Arteriopathy obliterans | Symptoms, diagnosis & treatment in Turkey

What is arteriosclerosis obliterans?

Arteriosclerosis obliterans, also known as peripheral artery disease (PAD), is a progressive vascular condition. It is characterized by the narrowing or blockage of arteries. This significantly reduces blood flow to the limbs.

As a result, this reduced circulation can lead to:

• Pain and numbness in the legs.
• Difficulty walking.
• Tissue damage in severe cases.

Early detection and treatment are essential. They help prevent complications, improve circulation, and maintain mobility.

Causes of arteriosclerosis obliterans

Arteriosclerosis obliterans results from the gradual accumulation of fatty deposits (atheromatous plaques) inside the arterial walls. This process is called atherosclerosis.

It narrows the arteries over time and is driven by several major risk factors:

• Age and gender: This condition is more common in older adults. Men also face a higher risk of developing it.
• Lifestyle & health conditions: Smoking, high blood pressure, diabetes, high cholesterol, and obesity are major risk factors.
• Family history: A family history of cardiovascular disease significantly increases your personal risk.
• Other medical conditions: Less common factors, such as certain chronic kidney diseases or congenital heart defects, can also predispose you to arterial blockages.

Symptoms and stages of the disease

Symptoms depend on how severely blood flow is reduced. Doctors categorize PAD using four main stages:

• Stage 1 (Asymptomatic): Arteries are starting to narrow. You do not feel any pain yet.
• Stage 2 (Intermittent claudication): You feel muscle pain or cramping in your calves, thighs, or buttocks while walking. The pain goes away after a few minutes of rest.
• Stage 3 (Rest pain): Pain persists even when you are resting, sleeping, or lying down. It often affects your feet and toes.
• Stage 4 (Tissue damage / gangrene): Blood flow is severely blocked. Non-healing sores, ulcers, or dark, dead tissue (gangrene) appear on your feet.

How Is PAD Diagnosed in Turkey?

Before treatment, vascular specialists use quick, non-invasive tests to map your arteries:

• Ankle-brachial index (ABI): A simple test comparing blood pressure in your ankle to blood pressure in your arm.
• Doppler ultrasound: Uses sound waves to show blood flow through your leg arteries in real time.
• CT or MR angiography: Advanced imaging that creates a detailed 3D map of your blockages. This helps surgeons plan your intervention.

Treatment of obliterating arterial disease in Turkey

Treatments for obliterative arterial disease, or peripheral artery disease (PAD),aim to improve blood circulation and relieve symptoms. Therapeutic approaches in Turkey include

Medication treatment

The initial treatment of PAD is based on medications, including:

• Antiplatelet agents: Prevent the formation of blood clots that can worsen arterial blockage.
• Vasodilators: Dilate blood vessels, making it easier for blood to circulate.
• Statins: Lower levels of bad cholesterol (LDL),which may help slow disease progression.

Lifestyle changes

Lifestyle changes play an important role in the treatment of AOMI:

• Smoking cessation: Smoking accelerates atherosclerosis.
• Eat a balanced diet: A diet rich in fruits, vegetables, and fiber and low in saturated fat is beneficial.
• Regular physical activity: Individualized exercise improves circulation.

Surgical procedures

Obliterative arterial disease of the lower limbs (OADL),characterized by narrowing of the leg arteries, may require surgical intervention when medical treatment proves inadequate.
The choice of surgical technique depends on several factors, including:

• The location and extent of the arterial lesions: Affected arteries may be located in the hips, thighs, or calves.
• The severity of symptoms: Pain when walking, wounds that do not heal, etc.
• The patient's general health: Other comorbidities may affect the choice of treatment.

Surgical treatment of IMA

Three main surgical techniques are used to treat IMA:

Angioplasty with or without stent placement

In this procedure, an inflatable balloon is inserted through a small incision, usually in the groin, to widen the narrowed artery. A stent (a small metal device) is often placed to keep the artery open. Stents can be plain or coated with a drug to prevent the narrowing from recurring.

Angioplasty is a less invasive procedure than other techniques and is often done under local anesthesia. However, there is a risk of long-term narrowing of the artery, which sometimes requires further intervention.

Endarterectomy technique

This procedure removes the atheromatous plaque (fatty buildup) that is blocking the artery. It is usually performed on large caliber arteries (hips, thighs).

Endarterectomy is an effective technique for large lesions. However, it is a more extensive procedure than angioplasty, requiring general anesthesia and a larger incision.

Coronary artery bypass surgery

Bypass surgery consists of creating a "detour" using a piece of vein or a synthetic graft to connect the two ends of the diseased artery. This technique is used when lesions are too long or too complex to be treated by angioplasty or endarterectomy.

This technique permanently restores circulation. However, it is a more complex procedure that requires general anesthesia and a longer hospital stay.

The choice of the most appropriate technique is made in consultation with the vascular surgeon, depending on the characteristics of each patient and the disease.

Benefits of surgery

Surgical treatment for peripheral artery disease (PAD),also known as AOMI, aims to achieve several key benefits:

• Relieve pain: By improving blood circulation, walking pain is significantly reduced.
• Promote wound healing: Improved blood flow allows wounds to heal more quickly.
• Prevent complications: Amputation, a serious complication of AOMI, can be avoided with proper treatment.
• Improve quality of life: With improved mobility, patients can resume daily and social activities.
• After surgery, regular monitoring is required to assess the effectiveness of the treatment and to detect any complications. Medications may be prescribed to prevent blood clot formation and reduce the risk of recurrence.

It's important to note that every patient is unique and the results of surgery may vary. Don't hesitate to ask your doctor in Turkey any questions you may have to better understand the different treatment options available to you.