Location of occlusive arterial disease of lower extremity. Possible importance of local factors in pathogenesis.

Abstract

Arterial lesions were studied in 121 patients with ischemic lower extremities using a technique termed complete arteriography which permits the viewing of all arteries in the thigh, calf and foot in a single investigation. When atherosclerotic occlusions or plaques are present in a single artery, they are predominantly in the femoral artery; however, two or more arteries are affected in the majority of cases. Atherosclerotic lesions are common in the superficial femoral artery, but rare in the deep femoral artery. Occlusions accumulate mainly in segment III of the superficial femoral artery, while most plaques are found in segment IV. In the anterior tibial artery, the number of occlusions increases gradually in the proximo–distal direction, while the number of plaques decreases. These relations are established within the first three years of the disease. The rate at which atherosclerotic occlusions of the femoral artery spread from the initial segmental obliteration in the adductor canal to the adjacent segments proximally and distally, when expressed as a simple function of time, was virtually identical for both segments. In the uppermost segment of the artery, however, the development of occlusions is more rapid, although the final number of obliterations here is not much different. We conclude that the differences in frequency, location and rate of formation of the pathologic changes cannot be explained by the general metabolic inclination per se but must be due to the coaction of local factors.