INTRODUCTIONHere you will find a general overview of the symptoms and treatment options for peripheral arterial disease. It's important to remember that when a condition is diagnosed, the situation can be different for everyone.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 arterial wall and by calcification of the arterial wall. This process is called arteriosclerosis (hardening of the arteries). The following factors contribute to the development of arteriosclerosis: smoking, high blood pressure, diabetes, obesity, and high blood fat (cholesterol) levels.
Arteriosclerosis usually leads to narrowing or even complete blockage of the artery. However, it can also cause a weakening of the arterial wall, which then widens due to the (high) blood pressure (aneurysm formation). Both possibilities are discussed below.Narrowing or occlusion of an arteryNarrowing or blockage of an artery results in reduced blood flow, and the tissues dependent on that blood vessel receive insufficient blood (and therefore oxygen). As a result, if the artery to your leg is affected, you may experience pain in your calf after walking a short distance. After a short rest, the pain disappears, and you can walk a short distance again (intermittent claudication). It's even possible that very little blood flow to your leg is present, so little that you can no longer walk at all and experience pain even at rest. If the carotid artery is affected, you may experience speech impairment, blindness, or paralysis, which can be temporary or even permanent.
Depending on the severity of the condition and the artery involved, there are several options:
- Conservative treatment
- Angioplasty
- Surgical treatment
Conservative treatment
If the narrowing is not severe or if many new blood vessels have formed, it is often possible to significantly improve the situation through exercise and possibly the use of blood-thinning medication.
Angioplasty.
Sometimes the narrowing is so severe that it must be determined whether it is possible to dilate the blood vessel at the site of the narrowing, thereby improving its patency. This procedure is called "angioplasty" in the Netherlands, after its inventor. It is a minimally invasive procedure that can sometimes be performed on an outpatient basis. Fortunately, the method rarely has serious complications, although bleeding at the injection site can occur. It is, of course, possible that dilating the vessel is unsuccessful or that the narrowing reoccurs after a relatively short time.
Surgical Treatment:
Various surgical options are available, such as cleaning the vessel at the site of the narrowing or surgically widening the narrowed area. This surgery is primarily performed for a narrowing of the carotid artery. For most other blocked arteries, a bypass is created using a vascular graft or a vein from your own vein. The choice of surgery naturally depends on many factors. The severity of the surgery naturally depends on the location of the blockage in the body. Your surgeon can provide you with detailed information about this. After the surgery, you will be cared for briefly in the intensive care unit (depending on the severity).
Possible complications
No procedure is without the risk of complications. These surgeries also carry the usual risks of surgical complications, such as wound infection, bleeding, thrombosis and pulmonary embolism, pneumonia, bladder infection, and heart attack. Furthermore, you can expect normal sensation in the area of the surgical scar to disappear after healing.
Arterial surgeries have specific complications: postoperative bleeding or occlusion of the vascular prosthesis or the used vein. If such a complication occurs, further surgery is often necessary.
Naturally, we strive to minimize these risks. Therefore, you will often be thoroughly examined by an internist, cardiologist, or pulmonologist before surgery, and numerous precautions will be taken.THE ANEURYSMAn aneurysm most commonly occurs in the aorta, often starting just below the branch to the kidneys and ending above the branch to the left and right legs. Sometimes, side branches of the aorta are also dilated.
When an aneurysm is found in an artery, surgery is often necessary. This is because the dilation creates a weak spot in the arterial wall, where a tear can occur, resulting in life-threatening bleeding. The larger the aneurysm, the greater the risk. A blood clot or a fragment of the arterial wall can also suddenly cause a blockage in an artery further downstream (embolism).THE OPERATIONThe above-mentioned risks can be prevented by surgery, in which the aneurysm is replaced with a vascular graft. For an aneurysm of the aorta or one of its direct branches, this is a major operation that can require a hospital stay of up to ten days. After the surgery, you will usually be transferred to the intensive care unit and sometimes placed on a ventilator overnight.
Possible complications
These are essentially the same as those mentioned for vasoconstriction, except that the risk of death is slightly higher as a result of the surgery. In men, it is possible that after aortic surgery, erections are impaired or that, despite a normal erection, ejaculation is absent. This can be temporary, but is usually permanent.HOME AGAINAfter discharge from the hospital, you'll notice that you tire easily, especially after major surgery. This often lasts a long time, sometimes six months. You'll often need to continue taking medication to thin your blood. It's wise to prevent arteriosclerosis from progressing faster than normal as much as possible. This means living as healthily as possible, not smoking, getting plenty of exercise, and avoiding being overweight.
If you have diabetes, high blood pressure, or high cholesterol, these should all be well-controlled.
After discharge from the hospital, you'll notice how difficult the surgery was. It can take a long time to fully recover. Generally, blood thinners aren't always necessary. A healthy lifestyle is very important, so: absolutely no smoking, plenty of exercise, not being overweight, and well-regulated blood pressure, diabetes, and cholesterol. |
