Focus on the Most Common Paucisymptomatic Vasculopathic Population, from Diagnosis to Secondary Prevention of Complications

Figures

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  Figure 1. Localization prevalence of aortic aneurysms.

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  Figure 2. Abdomen palpation in the search for an abdominal aortic aneurysm (AAA). An abnormal pulsating mass in the mesogastrium, expanding in all the directions, is strongly suspected to be an AAA.

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  Figure 3. Duplex scan of the abdominal aorta can easily confirm the clinical suspect of abdominal aortic aneurysm. Short axis (left) and long axis (right) view.

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  Figure 4. Suggested flow-chart for the detection of patients with abdominal aortic aneurysm (AAA). BP, blood pressure; BMT, best medical therapy.

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  Figure 5. Suggested flow-chart for the detection of patients with extracranial internal carotid stenosis (EICS). ATS, atherosclerosis; NASCET (North American Symptomatic Carotid Endarterectomy Trial criteria); BMT, best medical therapy.

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  Figure 6. Duplex scan (long axis view) of the extracranial carotid bifurcation, clearly showing an atherosclerotic plaque causing stenosis of the internal carotid artery.

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  Figure 7. Methods of measurement of severity of ICA stenosis, reproduced with permission from Bir and Kelley [43]. CCA, common carotid artery; ICA, internal carotid artery; ECA, external carotid artery; ECST, European Carotid Surgery Trial; NASCET, North American Symptomatic Carotid Endarterectomy Trial.

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  Figure 8. Arteriography showing obstruction of the left iliac axis, with an efficient collateral pathway revascularizing the common femoral artery. Depending on his/her age and lifestyle, this patient can eventually be asymptomatic or paucisymptomatic for intermittent claudication. An accurate physical examination (detecting the absence of the left femoral pulse), and the subsequent left ankle-brachial index (founded to be reduced) can easily allow for this patient to be classified as vasculopathic.

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  Figure 9. Suggested flow-chart for the detection of patients with lower extremity arterial disease (LEAD). IC, intermittent claudication; ATS, atherosclerosis; ABI, ankle-brachial index; BMT, best medical therapy.

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  Figure 10. On the left, the ankle-brachial index (ABI), an absolute number which inversely correlates with the severity of lower extremity arterial disease (from https://www.aemmedi.it/files/la_scuola_AMD/2014/diabete_e_arteriopatia/9a_SimoniIparte.pdf (accessed on 1 May 2023)). On the right, the ABI’s measurement technique (from Wikimedia: https://www.nhlbi.nih.gov/health/health-topics/topics/pad/diagnosis (accessed on 1 May 2023)).

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  Figure 11. Arteriography showing popliteal artery aneurysm. The physiologic flexion movement of the knee can dislocate part of the mural thrombus, which embolizes and occludes some tibial arteries, giving rise to clinical pictures ranging from an asymptomatic state to intermittent claudication, or chronic limb-threatening ischemia, or acute limb ischemia.

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  Figure 12. Suggested flow-chart for the detection of patients with popliteal artery aneurysm (PAA). ATS, atherosclerosis; AAA, abdominal aortic aneurysm; IC, intermittent claudication; ABI, ankle-brachial index; BP, blood pressure.