Pathophysiology of Peripheral Arterial Disease (PAD): A Review on Oxidative Disorders.

Elisa Marino,Salvatore Scuto,Salvatore Santo Signorelli,Domenico Di Raimondo

doi:10.3390/ijms21124393

Abstract

Peripheral arterial disease (PAD) is an atherosclerotic disease that affects a wide range of the world’s population, reaching up to 200 million individuals worldwide. PAD particularly affects elderly individuals (>65 years old). PAD is often underdiagnosed or underestimated, although specificity in diagnosis is shown by an ankle/brachial approach, and the high cardiovascular event risk that affected the PAD patients. A number of pathophysiologic pathways operate in chronic arterial ischemia of lower limbs, giving the possibility to improve therapeutic strategies and the outcome of patients. This review aims to provide a well detailed description of such fundamental issues as physical exercise, biochemistry of physical exercise, skeletal muscle in PAD, heme oxygenase 1 (HO-1) in PAD, and antioxidants in PAD. These issues are closely related to the oxidative stress in PAD. We want to draw attention to the pathophysiologic pathways that are considered to be beneficial in order to achieve more effective options to treat PAD patients.

Highlights

Introduction on TopicPeripheral arterial disease (PAD) is one of the clinical types of atherosclerotic diseases
PAD is often under-diagnosed, we are in possession of non-invasive diagnostic techniques such ultrasound examination by measuring the ankle brachial index (ABI), which is an easy and repeatable tool helpful in diagnosing PAD as well as in monitoring the outcome of PAD patients [3]
Pathophysiology of PAD is complex as it includes hemodynamic disturbances such as reduced hematic load, progressed reductions of muscle tissue perfusion, damage of muscle fibers, and reduction of cell respiratory capability

Summary

Introduction

Peripheral arterial disease (PAD) is one of the clinical types of atherosclerotic diseases. For this reason, particular attention should be given to its frequent diagnosis in elderly individuals, with particular prevalence of PAD-affected patients in socially and economically advanced countries [1,2]. It is important to highlight the close link between PAD and a high risk of acute cardiovascular events, as shown by the frequency of coronary and carotid ischemic events occurring in PAD patients [5]. Guidelines on PAD treatment suggested the use of many drugs (statins, aspirin, clopidrogel, dual anti platelet drug therapy, cilastazol, pentoxyfilline, nifedipine); efficacy in the improvement of the symptoms (intermittent claudication, pain free walking distance) or long term outcome (cardiovascular risk, cardiovascular acute event) is still being debated

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