Arterial Diseases
Atherosclerotic Plaque and Arteries
Written byTriantafyllos Giannakopoulos MD, PhD, FEBVS, FACSMedically reviewed: 27 July 2026
Understand the formation of atherosclerotic plaque and its effects on the arteries of the lower limbs. Early diagnosis and treatment prevent serious complications.
Atherosclerotic Plaque and Arteries
How plaque forms and affects arteries
The formation of atherosclerotic plaque (cholesterol plus reactive cells) takes place on the inner wall of arteries and gradually causes narrowing and eventually blockage. When it appears in the arteries carrying blood to the lower limbs, it can create stenoses of varying degrees and chronicity.
Hypertension
Main risk factor accelerating plaque formation
Smoking
Metabolic disease damaging the endothelial lining of arteries
Diabetes
Predisposing factor significantly increasing risk
Lack of Activity
Sedentary lifestyle burdening vascular health
Atherosclerosis Animation in Blood Vessel
Types of Ischemia
How Extent, Stenosis, and Chronicity Affect Atherosclerotic Plaque
Acute Ischemia
The blockage develops suddenly without the arterial network having prepared with collateral pathways.
Result: Sudden pain, rapid loss of sensation and movement, and ultimately irreversible limb damage beyond 6 hours (amputation).
Intermittent Claudication
The blockage develops gradually and the arterial network has prepared with collateral pathways.
Presentation: Pain when blood demands increase, e.g. while walking, and gradually the walking distance decreases, forcing the patient to limp intermittently.
Critical Ischemia: Gangrene
These are neglected conditions of gradual limb ischemia where the collateral network is insufficient and the foot hurts even at rest.
Characteristics: Patients hang the foot off the bed to sleep, while wounds and trophic changes (Gangrene) eventually appear, which can lead to amputation.
Diabetic Foot
Diabetes mellitus and its effects on the lower limbs
Diabetes mellitus is a metabolic disease in which the body's ability to effectively metabolize glucose is disrupted. From the early stages of the disease, the function of the nerves that transmit pain sensation to the brain is affected, resulting in diabetic patients not feeling pain in their feet.
In later stages, the disease affects the smaller arteries further below the knee and causes ischemia. The lack of pain (the human body's alarm) combined with ischemia can lead to neglected irreversible conditions of ischemia and inflammation accompanied by an increased risk of amputation.
Daily Examination
Diabetic patients should daily and carefully visually examine their feet, even between the toes
Immediate Visit
Visit your Vascular Surgeon immediately when wounds of any kind appear
Preoperative Consultation
Before any planned lower limb procedure, consultation with a Vascular Surgeon is strongly recommended
Diabetic Ulcers on Foot
Therapeutic Options
Treatment of Atherosclerotic Plaque
Treatment is decided based on the symptoms it causes, and when it involves intervention, preoperative Angiography is required to determine the strategy.
Minimally Invasive Endovascular
- Balloon Angioplasty
- Drug Eluting / Coated Balloon (DEB/DCB) Stenting
- Atherectomy Device
Classic Surgery
- Bypass
- Endarterectomy
- Thromboembolectomy
- Combination of methods in one session
Preoperative Assessment
Each case is evaluated individually
Each case is evaluated individually based on findings of preoperative imaging, the presentation and overall condition of the patient.
Angiography
Essential for determining the therapeutic strategy
Personalized Approach
Method selection based on symptoms and condition
Doctor Analyzing Ultrasound in Medical Office
Need Specialized Treatment?
Early diagnosis and treatment of atherosclerotic plaque in the lower limbs is vital for preserving your mobility. Contact us for a specialized evaluation and treatment.
Related Conditions
References
- Nordanstig J, et al. ESVS 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication. Eur J Vasc Endovasc Surg 67(1):9–96 (2024) — doi.org/10.1016/j.ejvs.2023.08.067
- Fitridge R, et al. Intersocietal IWGDF, ESVS, SVS Guidelines on Peripheral Artery Disease in People with Diabetes Mellitus and a Foot Ulcer. J Vasc Surg 78(5):1101–1131 (2023) — doi.org/10.1016/j.jvs.2023.07.020
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