Peripheral Vascular Diseases

The vessels that feed the internal organs, arms and legs are called peripheral vessels. Peripheral vascular diseases often occur as a result of narrowing or complete obstruction due to atherosclerosis in the vessels feeding the legs. It is often seen in the vessels feeding the lower extremities. It manifests itself with pain and cramping in the legs with exertion. As the disease progresses, resting leg pain and gangrene develops in the foot.

Frequency and risk factors:

The most important risk factors are smoking and diabetes. It is five times more common in men than in women. Its frequency in the adult population is around 10%. In the elderly, it varies between 12% and 20%. Concomitant coronary artery disease is present in 40-50% of patients. In 15%, there is stenosis in the jugular vein.

Underlying mechanism in peripheral vascular disease

In peripheral vascular diseases, the severity of the clinic is determined by the degree of vascular stenosis and whether the collateral vessels are sufficient or not. Patients with very well developed collateral may not show any symptoms. If the stenosis is over 90%, the pulse cannot be taken. During the examination, pallor, coldness, necrosis or gangrene findings may be detected in the leg.

Diagnosis:

Physical examination is made with ankle/brachial index, DSA (digital subtraction angiography).

Treatment:

Smoking should be stopped, blood pressure, blood sugar and cholesterol should be regulated. The obstruction can be treated percutaneously or surgically. In percutaneous treatment, different techniques are used according to the type and location of the lesion.

In percutaneous transluminal angioplasty, the balloon and/or stent are entered from different regions (groin or arm) depending on the location of the vessel to be treated, and the lesion area is reached with catheters. Before deciding on the procedure, it is very important to evaluate the suitability of the lesion for the procedure. The presence of clots in the lesion area, excessive calcification, excessive tortuosity (folding) in the vessel before the lesion increases the success of the procedure and the risk of complications during the procedure.

In patients with diabetic foot (foot wounds due to diabetes), occlusion usually occurs in the veins below the knee. If there is a wound on the foot, it must be evaluated with angiography, and if appropriate, angioplasty should be performed. Wound treatment is not possible before sufficient blood reaches the foot.

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