Peripheral Vascular Diseases

Peripheral vascular disease; It is a disease that occurs as a result of partial narrowing or complete blockage of the arteries that carry oxygen-rich blood to our arms, legs and internal organs due to hardening of the arteries (atherosclerosis). It is more common in men than women. Atherosclerosis is a natural process that occurs with age in all arteries in our body. Approximately 5-15% of men over the age of 50 have peripheral vascular disease that does not cause any complaints.

Atherosclerosis (Atherosclerosis)

Atherosclerosis occurs when cholesterol sticks to the inner surface of the arteries. Cholesterol particles adhering to the inner surface of the artery cause the hardening of the artery over time, narrowing the inner diameter of the vessel through which the blood passes, or completely occluded. Atherosclerosis is a natural process and begins to occur at an early age. Atherosclerosis may progress with age, depending on other accompanying risk factors. Depending on the area it affects, they cause some complaints in patients.

Risk factors in peripheral vascular diseases

Peripheral vascular diseases are more common in men than women. Risk factors are the same as the causes of atherosclerosis (hardening of the arteries). These risk factors are:

Diabetes Mellitus (diabetes)

High blood pressure (hypertension) or a family history of hypertension

Smoking

Family history of disease related to atherosclerosis (hardening of the arteries)

High levels of LDL cholesterol (bad cholesterol) and triglycerides in the blood

Low HDL cholesterol (good cholesterol) levels in the blood

chronic kidney failure

Overweight or obesity

Symptoms in peripheral vascular diseases

Most people with peripheral vascular disease have no symptoms. When the narrowing of the artery reaches a certain rate (at least 50% of the inner diameter of the artery), it causes complaints depending on the area fed by the artery.

Pain in the legs after walking (Claudication – Intermittent claudication): It is the most common complaint. It is cramp-like pain that occurs in the extremity (hip, thigh, calf) when walking a certain distance. The pain goes away when you rest and comes back when you start walking. The patient has to rest again. That's why it's called 'Intermittent Lameness'. The reason for the pain is the increase in oxygen demand in the extremity used with exercise and the inability to meet the oxygen demand of the tissue by the severely narrowed or occluded artery.

Resting pain: It is an indication of the progression of the disease. Patients try to relax by hanging their feet below the level of the heart due to pain.

Coldness in the legs and feet, feeling cold,

numbness in the legs,

Weakness in calf muscles

Discoloration, bruising on the feet, fingers,

The hair on the back of the feet begins to fall out,

Thickening of the toenails

Foot wound: It usually occurs on the fingers and heels where the body pressure is most on the feet.

gangrene

Diagnosis in peripheral vascular disease

Inspection: It can be put at a rate of 70-80% with a detailed examination.

Examination for pulses in the arms and legs: Weak or no pulses

Blood pressure difference between arms and legs (>20 mmHg difference)

changes in skin color

Changes in nails

shedding of foot hair

Wound: Control of pressure points (toes and heel)

Radiological imaging methods

Doppler Ultrasound

Classical (Conventional) Angiography

CT - Angiography

MRI - Angiography

Treatment methods in peripheral vascular disease

The following should be considered in the treatment of peripheral vascular diseases:

Relief of leg pain caused by exercise or walking,

Increasing the walking distance until pain occurs and thus increasing the exercise capacity of the patient.

Prevention of limb (arm, leg) loss.

Changing lifestyle and diet

Smoking cessation (Nicotine replacement therapy, psychotherapy)

Diet: Lowering blood cholesterol and other fat levels

Keeping blood pressure under control

Keeping diabetes under control (Diabetes treatment should be planned so that Glycolyzed Hemoglobin A1c <6.0%. 1% increase in glycosylated hemoglobin increases the risk of peripheral vascular disease by 28%.

Regular exercise / Walking exercise

With appropriate exercise programs, it is ensured that the muscles use oxygen more effectively. At the same time, it provides the development of side pathways (collateral circulation; a new vessel network consisting of small arterial branches developed beyond the occlusion) in the occluded artery.

Medication

blood thinners

cholesterol-lowering drugs

Drugs that control sugar and blood pressure

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Endovascular interventions (non-surgical procedures)

They are methods used to widen or open narrowed or completely blocked arteries. During the procedure, the artery can be expanded with a balloon or a stent can be inserted.

​Surgical Treatment

Bypass surgery: With the help of a vein or a synthetic vein taken from your leg,