Relationship between peripheral arterial diseases and hemorheologic disorders. Pathophysiologic and therapeutic implications

Abstract

Hemorheologic changes may be primary, associated, or secondary, in relation to arterial disease and ischaemic damage. Therefore the significance of the hemorheologic changes in the pathophysiology of POAD, also in view of a therapeutic approach, needs careful assessment in each patient. Goals of the “hemorheologic” treatments in POAD are: 1) to induce a moderate lowering of peripheral resistance even when the vasodilatory reserve has been exhausted; 2) to improve blood flow in the microcirculation; 3) possibly, to increase blood flow in the newly formed collateral vessels. Some therapeutic measures dramatically altering blood rheology have been reported as effective in critical phases of POAD, thus proving that lowering of blood viscosity improves blood flow and clinical conditions in certain groups of patients. Recent trials with “hemorheologic” drugs, mostly acting on blood filterability, suggest that some of them may indeed be effective in improving the walking ability of patients with intermittent claudication. However, the relation between hemorheologic and therapeutic effects of these drugs is not yet established. It is suggested that these drugs may be especially effective in a number of “good responders”, whose identification is however still doubtful.