Leg arterial occlusion, known as peripheral arterial disease (PAD), is generally caused by atherosclerosis resulting from the accumulation of fat deposits in the arteries. This condition prevents sufficient blood flow to the legs, manifesting with symptoms such as pain, numbness, weakness, and a sensation of coldness. Patients experience pain during walking that subsides with rest.
In the treatment process, lifestyle changes such as quitting smoking, adopting a healthy diet, and exercising regularly are very important. In advanced cases, surgical interventions such as angioplasty, stenting, or bypass surgery may be necessary to regulate blood flow.
Prof. Dr. Özgür KILIÇKESMEZ
Interventional Radiology / Interventional Neuroradiology
What Is Leg Arterial Occlusion?
Leg arterial occlusion is a health problem referred to as peripheral arterial disease (PAD) and occurs due to the narrowing or blockage of arteries that carry blood to the legs. In this condition, the accumulation of substances such as fat and calcium in the arteries reduces blood flow and prevents tissues from receiving enough oxygen. This condition is more common in individuals over 50 years of age and develops under the influence of risk factors such as smoking, hypertension, diabetes, and high cholesterol. Leg arterial occlusion presents with symptoms such as pain, numbness, coldness, and weakness in the legs during walking and can significantly affect a person’s quality of life.
What Are the Causes of Leg Arterial Occlusion?
Leg arterial occlusion is generally known as peripheral arterial disease (PAD) of the lower extremity and results from the narrowing or blockage of the arteries. The most important factor leading to this condition is the plaques composed of substances such as fat and cholesterol that accumulate in the arteries. These plaques adhere to the arterial wall, making blood flow difficult and thereby reducing the oxygen and nutrients delivered to the legs.
Main causes:
- Atherosclerosis
- Thrombosis
- Embolism
- Arterial calcification
There are also various factors that increase the risk of these occlusions:
- Smoking
- Diabetes
- Hypertension
- Hyperlipidemia
- Advanced age
- Sedentary lifestyle
- Family history
This disease often progresses slowly and may not show symptoms in its early stages. However, being aware of the risk factors and undergoing regular health check-ups is important for prevention and early diagnosis. In particular, adopting a healthy lifestyle, eating a balanced diet, and exercising regularly are effective in reducing the potential risk of arterial occlusion in the legs.
How Common Is Leg Arterial Occlusion?
Leg arterial occlusion is a common health problem worldwide, especially seen in older individuals. According to 2019 data, 113 million people over the age of 40 are affected by this disease, which corresponds to approximately 1.52% of the world’s population. It is particularly more common in women than in men, and the prevalence increases with age:
- Prevalence in the 80–84 age group is 14.91%
- Occurs at a higher rate in women
- In terms of disability-adjusted life years (DALY), the impact is similar between women and men
When looking at geographic distribution, PAD prevalence is higher in high‑income countries. For example, in the USA there are 3,799 cases per 100,000 people, and in Denmark, 5,330 cases have been recorded. Although the proportional prevalence is lower in low‑income countries, the burden of the disease is heavier. This results in a U‑shaped distribution, with the highest disease burden seen in both high‑ and low‑income countries.
It has been recorded that PAD has increased worldwide between 1990 and 2019. During this period, the prevalence increased from 1,229 to 1,466 per 100,000 people, representing a 19% increase in disease prevalence. Risk factors such as hypertension, diabetes, chronic kidney disease, and smoking trigger this increase. The presence of these factors significantly raises the risk of PAD.
What Is the Pathogenesis of Leg Arterial Occlusion?
The formation of leg arterial occlusion begins with plaque accumulation in the arteries and proceeds through a series of steps. This process is particularly associated with atherosclerosis, which causes deterioration in the structure and function of the arterial walls. Various stages can be observed in the development of atherosclerosis:
- Endothelial dysfunction
- Lipid accumulation
- LDL oxidation
- Monocyte migration
- Foam cell formation
- Fatty streak formation
- Smooth muscle cell migration
- Plaque progression
- Calcification
These processes lead to the gradual narrowing of the arteries and a significant reduction in blood flow. In advanced stages, calcification within the plaque or weakening of the fibrous structure may cause plaque rupture, which can lead to the formation of clots that completely obstruct blood circulation. This process in the leg arteries is known as peripheral arterial disease (PAH) and presents with symptoms such as leg pain and a feeling of coldness during walking.
