What is peripheral artery disease, how does it progress and what are its causes?
The Turkish word for artery is 'artery'. Arteries can be defined as the pipe system that carries the blood pumped from the heart to our tissues and organs. Peripheral artery is the general name given to the arteries that go to all tissues and organs except the heart. Peripheral artery disease is a condition in which the vessels narrow as a result of swellings extending into the vessel, which contain high cholesterol content between the layers of the artery wall, and as a result, not enough blood can flow to the area fed by the vessel. Sometimes narrowing of the vessels may occur as a result of inflammatory diseases of the vessel wall, rheumatic diseases, diseases affecting the immune system, intravascular coagulation, congenital diseases or other disorders. Peripheral artery disease may not cause any complaints (asymptomatic), or it may cause pain in the hip or calf when walking (claudication) and gangrene. If there is narrowing in the veins going to the arm, it may cause pain in the arm, inability to bear weight, and blood pressure differences between the arms. It does not cause any complaints in most patients (50-80%). However, even if it does not cause any complaints, these patients have a high risk of cardiovascular disease (heart attack, stroke, etc.). Therefore, these patients need to be treated very intensively.
What is peripheral angioplasty and why are these procedures needed?
Peripheral angioplasty is the name given to the process of widening and opening narrowed or blocked peripheral arteries using a balloon, stent (wire cage), or both. These procedures may be needed in patients whose complaints do not regress or progress despite drug treatment. In case of vascular occlusions in the hips, legs and arms, balloon/stent application is required to relieve pain that occurs especially with exercise. It is necessary to prevent or minimize amputation, especially in patients at risk of leg amputation (ischemia) due to occlusions in the vessels below the knee. It may be necessary to improve kidney functions and regulate uncontrolled hypertension in cases of narrowing of the vessels leading to the kidney. Peripheral angioplasty also includes the aortic artery, the main vessels branching off from the aorta, the vessels leading to the lungs, or It can also be applied to the veins leading to other organs, depending on the patient's clinic. Your doctor will explain which vein you will be treated for.
Where, how and by whom is peripheral angioplasty performed, what is its estimated duration?
Peripheral angioplasty is performed in the angiography (or catheter) laboratory on the 2nd floor of our hospital. These procedures are performed by a team of specially trained interventional cardiologists, nurses and technicians. After the evaluations made by your doctor, the procedure can be performed through the groin (femoral) or arm (radial/brachial) route. Like angiography, the artery in the groin or arm is entered and after entering the blocked artery, the stenosis is passed with the help of special wires and then the stent procedure with a balloon begins. Stenosis is eliminated by controlled inflation of a specially designed balloon in the stenosis area within the vein. When the balloon is inflated, it pushes the plaque against the artery wall. After the balloon is removed, blood flow is restored from the blocked area. If your doctor thinks that balloon treatment is sufficient for vascular patency, the procedure is terminated. However, patients who have undergone balloon surgery generally also undergo stenting. Stents have been developed to eliminate some of the difficulties encountered in balloon treatment and to provide a better blood flow in the opened vessel.
(steel wire cage) is a system that is mounted directly on the inner wall of the vessel after balloon treatment in the coronary vessels or sometimes without a balloon. One or more stents may be required depending on the length of the narrowed area. Within weeks, these stents are covered with an endothelial layer and the stent remains in the vessel wall for life. In case of narrowing within the stent, balloon or stent or surgery options can be applied again. After balloon or stent placement, the patient may be taken to the coronary intensive care unit, depending on his condition. Although the total duration of this procedure varies from patient to patient, it takes approximately 30-90 minutes on average.
Can there be undesirable events (complications) associated with peripheral angioplasty, what is the risk of the procedure?
Interventional (balloon and stent) treatment of peripheral artery disease is a small-scale surgical procedure. Therefore, during application Some undesirable situations, which we call complications, may occur. However, the risk of complications in these procedures is quite low and is often not of vital importance. A piece or clot may break off from the vascular wall and travel to other vascular areas and block that area, this phenomenon is called 'embolism'. If organ damage as a result of embolism is in the arm or leg, emergency surgery may be required; rarely, gangrene and organ amputation may be required. Rupture or puncture in the vein is very rare and may occur due to the wire passed through the stenosis area and the devices used to expand the vein. The incidence rate is approximately one in a thousand patients. There may be an urgent need for surgical intervention (surgery). Separation of the vascular layers (dissection) can be seen during the procedure and can often be treated immediately by using a stent or by inflating the balloon for a long time. Very rarely, emergency surgery may be required. Spasm (contraction, shrinkage) in the vein may occur during the procedure, causing pain and sometimes damage to the organ fed by the vein. It is often corrected by administering antispasmodic drugs directly into the vein; It is very rare to cause damage. Rarely, the vein that is attempted to be opened may be completely blocked, in which case damage may occur to the organ fed by the vein and emergency surgery may be required. During the procedure, heart rate and blood pressure may decrease as the vessel is dilated or depending on the medications given; but this is often corrected without causing a problem. Ballooning (aneurysm), rupture, or blockage in the artery in the area where the artery is entered may rarely occur and may require surgery. Rarely, depending on the drugs used during the procedure, bleeding may occur in a very different area than the procedure area, or in the procedure area or in the area where the artery is entered. There may be swelling due to bleeding in the area where the artery is entered, this swelling usually disappears in 3-4 weeks. Renal failure may develop due to the medications used during the procedure, especially iodinated contrast material. Although most patients who develop kidney failure recover, rarely, patients may need to receive dialysis treatment later in life. All kinds of allergies may develop due to medications; but these can often be controlled with other medications given.
Peripheral angioplasty is necessary but not performed What kind of problems can be encountered and what method should be followed when we decide to have it done?
In patients who do not have peripheral angioplasty although it is necessary, the complaints may progress further and lead to leg gangrene. This can lead to loss of the leg (amputation) 4
or even death. Again, failure to perform balloon/stenting in the arm or other vessels may lead to organ damage. Failure to open the renal vein may also lead to renal dysfunction, uncontrolled hypertension, and the need for dialysis. If you decide to have peripheral angioplasty later, you can come to the cardiology service and make an appointment and have your angiography done on the given date.
Are there alternative examination methods that can replace peripheral angioplasty?
Another treatment option that can replace peripheral angioplasty is surgery, but surgery may also have some complications. In addition, there is a risk of narrowing again in the surgical vessels.
What lifestyle changes need to be made?
Some medications should be used before and after peripheral angioplasty. These drugs are blood thinners, cholesterol lowering drugs and drugs for other diseases (diabetes, hypertension). Some of these medications can be given orally before the procedure and used for a long time or even for life after the procedure. During the procedure, anticoagulant or clot-dissolving drugs, as well as vasodilator drugs, may be administered directly into the vein. Patients who undergo this procedure must use their medications as prescribed by their doctor. Smoking should definitely be quit. It is mandatory to walk every day and choose cholesterol and fat-free, salt-free foods under the supervision of a dietitian.
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