• Arterial stiffness (Atherosclerosis): Peripheral (non-central, peripheral) vascular disease (PVD) is defined as narrowing or occlusion of arteries outside the coronary arteries supplying the heart, causing insufficient blood flow to the organs they supply. The most common type of peripheral vascular disease, atherosclerosis, causes thickening and loss of elasticity of the arterial wall, and plaques form inside; increasing accumulation of cholesterol and other substances (plaques) narrows or completely blocks the arterial lumen.

• 15% of people over 55 have asymptomatic peripheral vascular disease. Peripheral vascular disease causing reduced walking distance is found in 5% of people over 55 and 24% of those over 85. A patient with peripheral arterial atherosclerosis has a 5 times higher risk of death due to heart attack or stroke within 10 years compared to individuals without PVD. The risk of death in asymptomatic peripheral vascular disease is 4%, and the risk of developing leg pain that limits walking distance is 7-15%. In patients with leg pain that limits walking, the risk of further shortening walking distance is 20-30%, 5-year mortality is 30%, 10-year mortality is 50%, and the risk of foot or leg amputation is 4%. In patients with critical limb ischemia, mortality is even higher (50% in 5 years), and the risk of amputation increases (25%). Peripheral vascular disease occurs in both sexes but is more common in males.

Diagram: Course of abdominal artery and narrowed artery in the leg

• Acute arterial occlusion: Sudden thrombus formation on a pre-existing stenosis or embolism, for example a clot coming from the heart blocking an artery, is an emergency. The area supplied by the blocked artery undergoes ischemia causing cell death and tissue loss. For example, if leg arteries are occluded and not treated within a certain period, gangrene and amputation may occur. Therefore, in a patient with long-term irregular heart rhythm, sudden leg pain, paleness and coldness in the leg, loss of sensation, and decreased movement should raise suspicion of acute arterial occlusion, and the patient must present to hospital within 6 hours to have the clot surgically removed.
• Buerger’s disease: Another common form of chronic arterial occlusion is Buerger’s disease. It mostly affects young male smokers, involving small arteries in the legs and often small veins and nerve sheaths as well. Symptoms include leg pain on walking, coldness, cold sensitivity, and recurrent superficial phlebitis attacks. In later stages, severe rest pain, ulcerations (called ulcers), and gangrene are often seen. Early smoking cessation can greatly prevent disease progression. However, surgery is frequently required.
• Aneurysm: As mentioned before, aneurysms are a marked enlargement of the artery due to weakening of the vessel wall at any point, caused either by disease or, rarely, injury. If an aneurysm is in the arm or leg, for example the popliteal artery behind the knee, the patient notices a pulsatile swelling like a pulse. The pulse can be easily felt and, if the aneurysm is large enough, it can be seen with the naked eye. If the aneurysm is in the abdominal aortic branch, the patient often feels the pulsation especially when lying on the back in bed. When aneurysms enlarge, they may become non-palpable and, especially those near the spine in the aorta, often cause pain. Aneurysms inside the abdomen or chest can enlarge significantly without causing discomfort and may be found incidentally during examination.

The main danger of aneurysms arises when the ballooned vessel wall ruptures. A large amount of blood spills into the surrounding tissues of the arm or leg or into the abdominal or thoracic cavities. Sudden massive blood loss and shock due to falling blood pressure can cause death within minutes. (There should be a link related to EVAR; Dr. Cengiz will provide address.) Ruptured cerebral aneurysms cause headache, progressive loss of consciousness, and may lead to death. Ruptured aneurysms always require complex and dangerous surgeries; therefore, they should be detected and treated before rupture occurs.

• Connective tissue diseases (rheumatoid arthritis, scleroderma, Takayasu, etc.): These are a group of diseases of unknown cause. Patients with these diseases exhibit vascular occlusions and related symptoms in various parts of the body.