Peripheral artery disease (PAD) is highly prevalent in older adults. PAD is associated with cognitive impairment; however the underlying mechanisms are unclear. The brain's metabolic needs rapidly change in response to neuronal activity requiring adjustment of regional cerebral blood flow, termed neurovascular coupling (NVC). The microvascular endothelium contributes to NVC responses. Patients with PAD have endothelial dysfunction that may extend to the cerebral circulation, impairing NVC and cognitive function. The present study examined NVC responses to cognitive stimulation using Transcranial Doppler Ultrasonography (TCD) in older adults with PAD. Participants underwent bilateral TCD in the middle cerebral arteries during four recordings; baseline and tasks from Addenbrooke's-III Cognitive Examination and Digit Span. Mean absolute change in cerebral blood velocity (CBv) was measured at two time points (25-30s; 30-40s) from a 20s baseline. Nineteen patients with intermittent claudication and 20 age-matched controls (mean: 68.4 [8.1] years; female: 12) were included. CBv increased on all cognitive tasks, however no significant differences were observed between patients (range: 0.9-7.4 cm/s) and controls (range: 1.1-6.9 cm/s). Patients with PAD had significantly poorer working memory and global cognitive function. Older adults with PAD had similar NVC responses to age-matched controls. The lack of differences may be due to the low prevalence of cognitive impairment, disease severity, small sample size, or the relatively simple cognitive paradigms. Future studies examining NVC in patients with PAD during tasks with higher cognitive load, and in more advanced disease stages, are needed to further understand whether impaired NVC contributes to PAD-related cognitive impairment.

People with peripheral arterial disease (PAD) of the lower limbs are at very high risk of cardiovascular events and therefore the cornerstone of their management is medical therapy and behaviour modification to reduce that risk. The risk of limb loss (through major amputation) is low in people with asymptomatic PAD or intermittent claudication with only a few patients progressing to the most severe form of PAD: chronic limb threatening ischaemia. Supervised exercise therapy is effective in patients with intermittent claudication to improve their walking capacity and avoids the risks associated with revascularisation procedures to improve blood flow to the limb. Although some people with intermittent claudication might need revascularisation, it is overused in this group. Revascularisation of stenosed or occluded arteries can be done by open or endovascular surgery and is generally reserved for people with chronic limb threatening ischaemia who are at highest risk of limb loss because these interventions carry substantial peri-procedural risks and often have minimal durability. Innovative therapies to treat PAD focus on improving health-related quality of life, reducing limb loss, and improving survival but the disease remains challenging due to its impact on multiple arterial levels and in different organ systems (polyvascular disease).

Popliteal artery entrapment syndrome (PAES) is a cause of exertional calf pain, predominantly affecting young athletic patients without pre-existing vascular disease. Although the condition is generally rare, the number of undetected asymptomatic cases is thought to be substantial. In up to two thirds of cases the PAES is bilateral. Pathophysiologically, it results from external compression of the popliteal artery within the popliteal fossa. The classification distinguishes between anatomical variants (types I-V), which arise from embryological maldevelopments of muscular and tendinous insertions, most commonly involving the medial head of the gastrocnemius muscle and functional entrapment (type VI), which is caused by muscle hypertrophy. Chronic compression leads to intimal damage, fibrosis, occlusions and poststenotic aneurysms. In addition to the clinical angiological examination, the diagnostics are based on duplex ultrasonography, magnetic resonance (MR) or computed tomography (CT) angiography and invasive angiography. For anatomically driven PAES (types I-V), surgical intervention is indicated due to the risk of permanent vascular damage. If the artery is intact, myotomy alone yields excellent long-term results; however, if stenoses or occlusions are already present, arterial reconstruction is required. For symptomatic functional PAES (type VI), botulinum toxin injections offer a nonsurgical alternative to myotomy.

Cholesterol embolization syndrome is a clinical condition caused by cholesterol crystals dislodged from atherosclerotic plaques, leading to distal arterial occlusion and subsequent organ ischemia. We present a case of a 61-year-old male who developed blue toe syndrome, reticular livedo, and gastrointestinal bleeding 1 week after aortic interventional therapy for intermittent claudication. The patient exhibited eosinophilia and multiorgan dysfunction. Diagnosis was confirmed by fundoscopic examination revealing a cherry-red spot at the macula. This case, combined with a literature review, discusses the clinical features, diagnostic criteria, and therapeutic strategies of this disease to enhance clinician awareness. The patient was followed for 3 months with ongoing follow-up thereafter, during which renal function partially recovered from stage 4 to stage 3b chronic kidney disease with conservative management.

This article presents literature data on the history, mechanism of action, clinical application, and effectiveness of lumbar sympathectomy in the treatment of lower extremity ischemia. The results of numerous studies are compared and the seminal works on this topic are examined in more detail, with a particular focus on systematic reviews. It concludes that lumbar sympathectomy remains a recommended surgical procedure when other treatments are impossible or ineffective.

BackgroundPeripheral artery disease (PAD) is common in maintenance hemodialysis patients, and ankle-brachial index (ABI) may underestimate disease because arterial calcification can yield falsely normal or elevated values. Toe-brachial index (TBI) may better detect distal ischemia. This study compared PAD detection by ABI and TBI and identified factors associated with TBI-defined PAD.MethodsIn this multicenter cross-sectional study, 211 maintenance hemodialysis patients underwent ABI and TBI assessment. PAD was defined separately as ABI <0.90 and TBI <0.70 using guideline-supported thresholds. Intermittent claudication, chronic wounds and burning toe pain were recorded. Detection rates were compared using McNemar's test, and associated factors were evaluated using multivariable Poisson regression with robust variance.ResultsPAD prevalence was 13.3% by ABI and 76.3% by TBI. TBI identified more patients with PAD than ABI (p < 0.001), with 133 patients (63.0%) showing normal ABI but abnormal TBI. Among these, 9.2% had at least one clinical ischemic feature. Diabetes mellitus, older age, and longer renal replacement therapy duration were independently associated with TBI-defined PAD.ConclusionTBI identified substantially more PAD than ABI and may provide complementary information when ABI alone could miss clinically relevant ischemia. Diabetes mellitus, older age, and longer RRT duration were independent correlates of TBI-defined PAD.