What Are the Symptoms of Leg Arterial Occlusion?
The symptoms of leg arterial occlusion result from insufficient blood flow to the lower extremities and vary according to the stage of the disease. These symptoms are most evident during physical activities and negatively affect daily life:
- Muscle pain
- Cramps
- Burning or aching during rest
- Coldness in the leg or foot
- Numbness
- Weakness
- Pallor or bluish discoloration of the skin
- Shiny skin
- Hair loss
- Fragile nails
- Non‑healing wounds on the foot or leg
- Impotence in men
- Muscle wasting or atrophy
In the early stages, symptoms may be mild or absent, but as the disease progresses these issues become more pronounced and can restrict mobility. If left untreated, serious circulatory problems, tissue damage, and infections may develop. Early diagnosis and appropriate treatment methods can control disease progression.
How Is Leg Arterial Occlusion Diagnosed?
The diagnosis of lower extremity peripheral arterial disease (PAD) is detailed through the patient’s history, physical examination, and various diagnostic tests. First, the characteristics of the pain—especially pain during exercise that subsides with rest and non‑healing wounds—are evaluated. Then a vascular examination is performed by checking the pulses in the legs and auscultating abnormal sounds in the femoral artery.
Diagnostic tests used to support the diagnosis include:
- Ankle-Brachial Index (ABI)
- Toe-Brachial Index (TBI)
- Segmental Leg Pressures
- Pulse Volume Recordings (PVR)
- Doppler Ultrasonography
- Computed Tomography Angiography (CTA)
- Magnetic Resonance Angiography (MRA)
- Conventional Angiography
Additionally, laboratory tests are performed to evaluate blood parameters. Blood tests for hyperlipidemia, diabetes, and kidney function—risk factors associated with PAD—are conducted. These tests provide a comprehensive analysis of the patient’s health status and increase the effectiveness of the treatment plan. Early diagnosis plays a critical role in slowing disease progression and preventing complications.
How Is Leg Arterial Occlusion Treated?
Treatment for leg arterial occlusion involves various methods to reopen the blocked vessels and restore normal blood flow. These methods range from minimally invasive procedures to surgical interventions. When conservative treatments fail or in cases of critical limb ischemia, interventional procedures are considered. Factors determining treatment success include the location and length of the lesion as well as the patient’s overall health.
Endovascular Methods:
- Angioplasty
- Stent placement
- Atherectomy
- Subintimal angioplasty
- Thrombolysis and thrombectomy
- Drug-coated balloons and stents
Angioplasty is the most commonly used endovascular method to widen narrowed or occluded vessels. In this procedure, a balloon is used to open the occluded segment and, if necessary, a stent is placed to prevent re‑occlusion. Atherectomy involves the removal of calcified plaques from the vessel wall with specialized devices and is used as an adjunct when other endovascular methods are insufficient. Thrombolysis and thrombectomy are used in acute occlusions to dissolve or physically remove clots.
Surgical Methods:
- Bypass surgery
- Endarterectomy
Surgical interventions are generally reserved for cases where endovascular options cannot be applied or are insufficient. Bypass surgery uses autologous veins or synthetic grafts to reroute blood around the blockage. Endarterectomy involves the surgical removal of plaque from the arterial wall.
With advances in technology, innovative devices are now used to treat arterial occlusions. Catheters equipped with high‑resolution ultrasound technology have improved precision and safety during treatment. These devices provide guidance for the intervention, thereby increasing success rates. Patient selection is based on factors such as age, comorbidities, and vascular anatomy.
What Are the Complications of Leg Arterial Occlusion?
If leg arterial occlusion progresses, it can lead to serious complications due to inadequate blood supply, resulting in tissue damage and other severe health issues. If early symptoms are missed or neglected, the risk of complications increases and treatment becomes more difficult. Complications of PAD include tissue hypoxia, increased infection risk, and in severe cases, limb loss.
Complications:
- Pain in the legs
- Reduced walking distance
- Wound healing problems
- Risk of infection
- Color changes in the feet and toes
- Thinning and dryness of the skin
- Fragile nails
- Sensation of coldness
- Muscle weakness in the legs
- Narrowing or blockage of the arteries
- Gangrene (in severe cases)
As PAD progresses, tissue loss or gangrene in the legs may occur. This is usually a result of prolonged oxygen deprivation and can become life‑threatening when combined with infection. Untreated PAD not only affects leg health but also overall cardiovascular health, increasing the risks of heart attack and stroke.
