The arteritis of the lower limbs is an affection of the lower limbs arteries’ wall, mostly related to a atheromatous disease - which is responsible for the platelets that form around the arteries wall.
This affection is responsible for the decrease of the arteries diameter (stenosis) which will eventually get blocked (obliteration or thrombosis).
The arteritis of the lower limbs is one of the atheromatous disease’s prefered locations (cholesterol platelet in the arteries) along with the cerebral locations, especially the carotid, the coronary and the aorta (diseases that shorten life expectancy by 10 years in average).
The arteritis of the lower limbs is caused by the atherosclerosis in over 90% of the cases and mostly manifesting itself after age 50 in smokers.
Generally, the first symptom is the intermittent claudication.
This symptom is a pain that appears while walking. After having walked a distance of 200 to 300 meters, one feels a growing inconvenience, a contortion, just like a calf cramp.
If one keeps on walking, if the path rises, this inconvenience becomes a pain and reaches the thigh then the buttock and then has to stop moving. After a few seconds, the pain disappears.
If the patient resumes his walk slowly, if the path is flat, he can walk the same distance until he gets the same feeling again.
This intermittent claudication is the signal of a stenosis or an obliteration on the involved side.
The clinical examination can show the disappearance of the pulse and a blow in an artery.
If the arterial intermittent claudication of the lower limbs is not spotted or incorrectly healed, the lesion will worsen :
Pains in the lower limbs while lying
Muscular then cutaneous ischemia (gangrene)
This gangrene can appear suddenly by distal embolism or build up more progressively outside of an acute ischemia syndrome in patients already suffering from serious trophic disorders. It mostly arises on the toes, often after untimely skin care, particularly in diabetics. It shows up as a dark localized zone.
The diagnosis is based upon a Doppler Ultrasound, which is the first examination to be carried out as it gives precise information.
If the lesions are serious and that a more aggressive treatment is planned, the check-up will have to be completed by an arteriography or an angio-scanner
Setting rules for a healthy lifestyle is essential :
Regular training : walking on a daily basis during one hour with a low and regular pace is the best possible training. The patient must have a 2-minute break as soon as the pain occurs and resume when the pain has disappeared completely. He then can increase progressively the lenght and speed of his walk.
Here are some other pieces of advice :
Washing one feet every day, insisting between the toes. Dry carefully. Change socks every day.
Use wide and flexible shoes so that feet are comfortable. In hot weather, give preference to canvas shoes.
Clip toenails short and square. Don’t hesitate to have this done by a professional pedicure in case of problems.
Quitting smoking completely and permanently is imperative
One must fight against obesity, diabetes and dyslipidemia
The patient must be able to call urgently a doctor in case of night pains, wounds, dark or infected zone on the skin (especially on the feet).
Il will generally consist of a dilatation or a re-canalization of the reduced or obliterated artery, followed by the laying of one or more stents.
If the lesions are more complex or too extended, one or more bypasses may be done, either through a vein picked from the leg, or through a prosthesis.