but recently, a procedure called percutaneous transluminal angioplasty (PTA) can be considered before surgery.
Balloon dilatation, which accurately diagnoses the condition of blood vessels through the various tests mentioned above and inserts a balloon into the narrowed blood vessel to widen it. It can be treated by inserting a special metal net (stent) that can serve as a skeleton of blood vessels into narrowed or clogged blood vessels to re-flow the blood. However, surgical treatment may be required if treatment alone is not sufficient.
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