When Can Leg Arterial Occlusion Treatment Be Performed?
Treatment for lower extremity peripheral arterial disease (PAD) is determined by the severity of symptoms and disease progression. Intervention is considered when symptoms significantly affect the patient’s quality of life or when the degree of arterial occlusion reaches a critical level.
Intervention should be considered in the following situations:
- Intermittent claudication
- Critical limb-threatening ischemia (CLTI)
- Acute limb ischemia (ALI)
- Failure of conservative treatment
- Significant anatomic occlusions
Intermittent claudication presents as leg pain during exercise that subsides with rest. If symptoms interfere with daily life and other treatments are insufficient, intervention may be planned. In critical limb ischemia, the leg is at risk, and ischemic rest pain with symptoms such as gangrene may develop, requiring urgent intervention.
Acute limb ischemia (ALI) threatens the limb due to sudden loss of blood flow, often caused by embolism or thrombosis. In such emergencies, rapid intervention is necessary. Patients who do not respond to conservative treatment despite medical therapy and lifestyle changes may also require intervention. Significant anatomic occlusions in critical vessel segments also necessitate intervention to maintain blood flow.
When Is Leg Arterial Occlusion Treatment Contraindicated?
Treatment for leg arterial occlusion cannot always be performed as it depends on the patient’s health and specific conditions. In some cases, the risks of interventional methods may outweigh the potential benefits, limiting their applicability. The main contraindications for treatment include:
- Severe bleeding disorders
- A history of serious contrast allergies
- Advanced renal failure
- Presence of infection at the vascular access site
- Diffuse arterial calcification
- Complete occlusions with inadequate collateral circulation
- Unstable cardiovascular or other serious health conditions
- Small vessel diameter or complex vascular anatomy
- Previous failed revascularization attempts
- Inability to adhere to post‑procedure care or treatment protocols
Each patient’s suitability for treatment is individually evaluated considering these factors. In patients not eligible for intervention, medical treatment, lifestyle changes, and conservative approaches are emphasized to slow disease progression or relieve symptoms. For such patients, alternative treatment options and a multidisciplinary approach are important in managing leg arterial occlusion.
What Is the Recovery Process for Leg Arterial Occlusion?
The recovery process after treatment for leg arterial occlusion varies depending on the type of intervention and the patient’s overall health. For a successful recovery, it is crucial to follow the doctor’s instructions, take necessary precautions, and attend regular follow‑up appointments. The post‑treatment recovery process includes postoperative care, wound care, early mobilization, and lifestyle modifications.
Monitoring and Control:
- The patient is monitored for complications such as bleeding or hematoma after the procedure.
- Vital signs and the surgical area are regularly checked.
Pain Management:
- Analgesics are administered to control pain, enhancing mobility and comfort.
Anticoagulant Use:
- Antiplatelet or anticoagulant therapy is prescribed to prevent clot formation, as determined by the treatment protocol.
Hospital Stay and Discharge:
- The duration of hospitalization is adjusted based on the procedure and the patient’s recovery speed.
- Before discharge, wound care, medication instructions, and signs of complications are explained to the patient.
Wound Care and Monitoring:
- The surgical area should be kept clean and dry.
- Signs of infection, such as redness, swelling, or discharge, are monitored.
Follow‑up Appointments:
- Regular follow‑up appointments for suture or clip removal.
- Monitoring graft or stent patency.
Early Mobilization and Physical Activity:
- Early movement is encouraged to reduce the risk of deep vein thrombosis.
- Gradual increase in walking and activity to support circulation.
Physical Therapy:
- Structured rehabilitation programs to improve limb function.
Lifestyle Modifications:
- Quitting smoking to protect vascular health.
- Maintaining a healthy diet and regular exercise to support cardiovascular health.
Complication Management:
- Awareness of the risk of graft or stent occlusion.
- Seeking medical attention if wound complications such as fluid accumulation or swelling occur.
Adhering fully to the doctor’s instructions is essential for a successful recovery. Regular follow‑up appointments help prevent complications. The process of returning to physical activity is gradual and should be guided by a specialist. Compliance with the prescribed medication regimen reduces the risk of re‑occlusion and is important for long‑term health.
How Can Leg Arterial Occlusion Be Prevented?
