Most often it starts with a strange tingling in one leg. Then the intense pain takes over, which forces you to stop after a few meters of walking, until the formation of lesions that do not heal. This is the chain of events that leads to critical ischemia of the lower limbs, the most advanced stage of peripheral arterial disease, a disease characterized by reduced blood flow to the arteries. In Italy it affects about 10% of the ‘over 40s’, with an increasing trend up to 23% in the coming years. In the most serious cases of the disease, it can lead to amputation, an extreme measure which unfortunately in Italy is resorted to more frequently than it should be, according to the experts gathered at the II edition of the “Rome Peripheral Interventions” meeting, underway in Rome until Tomorrow.
In fact, in our country, 3,382 amputations are performed every year (Pne 2021 data): yet half can be prevented by resorting to minimally invasive procedures and new lipid-lowering drugs, which are under prescribed – only 10% of patients receive them – due to the scarce information of doctors and the complex system of prescriptions. The aim of the conference is to provide the most recent updates on clinical evidence and current and future possibilities in the endovascular treatment of extra-coronary pathologies. The event is 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).
“Peripheral arterial disease develops when the arteries become clogged and are no longer able to carry all the nourishment that our body would need with normal regularity – explains Giovanni Esposito, full professor of Cardiology and director of the UOC of Cardiology, haemodynamics and Utic of the Federico II University Hospital of Naples and president of Gise – The obstruction of the arteries is caused by the presence of atherosclerotic plaques which progressively hinder the regular flow of blood”.
Although the symptoms of peripheral artery disease are hard to ignore, they are often confused with age-related disorders. It happens, therefore, that you go to the doctor when the disease is already advanced enough to require the amputation of the affected limb. “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 – There are two very important therapeutic options which, in most cases, help to avoid amputation of the limb”.
The first is drug 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 – he explains – Drugs that dilate the arteries are also used, such as cilostazol, which increases the autonomy of 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 ‘mechanical’ reopening of the arteries as is done on the coronary arteries”.
It is estimated, however, that “Pkcs9 inhibitors are prescribed to the patient only in 10% of cases – Esposito points out – There are also great differences in the use of ‘limb-saving’ revascularization procedures, especially the mini- invasive”. The insufficient use of these procedures thus results in a greater number of amputations and, consequently, in a greater burden of disability and a higher risk of early mortality. “Initiatives such as the ‘Rome Peripheral Interventions’ meeting therefore become crucially important appointments for specialists for updating and improving the treatments offered to patients”, concludes Esposito.
