- Clogging and narrowing due to arteriosclerosis
Degeneration of the arterial system in our body occurs due to atherosclerosis disease. . This degeneration is a process in which lime and fatty layers accumulate on the vessel walls, narrowing the inner space of the vessel and then completely blocking it as the disease progresses. Atherosclerosis is a disease that usually occurs in older ages (over 50 years of age). The most important factors in the emergence of the disease are hypertension, diabetes, high blood lipids, nicotine addiction, and family history of this disease and genetic transmission. The areas of the body most commonly affected by this disease are the arteries that feed the legs, heart and brain.
Complaints vary depending on the degree of narrowing in the system that feeds the legs and the location of the blockages.
Main complaints;
1-Pains that come with walking; They are cramp-like pains that occur in the muscles of the relevant area due to malnutrition caused by the inability to send adequately oxygenated blood to the narrowed or completely blocked area. For example, narrowing in the veins passing through the abdomen and reaching the groin area causes cramps in the hip and upper leg muscles during effort, while a narrowing or occlusion in the veins passing through the upper leg and feeding the area below the knee causes cramps and pain in the calf muscles of the lower leg. The more advanced and widespread the narrowing and obstruction, the shorter the distance from which the pain begins.
2- Pain that occurs even at rest; This symptom occurs in the advanced stages of the disease. The nutrition of the legs has deteriorated to such an extent that, despite no effort, the necessary oxygenated blood cannot reach the tissues even at rest, resulting in tiring, exhausting pain that continues all day long. Patients generally spend the night feeling sleepless and painful, sitting on the edge of the bed or on the couch, with their legs hanging down, due to the fact that the blood flow is slightly higher due to the effect of gravity, and the pain is relatively less.
3-Wounds on the feet, Gangrene; Your leg and feet Due to advanced deterioration of the blood's nutrition, tissue integrity can no longer be maintained, or a wound opened due to a reason such as trauma or incision does not heal and leads to foul-smelling gangrene. Partial or total limb loss is now inevitable.
What are the diagnostic methods; The diagnosis of the disease is first made by examining the patient's complaints and pulse examination. There are also auxiliary diagnostic tools other than examination; Angiographies performed with Doppler Ultrasonography, MRI and Computed tomography.
Angiographies performed by entering the vein, which were used as standard in the past years, are now insufficient for diagnostic purposes. It is applied to a small group of patients.
- What are the treatment options?
Since the effects differ according to the stages of the disease, there are individual differences in treatment. In the presence of rest pain, gangrene in the foot or a non-healing wound, an interventional treatment that will increase blood flow is absolutely necessary, as there is a danger of loss of limb and perhaps life. Since the quality of life is the affected factor in patients without complaints, patients can be evaluated according to their age, social living conditions, and how much their life is affected by the disease, and a different treatment can be prescribed for each patient. For example, a 65-year-old retired person living in a village who has pain in his leg that requires him to stop and rest after an effort of around 200 meters, and a 55-year-old person living in the city and actively working with pain that starts at 200 meters, may have their quality of life affected at different rates by the same complaints. While more supportive medical treatments can be recommended for the patient who already lives in the village at a distance of 400-500 meters, interventional treatments can be recommended for the other patient.
Medical treatment and exercise; The disease is high cholesterol, hypertension, diabetes. Since it may also contain a number of co-morbidities such as these, it should be evaluated in terms of these diseases and treatments should be started against these existing diseases. Be an addition to these Medicines that increase the diameter and number of capillaries, which are medically proven to be effective, are added to the treatment, as well as blood thinners, in order to prevent sudden blockages that may occur in narrowed areas.
Cutting the use of all tobacco products due to nicotine addiction, which is one of the main factors of the disease, will process the healing process of the disease. It accelerates as well as slows down its progression.
Regular walking exercises; It has been scientifically proven that regular walking exercises performed daily show their effects within 3-6 months and extend the current pain-free walking distances. On the contrary, reducing walking due to pain leads to a rapid shortening of the pain-free walking distance.
Interventional treatments; balloon expansion and/or stent placement accompanied by surgery or angiography
Balloon expansion and stent placement; These are interventions performed under the guidance of angiography in artery regions that have previously been narrowed or have short-length (less than 5cm) occlusions shown by relevant diagnostic methods. It is an effective treatment method that is frequently used in the world and in our country. During the procedure, the narrowed or occluded vascular area is crossed with thin wire systems and depending on the location and length of the stenosis, it is widened with balloon systems delivered to the area through the same wire system, or cages (stents) made of stretchy and durable materials are placed in the relevant area. These are the methods in which the wire system can be removed following the control and the patient can be sent home after resting sometimes for 1 night or sometimes for 6-8 hours. There are mainly two types of operation techniques; bypass and plaque removal operation
Bypass surgery; is a type of operation performed to restore blood circulation to the limb or organ through a newly created side path by connecting the lower and upper ends of a blocked area. taken from the body itself when performing bypass surgery in the legs and abdomen or artificial veins made of synthetically produced materials compatible with the human body are used. Naturally, the success of the operation varies depending on the length of the obstruction, location, material used and the experience of the surgeon. However, after the correct selection of all these factors, it is a method that prevents limb loss and improves the quality of life for many years.
Plates. cleaning (endarterectomy) surgery; Again, in short blockages or stenoses in areas where stents cannot be placed; It is the process of opening the affected vessel and removing the narrowing or blocking plaques from the vessel wall. It is an effective method that can be performed with local anesthesia and has satisfactory long-term results.
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