Peripheral arterial disease of the lower limbs: most effective dietary supplements

Peripheral arterial occlusive disease of the lower limbs (AOMI) is an atheromatous disease. Its frequency is high, including in developing countries. AOMI is not always defined by clinical signs because it is asymptomatic in two-thirds of patients. Currently, the definition of AOMI is based on reduced distal ankle pressures, with an ankle systolic pressure index (IPSc) < 0.90 at rest.

Symptoms

The clinical stages of AOMI are three: asymptomatic stage, exertional ischemia, and permanent or critical ischemia. The asymptomatic stage may affect up to 50% of patients. In the stage of exertional ischemia, the patient describes arterial claudication, that is an intolerable cramp-like pain occurring in the muscle territory downstream of the lesions for a given level of exertion; this pain rapidly subsides on stopping the effort. Permanent or critical ischemia corresponds to a very advanced stage of AOMI and is a therapeutic emergency requiring revascularization as soon as possible in addition to medical management. Critical ischemia is defined by the combination of clinical and hemodynamic criteria.

Treatment

Only early management of AOMI can improve its prognosis, and this therefore involves screening by measuring the IPSc in at-risk populations. Apart from permanent ischemia, which requires revascularization, the cornerstone of treatment is definitive and complete smoking cessation, long-term correction of all vascular risk factors, walking exercise training, and medications including a statin as standard.

Prevention

Primary prevention of AOMI is based on implementing strategies aimed at promoting a healthy lifestyle and controlling modifiable risk factors. These strategies include promoting physical activity, tobacco control, and management of hypertension. Screening for AOMI is based on calculating the IPSc.