Dr. Saliveros Apostolos

The vessels that carry the blood from the heart to the legs are called arteries. Peripheral arterial disease is the situation when the arteries of the legs are blocked or stenosed and the amount of blood (and oxygen) that reaches the peripheral tissues is not sufficient to sustain the viability of the tissue. The main two reasons for blockage is embolism and severe atheromatosis. Usually embolism is from cardiac arrythmia and the result is acute pain, pale colour, cold leg and diminished muscle  power of the infected leg. This is an emergency situation and the patient must be treated immediately in a vascular department (he needs embolectomy that is removal of the thrombus so the blood can flow freely again and avoid gangrene).

Atheromatosis is the formation of plaques inside the arteries in people that usually are diabetic, smokers, hypertensive or have high levels of cholesterol. When the plaques grow enough they cause stenosis of the lumen of the vessels and compromise the blood flow. The patient is having difficulty walking after a distance because of pain in the leg due to ishcemia and he has to stop for a few minutes for the pain to go away (this is called intermittent claudication). The therapy of this situation is conservative with drugs and exercise or surgical in more severe situation. The surgical approach can be endovascular (ie stents or balloon dilatation) or classic surgery (ie atherectomy or bypass).

The carotid arteries (together with the vertebral arteries) are the main arteries of the neck that supply the head (and the brain) with oxygenated blood. There have been extensive studies that established the relationship between atheromatosis of the carotid arteries and ischemic episodes of the brain.

There are two mechanisms causing brain infraction. 1. Severe stenosis of the lumen of the artery eg > 90% and 2. Embolism is when small pieces detach from the atheromatic plaque go in the brain and cause infarction of the brains vessels. So it is vital to know if there are atheromatic plaques in your carotid arteries. The diagnosis is very simple with the ultrasound.

Especially people who smoke, are diabetics, are hypertensive, have high cholesterol and of course people who have heredity of ischemic episodes.

Therapy of the carotid plaques : according to the percentage of stenosis or the risk of embolism there are two ways of addressing this problem. Treatment with what we call best medical therapy (that is changing the lifestyle and give medical drugs that protect the patient from suffering a stroke). And surgery that removes the high risk plaques from the carotid artery.

digital angiography of a carotid with significant stenosis of about 80%

the atheromatic plaque that was removed from that artery.

Diabetes can cause complications arising from hyperglycemia that can either be macrovascular or microvascular. The macrovascular disease affects mainly the cardiovascular and cerebrovascular systems, and the microvascular disease includes nephropathy, retinopathy, and neuropathies. A debilitating complication of diabetes mellitus is diabetic ulcers, which leads to increased overall morbidity in patients and the inciting factor is most often a minor trauma.

Arteriopathy is caused mainly by atheromatosis which is the formation of plaques inside the arteries in people that usually are diabetic, smokers, hypertensive or have high levels of cholesterol. When the plaques grow enough they cause stenosis of the lumen of the vessels and compromise the blood flow. As a result the tissue may not be viable and there is necrosis and thus an ulcer is formed.

In patients with ulcers it is necessary that a vascular surgeon examines them so as to find the cause of the ulcer. If there is a problem in macrovascular level that can be fixed it is of outmost importance to fix it (either with surgery or endovascular techniques) so as to restore the proper flow to the leg. If the problem is in microvascular level then the patient should be given instructions for changing lifestyle (healthy diet and exercise), control all the factors that cause atheromatosis (ie blood sugar levels, arterial blood pressure, levels of lipids in the blood), proper care of the feet (special ointments, correct cutting of nails etc) and of course pharmaceutical treatment.

The blood is carried from the heart to all the parts of our body by the arteries and the biggest artery is the aorta which starts from the heart and ends inside the abdomen near our belly button. The aorta is in fact an elastic tube that carries blood under pressure. Sometimes this elastic tube looses its strength and expands in diameter (from 2 cm diameter which is the normal it can reach 5,6,7 or more cm). The wall of the aorta then becomes fragile and there can be a rapture causing the blood to come out of the aorta and spread inside the abdomen. As a result the patient is in shock with high probability of loosing his life from hemorrhage. Thats why is very important to know if someone has aneurysm.

The diagnosis is very simple. All we need is an ultrasound of the abdomen checking the abdominal aorta.

The reasons why the aorta expands in diameter are mainly two : heredity and smoking. So it is advised that people who have a relative with aneurysm or smoke check the dimensions of their abdominal aorta with ultrasound.

The treatment is by open surgery or endovascular repair (stent).