Arteriopathy obliterans, also known as arterial occlusive disease, refers to a medical condition marked by the gradual narrowing or complete blockage of arteries, impacting blood flow and potentially leading to severe complications.
Arteriopathy obliterans in Turkey presents a multifaceted healthcare challenge, prompting the development of advanced diagnostic methods and treatment modalities tailored to the country's diverse patient population and healthcare infrastructure.
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Arteriosclerosis Obliterans : What is it?
Arteriosclerosis obliterans is a vascular disease that mainly affects the arteries of the lower limbs. It is characterized by a progressive narrowing of these arteries due to the accumulation of atheromatous plaques (fatty deposits).
This reduces blood flow and can lead to leg pain, cramps and even ulcers, especially during physical activity.
Although the lower limbs are most commonly affected, the disease can also affect the arteries of the upper limbs, as well as those that supply other organs such as the stomach, intestines or kidneys.
Causes of arteriosclerosis obliterans
Obliterate arteriosclerosis results from the gradual accumulation of fatty deposits (atheromatous plaques) in the arterial walls. This phenomenon, known as atherosclerosis, is favored by several factors, including :
- Age and gender: AOMI is more common in the elderly and in men.
- Lifestyle: Smoking, high blood pressure, diabetes, high cholesterol and obesity are major risk factors.
- Family history: People with a family history of cardiovascular disease are at greater risk.
- Other factors: Some less common conditions, such as certain kidney diseases or congenital heart defects, may also predispose to AOMI.
Symptoms of PAD
The symptoms of PAD vary, but intermittent claudication is one of the most common. It is characterized by muscle pain, cramps or fatigue in the legs during exertion (walking, climbing stairs),which disappears at rest.
Other symptoms may also occur, such as:
- Pain in the hips or thighs.
- Numbness and tingling.
- Cold in the lower limbs.
- Inflammation.
- Changes in skin color.
- Slower nail growth.
In some cases, arterial occlusive disease may be asymptomatic.
Diagnosis of obliterating arteriopathy
The diagnosis of obliterative arteriopathy is based on several tests:
- Clinical examination: The doctor will ask the patient about his or her symptoms and perform a physical examination.
- Ankle-brachial index (ABI): This test compares blood pressure in the ankle and arm. A low ABI indicates blockage of the arteries in the legs.
- Echodoppler: This test uses ultrasound to visualize blood flow in the arteries.
- Angiography: This test uses a contrast dye injected into the arteries to produce detailed images of the blood vessels.
- Other tests: Blood tests (CRP, cholesterol) may be performed to assess cardiovascular risk.
Treatment of obliterating arterial disease in Turkey
Treatments for obliterative arterial disease aim to improve blood circulation and relieve symptoms. Therapeutic approaches in Turkey include
Medication
The initial treatment of PAD is based on medications, including:
- Antiplatelet agents: Prevent the formation of blood clots that can worsen arterial blockage.
- Vasodilators: Dilate blood vessels, making it easier for blood to circulate.
- Statins: Lower levels of bad cholesterol (LDL),which may help slow disease progression.
Lifestyle changes
Lifestyle changes play an important role in the treatment of AOMI:
- Smoking cessation: Smoking accelerates atherosclerosis.
- Eat a balanced diet: A diet rich in fruits, vegetables, and fiber and low in saturated fat is beneficial.
- Regular physical activity: Individualized exercise improves circulation.
Surgical procedures
Obliterative arterial disease of the lower limbs (OADL),characterized by narrowing of the leg arteries, may require surgical intervention when medical treatment proves inadequate.
The choice of surgical technique depends on several factors, including:
- The location and extent of the arterial lesions: Affected arteries may be located in the hips, thighs, or calves.
- The severity of symptoms: Pain when walking, wounds that do not heal, etc.
- The patient's general health: Other comorbidities may affect the choice of treatment.
Surgical treatment of IMA
Three main surgical techniques are used to treat IMA:
Angioplasty with or without stent placement
In this procedure, an inflatable balloon is inserted through a small incision, usually in the groin, to widen the narrowed artery. A stent (a small metal device) is often placed to keep the artery open. Stents can be plain or coated with a drug to prevent the narrowing from recurring.
Angioplasty is a less invasive procedure than other techniques and is often done under local anesthesia. However, there is a risk of long-term narrowing of the artery, which sometimes requires further intervention.
Endarterectomy
This procedure removes the atheromatous plaque (fatty buildup) that is blocking the artery. It is usually performed on large caliber arteries (hips, thighs).
Endarterectomy is an effective technique for large lesions. However, it is a more extensive procedure than angioplasty, requiring general anesthesia and a larger incision.
Coronary artery bypass surgery
Bypass surgery consists of creating a "detour" using a piece of vein or a synthetic graft to connect the two ends of the diseased artery. This technique is used when lesions are too long or too complex to be treated by angioplasty or endarterectomy.
This technique permanently restores circulation. However, it is a more complex procedure that requires general anesthesia and a longer hospital stay.
The choice of the most appropriate technique is made in consultation with the vascular surgeon, depending on the characteristics of each patient and the disease.
Benefits of surgery
Surgical treatment of AOMI aims to:
- Relieve pain: By improving blood circulation, walking pain is significantly reduced.
- Promote wound healing: Improved blood flow allows wounds to heal more quickly.
- Prevent complications: Amputation, a serious complication of AOMI, can be avoided with proper treatment.
- Improve quality of life: With improved mobility, patients can resume daily and social activities.
- After surgery, regular monitoring is required to assess the effectiveness of the treatment and to detect any complications. Medications may be prescribed to prevent blood clot formation and reduce the risk of recurrence.
It's important to note that every patient is unique and the results of surgery may vary. Don't hesitate to ask your doctor in Turkey any questions you may have to better understand the different treatment options available to you.
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The obliterative arterial disease of the lower limbs or also known as PAD disease is generally diagnosed by a specialist, such as a general practitioner, cardiologist, or angiologist.
Diagnosis is based on :
- Anamnesis: by checking the medical history of the patient
- Physical examination: focusing particularly on the physical condition of the lower limbs
- Systolic pressure index (SPI) measurement: measurement of arterial pressure (at the ankles and arms) using a Doppler.
- Complementary examinations: echo Doppler, angiography, color Doppler ultrasound, computed tomography (CT),or magnetic resonance imaging (MRI).
Foods rich in fat should be avoided. It seems that white meats, fish, vegetables, and fruit are preferable to red meat. A diet based on olive oil is also recommended.
The life expectancy of a person with PAD can vary considerably, depending on many factors. It's important to note that PAD is not a fatal disease, but it can be associated with an increased risk of serious cardiovascular complications. Nevertheless, it may require a leg or foot amputation if left untreated.
The peripheral arterial occlusive disease is closely linked to smoking. This latter is one of the main risk factors for the disease development. According to recent studies, 90% of people with atherosclerotic disease of the lower limbs have a smoking history or are current smokers.
People with peripheral arterial disease need to maintain good blood circulation and promote cardiovascular health.
In many cases, moderate-intensity activities such as walking, swimming, and indoor cycling can help improve blood circulation and strengthen leg muscles.
