Vascular Disease Awareness Month 2022: Screening of Limb Ischemia

Atherosclerosis and ischemia

Humankind should be proud of the achievements in understanding, awareness, and dealing with the consequences of ischemia (shortage of blood) in the human bodies. We have many challenges to prevent or treat the most common cause of ischemia known as atherosclerosis and recently named atherothrombosis.

Atherosclerosis is a diffuse disease or disorder which affects any arteries in our bodies. Arteries are the vessels which carry blood full of oxygen and nutrients to the different organs, tissues, and cells in the human bodies. Atherosclerosis can be simply defined as thickening, hardening, narrowing and roughness of the arterial wall due to sub-intimal deposition of lipofatty material. These gradual, diffuse patch changes decrease the amount, speed and pressure of the blood flowing through the affected segment. These changes are known as signs of ischemia or shortage of blood. Subsequently the function and vitality of organs supplied by diseased arteries can deteriorate badly leading to major morbidities including death.

Atherosclerosis is a process found to be starting during the second decade of life!! This fact makes it closer to be a disorder than a disease. However, manifestations of shortage blood usually start to appear at the seventh decade. This process might be accelerated and presented earlier in life by different causes known as risk factors. These include smoking, high blood pressure, high cholesterols, Diabetes mellitus, age, being male and stressful life. The last two factors raise a potential impact of hormonal causes contributing of the process of atherosclerosis.

Ischemia can happen sudden and complete (acute) which cause major symptoms and signs and need a quick management to save organs, limbs, or lives. More commonly, it happens gradually and incomplete (chronic) which make the limb or organ presenting with only signs (mild shortage) or combined with symptoms when shortage of blood is significant. Such type of early presentation gives the treating physicians opportunities to pick up those patients, modify the changeable risk factors, and starts UK guideline measure in terms of walking exercise and best medical therapy to enhance risk reduction strategy against atherosclerosis and ischemia. This picking up is known as screening programmes. When the chronic process progresses with time, patients will become symptomatic in addition to the signs of chronic ischemia.

Limb ischemia                                            

Lower limbs might show signs and symptoms earlier than other vital organs such as the heart, brain, kidneys, or the bowel. Major complications might be the leading cause of death in 75% of patient presenting with limb ischemia. This demonstrates the high value of lower limb screening for shortage of blood among the population, not only to save the limbs, but also to save lives. Also, lower limb screening is simple, accessible, and non-invasive. Handheld Doppler which is a small ultrasound machine available in our outpatients’ setup, can detect early signs of ischemia showing a with small drop of arterial pressure at the ankle. It is not uncommon to diagnose a serious heart condition with high priority to treat in patients presenting with mild drop of ankle pressure.

Surgical management of limb ischemia demonstrated major advances over the last forty years. The evidence-based clinical guideline, diagnostic modalities, surgical techniques, balloons, and stents (endovascular) are integrating together to improve the outcome and quality of life in screening detected lower limb ischemia. However, more challenging are emerging and waiting for more research, discoveries, and innovations.

Written by Professor Hussien Rabee, Consultant Vascular Surgeon