The function of the veins in our body is to carry the oxygen the body needs to the relevant organs and to deliver the used products back to the excretion-cleaning organs. There are differentiated vessels in our body to perform this function. We call the systems carrying clean blood "artery" and the systems carrying dirty blood "venous". There are also vascular structures called "lymph" in our body, which are used to transport defense cells.
Risk factors:
• Smoking
• Hyperlipidemia
• Hypertension
• Diabetes/impaired glucose tolerance
• Genetics
• Obesity
• Hyperhomocysteinemia
• Rheological changes
Symptoms
Classified as clinical stages (Fontaine)
• Stage 1 Asymptomatic, no complaints
• Stage 2. Claudication (Pain that occurs when walking a certain distance)
– It is cramp-like
– 2-5 minutes with rest It also passes,
– The location of the pain changes depending on the location of the obstruction,
– Walking distance becomes shorter over time
– Pulse rates are generally decreased, but may also be normal
• Stage 3. Rest pain
• It usually starts at night
• It comes with lifting the foot up
• It then becomes permanent
• It is usually accompanied by ischemic scarring and gangrene at the ends
• No definite pulse can be taken
• Stage 4. Ulceration/Gangrene
– There is pain at rest
– Gangrene of the skin
– Ischemic wound
Diagnosis:
-Laboratory tests: information is obtained about blood lipids, sugar level and blood clotting factors .
-Physical Examination: The appearance, temperature and pulse of the extremity are checked.
-Color Doppler USG: It is a non-invasive test, it is common, cheap and easy to apply.
-MRI angiography
-Conventional angiography
Treatment: The aim of treatment is to eliminate symptoms, relieve pain, and control systemic atherosclerosis complications.
Treatment is continued in 3 arms.
1.Reducing risk factors; The most important treatment step is to quit smoking in smokers, to control diabetes if there is any, to apply diet and drug therapy to normalize blood lipids, and to control hypertension. Walking exercises should be recommended to the patient.
2.Medication
Aspirin
Pentoxifylline
Clopidogrel
Diltiazem
Diltiazem
p>Drug selection and combination are determined according to the patient. rhrfhhhh
3.Interventional (Endovascular) procedures: providing blood supply by opening the narrowed vessel with a stent
4.Surgical Treatment:
-Bypass methods: It can be applied in many different ways depending on the patient's angiographic results and vascular structure;
Aortabifemoral bypass
Aortailiac bypass
Iliofemoral bypass
;Femoro-femoral bypass
Fematopopliteal bypass
Popliteodistal bypass
-Thromboendarterectomy: Removal of the plaque that causes vascular occlusion.
>-Sympathectomy: Resolving the spasm in the vein as a result of cutting the sympathetic nerves through surgery and catheter.
Acute arterial diseases:
Vessel occlusion sometimes occurs suddenly. This is called acute arterial occlusion. Trauma, lacerations and embolism are the most common causes of acute arterial occlusion. Embolism, the source of a clot can be the entire circulatory system; It occurs when the artery (aorta, mitral valve, left atrium) suddenly blocks the blood flow. Whatever the reason, it is essential to urgently provide blood to the extremity whose blood supply has stopped due to vascular occlusion or incision. With surgical intervention, the clot in the vein is removed and circulation is restored. If the vein is damaged, the vein is repaired using an artificial vein. In rare cases, especially in late cases, if tissue death and gangrene has developed, amputation may be necessary.
BUERGER'S DISEASE (THROMBOANGITIS OBLITERANS)
It is known as the disease of young men who smoke. It is an occlusive vascular disease that often occurs in young male smokers, starting from the end arteries in the legs and progressing to the main vessels above. Often veins and nerves are also involved. Leg pain, coldness in the leg, and recurrent superficial inflammatory attacks occur with walking. In later periods, rest pain begins. Wound formations and gangrene are frequently observed. Exacerbation of the disease can be prevented to a large extent by quitting smoking in the early period. Surgical intervention is limited in these patients.
Risk factors
• Male/Female: 3:1
• Age: 20-45
• Smokers
Complications
• Ulcerations,
• Gangrene
• Chronic pain
• Need for amputation
Treatment
• Definitely quitting smoking ,
• General precautions
– Foot care
– Avoiding cold,
– Avoiding vasoconstrictor drugs
• Prostaglandin infusion
– Improves symptoms
– Accelerates the recovery of trophic changes,
– Reduces the risk of amputation
• Thrombolytic therapy
• Antibiotics and analgesics
Surgical Treatment
• Distal bypass
• Sympathectomy
• Medulla spinalis stimulation
• Amputation
• Distal arteriovenous fistula (?)
Carotid artery (cervical carotid artery) diseases:
Carotid arteries are the artery system that carries blood to the brain and can be affected by atherosclerosis like all other vessels and narrowing may occur. The findings vary depending on the degree of obstruction. Dizziness, flashes of light, fainting, and temporary visual disturbances may occur. Sometimes the patient may present with partial or complete paralysis as a result of sudden obstructions. Color Doppler ultrasonography is a very valid diagnostic method in terms of identifying both the diameter of the stenosis and the characteristics of the lesion. With the accompanying MRI angio, the vessel is visualized better and possible end vessel occlusions are shown. As a treatment, after checking whether there is any other accompanying disease, the artery is found through an incision in the neck area and the plaque (atheroma plaque) due to atherosclerosis in the artery is removed (carotid endarterectomy). It is often associated with coronary artery disease and other peripheral artery disease. If coronary artery bypass surgery is required in people with coronary artery disease, carotid endarterectomy can be performed before open heart surgery, in the same session during open heart surgery, or after.
Venous diseases (veins) :
Varicose Vein Disease:
There are two main vein systems in our legs that serve to carry dirty blood up. is found. The systems called superficial and deep vein systems are connected to each other through connections called "perforators". While there is a strong heart pump effect in the arteries that keeps the blood moving forward, unfortunately there is no such pressure support in the veins. Venous blood also reaches the right heart by the vacuum effect of the heart against gravity, thanks to the movements of the muscles and the valves in the veins. When the structure of the veins is disrupted due to various factors, the veins stretch, widen and varicose veins occur.
Varicose veins are the irreversible and abnormal enlargement of the veins. These veins appear as blue and curled swellings under the skin in the feet and legs, and complaints increase with standing and sitting for long periods of time. Varicose veins can be seen in 15-20% of the male population and 30-35% of the female population at different stages of life.
As varicose veins progress, complaints of pain and pressure in the feet occur. Untreated late-stage varicose veins may cause wounds on the ankles.
Risk factors:
1.Genetics: The incidence increases in those with a family history of varicose veins. .
2.Pregnancy: During pregnancy, hormonal changes, excessive water retention and the baby's head shaking may cause varicose veins. These may return to normal after pregnancy. Sometimes they can be permanent, and permanent varicose veins may occur with repeated pregnancies.
3. Standing and working standing for long periods of time
4. Excessive weight
5. Birth control pills
6. Smoking
7. Age: Varicose veins can be seen at any age, and the incidence of varicose veins increases with age.
8. Varicose veins may appear during menstruation in women or may only cause complaints in these cases. ..
Complaints:
1.They cause cosmetic discomfort
2.Pain and burning: Pain increases, especially when standing or sitting for a long time
3. Edema: Depending on the degree of the disease, edema is temporary at first and may become permanent later.
4. Infection: Superficial thrombophebitis may develop. pain and redness. sensitivity increases.
5. The risk of clot formation in enlarged vessels increases, which may cause pulmonary embolism.
Diagnosis:
Physics?
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