This brochure provides a general overview of the symptoms and treatment of peripheral (arterial) arterial disease. Please be aware that your individual situation may differ from what is described.WHAT'S GOING ON?You have been diagnosed with an abnormality in one of your arteries. This abnormality is caused by the deposition of fat in the artery wall and its calcification. This process is called atherosclerosis (hardening of the arteries).ATHEROSCLEROSISAtherosclerosis is actually incorrectly called arteriosclerosis because it damages the arteries. It is a collective term for various processes in the arterial wall that ultimately cause this wall to calcify and harden (= sclerosis). Atherosclerosis is an aging process of the arteries that begins as early as the age of twenty. The exact cause of atherosclerosis is unknown. However, it is clear that the presence of certain risk factors can significantly accelerate the process of arteriosclerosis. Some factors, such as smoking and high cholesterol, have a direct damaging effect on the arterial wall. For other factors, such as heredity, it is not yet clear why they increase the risk of developing arteriosclerosis.RISK FACTORSRisk factors that play a role in the process of atherosclerosis include:
Smoking:
This is the most important risk factor. Smoking releases many harmful substances into the bloodstream, which damage the artery walls. Smoking is a risk factor you can control. To prevent further progression of atherosclerosis, you must stop smoking, both actively and passively.
High blood pressure:
If the pressure in the blood vessels becomes too high, it can damage the artery walls. This accelerates the process of atherosclerosis. High blood pressure can be treated with dietary measures and medication.
Diabetes mellitus:
Diabetes accelerates the development of atherosclerosis. By keeping blood glucose levels within reasonable limits through dietary measures and medication, this increased risk is minimized.
Cholesterol
: High blood cholesterol also has a damaging effect on the artery walls. Sometimes treatment with medication is necessary, but a healthy diet is always the first step. High blood cholesterol can also be hereditary. Besides a healthy diet, medication is often necessary to lower cholesterol levels.
Being overweight and not exercising enough
can influence the process of atherosclerosis both directly and indirectly. Being overweight is often associated with diabetes, high blood pressure, and high cholesterol. It is also often associated with poor dietary habits and a lack of exercise. Losing weight and increasing physical activity are necessary to prevent the further development of vascular diseases.
Gender:
In women, sex hormones offer little protection against atherosclerosis.
A family history of cardiovascular disease: If a family history of cardiovascular disease
occurs at a young age, there is a greater risk of atherosclerosis.COMPLAINTS AND SIGNS OF ATHEROSCLEROSISAtherosclerosis can occur in any artery in the body. The signs and symptoms depend on the location, severity, and duration of the atherosclerosis. Atherosclerosis usually leads to narrowing or even complete blockage of the artery. However, it can also cause a weakening of the arterial wall, which then becomes too wide due to (high) blood pressure (aneurysm formation, see the leaflet). These two different conditions can also occur simultaneously.Narrowing or occlusion of an arteryA narrowing or blockage of an artery results in reduced blood flow to the tissues dependent on that blood vessel, which consequently receive too little blood (and therefore too little oxygen). Tissue that receives too little oxygen can become painful or even die due to acidification. This latter condition is called a heart attack. The consequence of acidification, in the case of an artery to a leg, is pain in the calf after walking a short distance. After resting, the pain disappears, and walking a short distance can be resumed (intermittent claudication). For more information, see the brochure "Intermittent Claudication." Eventually, so little blood flow to the leg can occur that pain in the leg occurs even at rest. Narrowing of the coronary arteries to the heart causes chest pain during exertion (angina pectoris). If the narrowing worsens or the exertion becomes too much, a heart attack can even occur. In the case of a narrowed carotid artery, speech impairment, blindness, or paralysis can occur, which are usually temporary, but can also be permanent (stroke). For more information, see the leaflet about narrowed carotid artery. Besides narrowing or blockage of an artery, arteriosclerosis can also cause an embolism. A piece of the calcified plaque (embolism) breaks off and is carried to a smaller blood vessel further downstream. This smaller blood vessel can then suddenly become blocked by the embolism, causing the body part or organ that depends on it to receive no or insufficient blood.ANEURYSM FORMATIONFor more information, see the brochure on aortic aneurysms. Aneurysm formation is a localized widening of an artery. At the site of the widening, the artery wall has stretched and thinned, posing the risk of a tear developing at this weak spot, resulting in bleeding. The larger the aneurysm, the greater the risk. An aneurysm develops unnoticed and grows gradually. It can occur in any artery in the body, but is most common in the aorta, the main artery of the body. An aneurysm usually does not cause serious symptoms and is discovered incidentally. If an aneurysm is discovered in an artery, surgery may be necessary. In an aneurysm, blood flow is also disrupted, with blood swirling in the localized widening. This causes a blood clot to form in the aneurysm. Occasionally, a piece of this clot can break away and suddenly cause a blockage in an artery further downstream (embolism).RESEARCHTo determine the degree of stenosis and its exact location, several tests are necessary. This will often initially involve an examination in the vascular laboratory. For more information, see the brochure on vascular examination: Doppler, duplex, and walking test. If a stenosis requires treatment, an X-ray contrast study of the arteries can be performed. For more information, see the brochure on angiography. An ultrasound is the preferred examination for detecting an aneurysm.TREATMENTAtherosclerosis cannot be cured. Treating the risk factors aims to halt the process and prevent symptoms from worsening. In general, a healthy lifestyle is recommended:
• Quitting smoking is the most important thing.
• Healthy eating: less fat and carbohydrates. Saturated fatty acids (butter, meat, and cheese), in particular, increase blood cholesterol levels. It is better to limit their consumption and replace them with unsaturated fatty acids (vegetable fats, olive oil, and fish).
• Consuming large amounts of carbohydrates (starches and sugars) can also lead to increased blood cholesterol levels.
• Increased exercise and weight loss if overweight.
In addition to recommendations for a healthy lifestyle, the following specific treatment options may be considered, depending on the severity of the condition:
• Conservative treatment
• Angioplasty
• Surgical treatment.
Conservative treatment
primarily focuses on further limiting the risk factors mentioned above. If the narrowing is not severe, walking exercises and possibly the use of blood-thinning medication can significantly improve the situation.
Angioplasty.
Angioplasty is performed during an X-ray contrast examination. An artery is punctured and a catheter with a deflated balloon is inserted into the artery. By inflating the balloon at the site of a narrowing, the narrowing is stretched. The blood vessel then becomes more patency. Nowadays, it is possible to combine this treatment with the placement of a small tube (a stent) in the stretched vessel segment, which keeps the blood vessel wider after stretching. Angioplasty is a minimally invasive procedure that can sometimes be performed on an outpatient basis. Fortunately, the method rarely has serious complications, although bleeding can occur at the arterial insertion site. Of course, it is not always successful to dilate a vessel. It is also possible for a narrowing to recur after a relatively short time.
The surgical treatment
Several surgeries are possible. For example, an artery can be cleaned by surgically removing the calcification at the site of the blockage or by widening the blood vessel at the site of the blockage. This surgery is primarily performed for a blockage in the carotid artery. For most other blocked arteries, a bypass is created using a vascular prosthesis or a vein (for more information, see the brochure "Bypass: Blood Vessel Bypass Surgery"). The choice of surgery naturally depends on many factors. The severity of the surgery and the severity of potential complications depend on the location in the body where the blockage is located and the location where the surgery is performed. |
