CREMONA – Most often it starts with a strange tingling in one leg. Then comes the acheintense, which forces you to stop after a few meters of walking, up to the formation of non-healing lesions. This is the chain of events leading up to allcritical ischemia of the lower limbs, the most advanced stage ofperipheral arterial diseasedisease characterized by reduced blood flow to the arteries. In the most serious cases, it can lead to amputation, an extreme measure. In Italy, in fact, 3,382 amputations are performed every year (PNE 2021 data), half of which could be prevented by resorting to minimally invasive procedures and the new, under-prescribed lipid-lowering drugs (only 10% of patients receive them).
The second edition of “Rome Peripheral Interventions” is underway. The purpose of the event is to provide the most recent updates on current and future clinical evidence and possibilities in the endovascular treatment of extra-coronary pathologies.
Sponsored by the Italian Society of Interventional Cardiology (GISE), the Italian Association of Diagnostic and Interventional Neuroradiology (Ainr) and the Italian Society of Vascular and Endovascular Surgery (Sicve), the conference brings together clinicians and interventional updated and live cases, aims to improve the quality of daily practice with a multidisciplinary approach.
“Peripheral arterial disease it develops when the arteries become clogged and are no longer able to carry all the nourishment our body needs with normal regularity – he explains John Esposito, ordinary professor of Cardiology and director of the UOC of Cardiology, Hemodynamics and Utic of the Federico II University Hospital of Naples and president of the Italian Society of Interventional Cardiology (GISE) -. The blockage of the arteries is caused by the presence of atherosclerotic plaques which progressively impede the regular flow of blood”.
It is estimated that peripheral arterial disease affects 200 million people worldwide, of which 40 million in Europe alone. In Italy the prevalence of the disease is around 10% in people over 40 years of age with an increasing trend up to 23% in the coming years. Pathology, which often occurs with age, is more frequent in diabetic subjects.
Particularly at risk are also smokers or those with a history of smokingfor whom the risk of developing this type of pathology is four times higher than for the others.
THE PREVENTION
“Prevention of peripheral arterial disease is based on strict control of risk factors: for this reason it is necessary to follow a balanced diet, with a reduced content of sugars and fats, stop smoking and practice regular physical exercise – specifies Esposito -. For diabetic patients, in particular, it is very important to avoid trauma to the limbs because they increase the chances of ulcerations, sores and infections”.
Although the symptoms of peripheral artery disease are hard to ignore, they are often confused with age-related disorders. It therefore happens that you go to the doctor when the disease is already advanced to the point of requesting the amputation of the limb affected by the disease. “In Italy, unfortunately, this extreme solution is often used which, in addition to having a significant impact on the quality of life, is associated with a significant risk of mortality – underlines Esposito -. Indeed there are two very important therapeutic options which, in most cases, help us avoid the amputation of the limb”.
TWO IMPORTANT THERAPEUTIC OPTIONS
The first is the pharmacological therapy which is based on molecules that make the blood more fluid. “There are antiplatelet agents such as aspirin and clopidogrel, to which the anticoagulant rivaroxaban has been added in a ‘vascular’ dosage – explains the expert -. Also used are drugs that dilate the arteries, such as cilostazol, which increases walking range and reduces pain. A fundamental role is played by anti-cholesterol drugs, especially the new generation ones, the so-called PCSK9 inhibitors, capable of reducing the risk of amputation by 30%. The revascularization interventions through angioplasty they then allow the ‘mechanical’ reopening of the arteries as is done on the coronary arteries”.
In Italy, new generation lipid-lowering drugs are under-prescribed: “It is estimated that PKCS9 inhibitors are only prescribed to patients in 10% of cases – Esposito points out -. There are also great differences in the use of limb-saving revascularization procedures, especially minimally invasive ones”.
