RELATIONSHIP BETWEEN SUBJECTIVE DISCOMFORTS AND EVALUTION OF DIAGNOSTIC PROCEDURES BASED ON THE STAGES OF CHRONICAL ARTERY INSUFFICIENCY OF LOWER EXTREMITIES

Lower-extremity peripheral arterial disease (PAD) represents a group of disorders characterized by narrowing or occlusion of the arteries resulting in gradual reduction of blood supply to the limbs. The aim of this study was to examine the predominance of subjective discomfort, objective clinical findings and the predominance of localization of steno-occlusive lesions in patients with functional and critical ischemia of chronic arterial insufficiency (CAI) of the lower extremities. Prospectively, we analyzed a group of 50 patients, admitted at the Vascular Department of Surgical Clinic in Niš during the period from September 2000 to October 2001, with evident symptoms and signs of different stages of CAI of THE lower extremities verified by color Doppler ultrasonography and objective clinical examination. The critical ischemia was more frequently associated with the change of skin color (p<0.05), atrophic changes (p<0.001), absent pulsations (p<0.01), the occurrence of muscle atrophy (p<0.01), gangrene (p<0.05). Gangrene was the most dominant clinical occurrence with respect to ulceration (p<0,05) in the critical ischemia. The functional ischemia had frequent occurrence of pallor (p<0.01), as a significant sign, as well as preserved pulsations of a. poplitelis (p<0.01). Asymptomatic steno-occlusive lesions with stenosis of 1-19% were predominant in patients with stage I functional ischemia. Subcritical stenosis with 20-49 % stenosis was characteristic of patients in stage IIa, while critical stenosis with 50-99% stenosis was characteristic of patients in stage IIb and III stage of critical ischemia. Patients in the IV stage of critical ischemia had total occlusion of distal arteries of the lower extremities. In the stage of critical ischemia, the most common steno-occlusive process is localized on femo-ropopliteal segment (a. Femoralis superficialis) Early detection of PAD is crucial for the timely treatment and prevention of amputation, heart attack, stroke, and death. Acta Medica Medianae 2016;55(3):44-56.