Pathophysiology and diagnosis for arteriosclerosis obliterans

Patients with arteriosclerosis obliterans, or peripheral arterial disease have been conventionally diagnosed and treated from only the viewpoint of peripheral arterial circulation. These concepts may have improved the quality of life for patients, but could not contribute the prognosis of life, because peripheral arterial disease is associated with an increased risk of the coronary disease and cerebrovascular disease. Intermittent claudication, the most common symptom of peripheral arterial disease, results from flow-reducing lesions in the arteries of the lower extremity that cause exercise-induced muscle ischemia. In order to evaluate intermittent claudication, many kinds of noninvasive diagnostic studies, including ABPI (ankle brachial pressure index) and the measurement of claudication distance, et al have been proposed. We have used the recovery time of the ischemic reaction at foot sole, plethysmography, thermography, laser doppler flowmetry, or NIRS (near-infrared spectroscopy) after walking test, rather than ABPI. These examinations will be superior to ABPI to evaluate effects after ergotherapy or pharmacotherapy for patients with intermittent claudication. Carotid artery sclerosis may be a good marker of systemic atherosclerosis. By our assessment of risk factors, the progression of atherosclerotic change in carotid artery was strongly correlated with two risk factors, such as smoking and systolic blood pressure. In the cholesterol analysis, Lp (a) was only high risk factor for atherosclerotic change of carotid artery. Recent technical advances, adequate evaluation of systemic atherosclerosis, and reduction of risk factors should improve the prognosis of patients with peripheral arterial disease.