Leg arteries
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Summary
10 papers analyzed
These studies suggest that leg arteries are influenced by factors such as diagnostic methods, arterial dynamics, training, collateral circulation, arterial stiffness, and disease awareness, with variations in function based on age, sex, and physical activity.
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Advances in Understanding and Assessing Leg Arteries
Introduction to Leg Arteries and Peripheral Arterial Disease (PAD)
Peripheral arterial disease (PAD) is a common circulatory problem in which narrowed arteries reduce blood flow to the limbs. This condition affects over 230 million adults worldwide and is associated with increased risks of cardiovascular diseases and leg outcomes such as amputation. Despite its prevalence, PAD is often underdiagnosed and undertreated, necessitating improved diagnostic and therapeutic strategies.
Diagnostic Techniques for Leg Arteries
Color-Flow Duplex Scanning with Contrast Agents
Color-flow duplex scanning is a non-invasive imaging technique used to assess blood flow in the leg arteries. A recent study explored the use of a new contrast-enhancing agent, sulphur hexafluoride (SF6), to improve the visibility of leg arteries in patients with peripheral arterial disease. The study found that SF6-enhanced scanning significantly increased diagnostic confidence from 56% to 91% and showed a reasonable agreement with angiography regarding vessel patency (71%). This method is particularly useful in low-flow states and can help visualize collateral vessels, although these may sometimes be misleading.
Magnetic Resonance Angiography (MRA)
Gadolinium-enhanced magnetic resonance angiography (MRA) is another advanced imaging technique used to measure vessel diameters and assess stenosis prevalence. A study involving 756 male participants provided reference values for different segments of the pelvic and leg arteries, showing that vessel diameters decrease from proximal to distal arteries and increase with age. The study also found that stenoses were most prevalent in the lower leg arteries, with the risk of stenosis increasing significantly with age.
Anatomical and Functional Insights
Collateral Artery Pathways
Collateral arteries play a crucial role in maintaining blood flow when primary arteries are occluded. An anatomical study of cadaver legs identified 113 collateral vessels, with the majority originating from the deep femoral artery (DFA) and connecting to the superficial femoral artery (SFA) and popliteal artery (PA). These findings have clinical implications for planning endovascular procedures, as collaterals can be essential in cases of acute thrombosis.
Septocutaneous Vessels
The vascular anatomy of the leg includes septocutaneous vessels, which are important for skin circulation. These vessels arise from major arteries like the posterior tibial, anterior tibial, and peroneal arteries, and form anastomotic arcades along the leg. This system is crucial for various fasciocutaneous flaps used in clinical applications.
Angiosomes of the Leg
The concept of angiosomes, which are three-dimensional vascular territories supplied by specific source arteries, is vital for understanding blood supply to different tissues. An anatomical study defined the angiosomes of the leg, showing that most tissues receive branches from multiple angiosomes, facilitating circulation reconstitution when a source artery is compromised. This information is essential for designing flaps for local or free transfer in surgical procedures.
Impact of Physical Activity and Disease on Leg Arteries
Endurance Training
Endurance training can induce significant changes in the arterial structure of the leg. A study on one-legged cycle training showed that arterial cross-sectional area (CSA) increased by 16% in the trained leg, correlating with a 16% increase in one-legged peak oxygen uptake (VO2 peak). These changes were not observed in the control leg, indicating that regional blood flow increases, rather than systemic factors, are associated with training-induced arterial expansion.
Hyperglycemia and Vascular Health
Long-term hyperglycemia in type 2 diabetic patients is associated with higher arterial stiffness, greater peripheral vascular resistance, and lower blood flow in lower-leg arteries. These vascular changes contribute to the development of ischemic limbs even in the absence of peripheral artery occlusive disease, highlighting the importance of managing blood glucose levels to maintain vascular health.
Conclusion
Advancements in diagnostic techniques, anatomical understanding, and the impact of physical activity and disease on leg arteries have significantly improved our ability to assess and manage conditions like PAD. Enhanced imaging methods, such as SF6-enhanced duplex scanning and gadolinium-enhanced MRA, provide better diagnostic accuracy. Anatomical studies of collateral pathways and angiosomes offer valuable insights for surgical planning. Additionally, the effects of endurance training and hyperglycemia on vascular health underscore the importance of lifestyle and disease management in maintaining leg artery function.
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