Peripheral Artery Diseases

Arteries (arteries) transmit oxygen-rich and nutrient-rich blood known as clean blood in the body to all organs from the heart. The inner surface of these veins is covered with a tissue called velvety endothelium that will allow blood to flow comfortably.

Endothelial tissue is disrupted by the development of atherosclerosis, known as arteriosclerosis. With the progression of atherosclerosis, narrowing or blockage may develop in the leg arteries. The elderly are more at risk.

Peripheral Artery Diseases

What are the symptoms?

It may not give symptoms in the early stages. However, with the progression of the disease, the person begins to feel discomfort and pain in the leg. The person has to slow down and stop after a while. This intermittent lamping (intermittant cladica) is the most common symptom. It typically occurs much earlier, especially when climbing stairs or slopes. With the further progress of the disease, pain begins to occur at rest. Walking becomes impossible. In this case, which we call our critical leg isque, the leg is cold and pale. In patients who are not treated at this stage, wounds and even gangrene may occur over time.

What causes leg vascular occlusion?

As in the case of blockage of all vessels, the most important cause is atherosclerosis, known as arteriosclerosis. Atherosclerosis, which is a condition that increases with age, especially puts men over the age of 50 at risk. However, the causes that accelerate atherosclerosis, regardless of age, contribute to the blockage of the leg vein. These are

• Smoking (the most common and important cause)

  
  

  Diabetes

  
  

  Hyperlipidemia (High blood fats)

  
  

  Hypertension

  
  

  Obesity

  
  

  Homocysteine is high in the blood.

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How is the diagnosis made?

• A good physical examination with the questions asked to the patient and history is extremely insightful. For more detailed diagnosis;

  
  

  Ankle – arm pressure index: It is a data obtained by proportioning the blood pressure measured from these areas

  
  

  Color doppler vascular ultrasound: It is the easiest and most detailed insight examination. Allows veins to be displayed.

  
  

  Leg Vein angiography (DSA): It is an advanced examination that should be performed on patients who are considered to have surgery or intervention. It is the gold standard for the diagnosis and treatment plan of patients at this stage.

• Computed Tomographic Angiography: Aid for diagnosis.

  
  

  Magnetic Resonance Angiography: Helps in diagnosis.

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Cure

• Drug treatment: It is a treatment option made in the early stages of occlusion of the leg veins or in the advanced stages that are too damaged to be treated surgically. Today, there are highly advanced drugs in this regard. Drug treatment also includes other diseases such as hyperlipidemia (high blood fats), diabetes, etc. accompanying the picture.

• Endovascular Therapy: It is the opening of the blockage with a balloon or stent in patients suitable for this treatment.

  
  

  Surgical Treatment: It is the application of bypass surgery to the blockage vein by using the person's own vein or artificial vein. In this way, blood is delivered to the congestion.

  
  

  What is carotid artery?

  
  

  Carotid arteries, known as the veins, are arteries that travel on both sides of our neck and carry blood to our brain.

What is Carotid Artery Disease?

It is the narrowing or blockage of the carotic veins that they do not carry the blood needed to feed the brain. Adults over the age of 50 are at risk. The frequency between the ages of 50 and 59 is around 1% and this rate is a rate that should not be underestimated medically. After these ages, the frequency increases rapidly and this rate increases up to 10% over the age of 60. Clinically, the biggest risk is the paralysis of the plaques that cause obstruction or the pieces that break away from these plaques. In many cases, there is coronary artery disease.

Why Are Carotid Arteries Clogged?

As in the case of blockage of all vessels, the most important cause is atherosclerosis, known as arteriosclerosis. Atherosclerosis is a condition that increases with age. However, the causes that accelerate atherosclerosis, regardless of age, contribute to the blockage of the carotid vessel. These are

• Smoking (the most common and important cause)

  
  

  Diabetes

  
  

  Hyperlipidemia (High blood fats)

  
  

  Hypertension

  
  

  Obesity

  
  

  Homocysteine is high in the blood.

Symptoms of Carotid Stenosis

Unfortunately, the il symptom may be paralysis (stroke). However, although not every patient, there may be some warning signs;

Transient Ischemic Attack: It is the most common symptom. It is a picture that occurs in the form of temporary loss of power and/or numbness that holds one side of the body. Speech can become offended and completely broken. Temporary unilateral vision loss - can also be accompanied by screening. All or almost all of the complaints will be corrected within 24 hours. This picture is a very serious warning for stroke. Absolutely detailed examinations should be carried out to include carotid veins.

Amarosis Fugaks: It is a painless, sudden, unilateral, vision loss lasting 2 - 10 minutes. Carotid is a common symptom of artery disease.

How was Carotid Stenosis Diagnosed?

A good physical examination with the questions asked to the patient and history is extremely insightful. For more detailed diagnosis;

Color doppler vascular ultrasound: It is the easiest and most detailed insight examination. It provides visualization of carotid veins and measurement of blood flux passing through them. It is sufficient for diagnosis in 90% of patients.

Classic Angiography (DSA): It is an advanced examination to be performed on patients who are considered surgery or intervention. It is the gold standard for the diagnosis and treatment plan of patients at this stage.

Computed Tomographic Angiography: It is used to diagnose areas with little blood in the brain due to carotid vascular occlusion.

Magnetic Resonance Angiography: It shows blood flow and narrowings in the carotid vessels, it is an easy method to apply. However, it could not replace classic angiography.

Surgical Treatment of Carotid Stenosis

We call the removal of the obstructing plaque in the carotid artery endartrectomy. After the plaque that forms stenosis is removed, this area is expanded with a patch. Veins that are too wide may not be patched. During these procedures, according to the preference of the surgeon and the examination performed in the surgery, a pipe through which blood passes (intraluminal shunt) is used to provide blood flow to the brain.My personal preference is the use of shunt. Surgery is not performed in cases of complete occlusion in the carotid vein or acute stroke that is healing. The strategy is important in coronary artery patients accompanying carotid stenosis and requiring coronary bypass surgery. Surgical intervention is required for patients with carotid stenosis of 70% and above. In such patients, there are two types of strategies, progressive (first carotid for a while, then coronary or vice versa) and concurrent. My personal preference is to perform carotid and coronary bypass surgeries simultaneously.

Stent Treatment in Carotid Stenosis

It is the opening of the narrow region of the carotid vein by entering through the inguin or arm vein with a stent (wire cage). It may be an option in patients with additional diseases that cannot handle surgery. It is still a controversial treatment method. During this processAlthough precautions are taken to prevent the particle to the brain from escaping, this risk is always present. Long-term results were found to be worse than surgery.