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: the condition is more common in older adults, and men are more affected before age 70.
• Lifestyle and health conditions: smoking, high blood pressure, diabetes, high cholesterol and obesity are major risk factors.
• Family history: a close relative with PAD, heart attack or stroke increases your risk.
• Other conditions: less common factors include chronic kidney disease, inflammation of the blood vessels (vasculitis) and previous pelvic radiotherapy.

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

Treatment is adapted to your stage, symptoms and general health. The first line is risk-factor control and supervised exercise; revascularization is considered when these are not enough.

Medication and lifestyle

• Antiplatelet therapy and statins slow the disease and protect the heart. Blood pressure and, in diabetic patients, blood sugar are also controlled.
• Supervised walking exercise is recommended as first-line treatment of claudication and improves walking distance.
• Stopping smoking is the most effective measure to slow progression.

Some drugs sold for leg pain, such as vasodilators or pentoxifylline, are not recommended in guidelines for claudication, and cilostazol must not be used in heart failure. Never start or stop a medication on your own: your doctor decides.

Surgical and endovascular procedures

Revascularization is discussed when claudication remains disabling despite several months of medical treatment and walking, and it is needed in critical limb ischemia (pain at rest, non-healing ulcer, gangrene). The choice depends on:

• The location and extent of the arterial lesions (hip, thigh or calf arteries).
• The severity of symptoms: walking pain, wounds that do not heal.
• The patient's general health and other conditions.

Surgical treatment of IMA

Three main approaches are used to treat PAD when medical treatment is not enough.

Angioplasty with or without a stent

The surgeon accesses the femoral artery (in the groin) through a puncture. A catheter with a small balloon widens the narrowed artery, and a stent (a small metal mesh tube) may be placed to keep it open. It is minimally invasive and often done under local anesthesia, but the artery can narrow again, which may require a new procedure.

Endarterectomy

The surgeon opens the artery and removes the plaque that blocks it. It is used for localized lesions, for example in the common femoral artery. It is a more extensive procedure than angioplasty and usually needs regional or general anesthesia.

Bypass surgery

A "detour" is created with one of the patient's own veins or a synthetic graft to bypass the blocked segment of the leg artery. It is mainly used for long or complex blockages. It is a larger operation with a longer hospital stay, and the graft can block over time, so regular follow-up is needed.

The choice of technique is made with the vascular surgeon according to the patient and the lesions.

Benefits of surgery

Surgical or endovascular treatment of PAD can offer benefits when medical treatment and supervised exercise are not enough, or when the disease is severe:

• Relieve symptoms: by improving blood flow, walking pain may decrease.
• Promote wound healing: better blood supply can help wounds heal.
• Reduce the risk of complications: in critical limb ischemia, revascularization aims to avoid amputation, without guaranteeing it.
• Improve mobility: some patients regain a better walking distance.

After the procedure, regular monitoring is required to assess the treatment and detect complications. Medication is prescribed to lower the risk of clots and recurrence: never stop it on your own, the decision belongs to the prescribing doctor.

Every patient is unique and results vary. Ask your doctor in Turkey any questions you may have.