Every year August 6 is observed as World Vascular Day. Among the diverse causes that lead to ill health among us, non-communicable and communicable diseases, cancer and accidents are at the fore. These are non-communicable diseases also known as ‘lifestyle diseases’. Risk factors for lifestyle diseases – in men after age 60, are smoking, diabetes, obesity, high cholesterol levels, high blood pressure and physical inactivity.
Our Blood Circulation system consists of three components – the heart, the blood and a very extensive network of blood vessels that carry them (arteries – carrying pure blood, veins – carrying impure blood). Vascular & Endovascular Surgery deals with the diagnosis, treatment, prevention, research activities and study of vascular diseases. Adverse conditions affecting blood vessels and nerves cause more than 95% of diseases. Atherosclerosis is a condition in which fatty deposits build up in the blood vessels and cause them to narrow, and it mainly affects the aorta (aorta / aorta – the largest blood vessel that carries fresh blood and arterial branches). Diseases that commonly affect the aorta are aneurysms (inflammation of the arteries) and narrowing of the arteries due to fatty deposits. If aneurysms are not treated in time, the walls of the blood vessels can grow and collapse, leading to death. In the same way, if the fat in the blood vessels and their shrinking condition is not managed properly, the flow of clean blood to the organs is reduced and thus the functioning of the organs is negatively affected. Venous thromboembolic disease is a condition in which blood clots form in the veins of the legs and obstruct the flow of blood to the heart and lungs. In short, a person’s health is related to the functioning of their arteries.
Diseases that usually affect the arteries and aorta
How does arterial insufficiency affect the legs? (Artery insufficiency to legs)
1. Sudden arterial occlusion
If the arteries in the legs are blocked due to material from the heart/aorta or a blood clot, the patient will suddenly experience severe pain and be unable to walk as before. If this state of arterial embolism is reached, surgery is needed to remove the blood clot that caused it and restore perfusion to the organs. Arterial occlusion usually lasts for 6-8 hours. Therefore, surgery should be performed as soon as possible to avoid tissue damage in that area. However, if treatment is sought after 48 hours, the blood clot needs to be dissolved by immediate medication. Anti-coagulation medications should be continued to treat the actual heart problem. In an elderly patient, blood clots at the site of cholesterol deposition should be considered in intensive care.
2. Peripheral artery disease
Cholesterol/fat build-up in the arteries of the legs gradually reduces the blood flow to the legs, which can lead to pain in the thigh muscles of the patient while walking. As the blockage in the arteries increases over time, even walking a short distance can lead to excruciating pain in the legs. If this stage is not properly attended to, the patient may feel pain in the legs even at rest. If immediate medical attention is not given at this stage, the risk of losing the affected organ is very high.
History of the disease, physical examination, and duplex evaluation help determine the circulatory status of the extremities. If the disease is severe, a CT angiogram is needed to understand the blockage in the arteries. Initial treatment is medical management, with key-hole surgery (balloon angioplasty / stenting) becoming necessary in more severe cases. If that is not possible or fails, bypass surgery with an artificial graft is required.
In the early stages of the disease, the patient may feel pain in the thigh muscles while walking. Key-hole surgery is ideal for improving quality of life and reducing walking difficulties. If the patient is in critical condition, open surgery may be required. It is absolutely true that ‘foot health can determine quality of life’.
Carotid artery disease / stroke
A stroke is a medical condition caused by a sudden stoppage of blood in the arteries in different parts of the brain or by bleeding within the brain. It is a condition in which one side of the body becomes paralyzed, with or without affecting the ability to speak. This condition can be caused by many reasons, but the main cause is cholesterol/fatty build-up in the cerebral arteries. In this case, the patient can be evaluated with a duplex scan followed by a CT angiogram to determine the source of the bleeding. Treatment should be sought within a maximum of 3-4 weeks of symptom onset. Treatment should be ensured by carotid endarterectomy or carotid artery stenting.
Inflammation of the gastric arteries
If the aorta in the stomach is 2 cm or less in diameter, people over the age of 60 can develop a swelling in them, a condition known as an aneurysm. If not treated on time, over time, the inflammation increases and it is likely to suppurate. The degree of swelling is estimated to be a maximum of 5.5 cm. Smoking, lung disease, and high blood pressure increase the rate of inflammation. Clinical examination and ultrasound scanning help in diagnosis. A diagnostic procedure called CT Aortogram (CT Aortogram) confirms the size and extent of the aneurysm. Open surgery is the treatment method in the first stages. Endovascular surgery may be required if general/cardiovascular condition of patients is not favorable.
Rare arterial diseases
Inflammation of the aortic arch
If the aneurysm is larger than 6 cm, it is necessary to seek treatment. If there is an increase in pressure and breakdown in these, treatment should be started immediately. In short, inflammation of the arteries is discovered incidentally (no specific symptoms are present). But inflammation of the aortic arch presents with symptoms (chest discomfort, change in voice). CT angiogram imaging can help determine the size, extent, and presence of a blood clot. The use of a large-diameter prosthetic graft is effective for open surgical treatment. However, treatment is also possible with stent grafting (endovascular) through key-hole surgery. Hybrid Aortic Arch, an advanced treatment method, is superior to both of the previously mentioned methods.
Aortic dissection Aortic dissection refers to a tear in the inner wall of the aorta. As a result of which blood flows into the aortic wall, a condition called intramural hematoma occurs. This type of rupture can occur in different parts of the aorta (Stanford A and Stanford B). High blood pressure causes this condition to become complicated. A Stanford A dissection requires immediate surgery. Stanford B is curable with medications in the ICU setting. Controlling blood pressure is the mainstay of treatment. If not treated in time, a life-saving endovascular stent graft procedure may be required.
Dietary control and moderate exercise help to counteract the risk factors to some extent. Stop using tobacco and alcohol. Walking a kilometer a day or 5 days a week, 15 minutes of treadmill exercise is good for maintaining physical fitness. However, if vascular disease occurs, its severity can be reduced by controlling risk factors in men over 60 years of age. The most important thing is to seek treatment at the right time. Most of the vascular diseases can be completely cured if the doctor’s help is sought in the early stages of the disease.
ContentSummary: Vascular Diseases and Vascular Day