Preventing leg arterial occlusion requires controlling risk factors and careful implementation of treatment methods. First, maintaining vascular health through lifestyle changes is essential. Since smoking is a major trigger for this disease, quitting is mandatory. Dietary habits also affect arterial health; a diet rich in fruits and vegetables with a low saturated fat content is recommended. Regular physical activity, especially walking programs, supports circulation and alleviates symptoms.
Lifestyle Changes:
- Quitting smoking
- Healthy eating
- Regular exercise
Medical treatment is also crucial in halting disease progression. Antiplatelet medications reduce the risk of clot formation, while lipid‑lowering therapies, such as statins, help control LDL cholesterol. Keeping blood pressure within normal ranges with antihypertensive medications is essential for vascular health, and controlling blood sugar in diabetic patients is an important factor in preventing further vascular damage.
Medical Treatments:
- Antiplatelet medications
- Lipid‑lowering therapy
- Antihypertensive therapy
- Glucose control
Recent developments such as PCSK9 inhibitors also provide additional benefits in lipid management. Implementing these strategies is critical for protecting leg vascular health and reducing disease complications.
Frequently Asked Questions
The most common cause of leg arterial occlusion (PAD) is atherosclerosis, which is the buildup of fat, cholesterol, and other substances in the arterial walls. Smoking increases the risk of PAD by 400% and causes symptoms to appear up to 10 years earlier compared to non‑smokers. Diabetes, high blood pressure, high cholesterol, and being over 50 also increase the risk. In the United States, 12–20% of individuals over 60 are affected by PAD, and this rate approaches 50% in those over 85. Men are more frequently affected than women. Less common causes include vascular inflammations, limb injuries, abnormal muscle or connective tissue, and radiation exposure. About 80% of PAD patients currently smoke or have smoked, and having three or more risk factors increases the PAD risk tenfold.
Leg arterial occlusion (PAD) affects over 200 million people worldwide and causes symptoms such as intermittent claudication (leg pain during walking), muscle cramps, and weakness, which can seriously limit daily activities. While approximately 40% of PAD patients may not experience leg pain, some develop chronic limb‑threatening ischemia with pain at rest and non‑healing wounds, leading to tissue loss and limb amputation. PAD patients are 2 to 6 times more at risk for cardiovascular events such as heart attack and stroke compared to those without the condition.
Non‑surgical treatments for leg arterial occlusion (PAD) include lifestyle changes such as quitting smoking, regular exercise, and dietary modifications to manage risk factors like hypertension, diabetes, and hyperlipidemia. Statins help stabilize arterial plaques by lowering cholesterol, while antiplatelet medications reduce the risk of clot formation. Minimally invasive procedures such as angioplasty using a balloon to widen narrowed arteries and stenting to keep them open are common. Atherectomy, the catheter‑based removal of plaque, is another option. These treatments aim to improve blood flow, relieve symptoms, and prevent disease progression.
Adopting a healthy lifestyle is crucial to prevent leg arterial occlusion. Quitting smoking is mandatory, as tobacco use significantly increases the risk of PAD. Regular physical activity—such as brisk walking for 30 minutes a day—can improve vascular health. A diet with at least three servings of fruits and vegetables per day may reduce PAD prevalence by 18%. Controlling blood pressure, cholesterol levels, and diabetes through lifestyle changes and medications is also critical. Adequate sleep is beneficial too; getting less than five hours a day increases PAD risk by 74%. By following these measures, individuals can significantly reduce their risk of leg arterial occlusion and its complications.
If left untreated, leg arterial occlusion (PAD) can lead to serious complications. In the United States, approximately 82% of non‑traumatic amputations are due to vascular conditions, especially PAD. Patients with PAD have a 10 to 15 times higher risk of cardiovascular death compared to those without the condition. Untreated PAD may progress to critical limb ischemia, characterized by non‑healing wounds and infections, which can result in amputation. Additionally, PAD increases the risk of coronary artery disease, heart attack, and stroke. Early diagnosis and treatment are critical to prevent these severe outcomes.
Prof. Dr. Özgür Kılıçkesmez graduated from Cerrahpaşa Medical Faculty in 1997. He completed his specialization at Istanbul Education and Research Hospital. He received training in interventional radiology and oncology in London. He founded the interventional radiology department at Istanbul Çam and Sakura City Hospital and became a professor in 2020. He holds many international awards and certificates, has over 150 scientific publications, and has been cited more than 1500 times. He is currently working at Medicana Ataköy Hospital.
Vaka Örnekleri