CELIAC DISEASE AND VASCULAR SURGERY: SURGERY FOR PERIPHERAL ARTERIAL DISEASE IN PATIENTS WITH CELIAC DISEASE

Abstract

Introduction: Celiac disease, a systemic autoimmune enteropathy triggered by gluten ingestion in genetically predisposed individuals, has historically been understood by its gastrointestinal manifestations. However, increasing evidence has solidified its multisystemic nature, with repercussions extending far beyond the digestive tract. In parallel, peripheral arterial disease (PAD), a serious condition resulting from systemic atherosclerosis, was primarily associated with traditional risk factors such as smoking, diabetes, and hypertension. The intersection between these two pathologies has emerged as an area of ​​interest, considering that chronic inflammatory states, such as that observed in untreated celiac disease, have been recognized as a potent catalyst for the development and progression of atherosclerosis, raising questions about the implications of this association in the context of vascular surgery. Objective: The aim of this systematic literature review was to investigate the possible association between celiac disease and the severity of peripheral arterial disease, as well as to evaluate the particularities and outcomes of surgical treatment for PAD in celiac patients. Methodology: This study was conducted following the PRISMA checklist guidelines. A systematic search for articles published in the last ten years was performed in the electronic databases PubMed, Scielo and Web of Science. The following descriptors and their corresponding terms were used: "Celiac Disease", "Peripheral Arterial Disease", "Atherosclerosis", "Vascular Surgical Procedures" and "Prognosis". The following inclusion criteria were selected: (1) studies that evaluated the prevalence or severity of PAD in patients with a confirmed diagnosis of celiac disease; (2) articles that reported postoperative outcomes in celiac patients undergoing surgery for PAD; and (3) studies in adult humans. The following were excluded: (1) case reports with a sample of less than five patients; (2) review articles or editorials; and (3) studies that did not differentiate celiac disease from other enteropathies. Results: The results found in the literature suggested a possible association between celiac disease and accelerated atherosclerosis. The chronic inflammatory state and nutritional deficiencies resulting from malabsorption in untreated patients appeared to contribute to a higher risk and earlier presentation of peripheral arterial disease. In the surgical context, potential challenges were pointed out in this population, including a theoretical risk of impaired tissue healing and greater inflammatory reactivity, which could influence the patency of vascular grafts. Strict adherence to a gluten-free diet was shown to be a factor that mitigated some of these systemic risks. Conclusion: It was concluded that celiac disease may represent a non-traditional risk factor for the development and complexity of peripheral arterial disease. Surgical management of PAD in celiac patients has required careful attention to the individual's nutritional and inflammatory status. Evidence, although limited, has indicated the importance of a multidisciplinary approach involving gastroenterologists and vascular surgeons to optimize preoperative preparation and postoperative outcomes in this specific subpopulation of patients.