Description of the Disease
Atherosclerosis is a chronic disease of elastic and muscle-elastic type arteries, resulting from disturbances in lipid metabolism and accompanied by the deposition of cholesterol and some fractions of lipoproteins in the intima of blood vessels.
Deposits form as atheromatous plaques. Subsequent growth of connective tissue in them (sclerosis) and calcification of the vessel wall lead to deformation and narrowing of the lumen, up to closure (occlusion).
Cause of the Disease
Atherosclerosis is a disease affecting the arterial system of the human body, having a complex nature and based on genetic predispositions to disturbances in cholesterol metabolism and its deposition in the walls of blood vessels. The main cause of mortality and disability in the adult population of our planet is cardiovascular diseases caused by atherosclerosis.
Atherosclerosis is the process of cholesterol deposition in the vessel wall, and the formation of atherosclerotic plaques, causing narrowing of the artery, reducing blood flow to the organs (ischemia), and subsequent thrombosis with complete occlusion of the artery. Blood flow stops, and part or all of the organ dies.
ALL arteries are susceptible to atherosclerosis. Most often affected are the arteries supplying the heart muscle - coronary arteries, supplying the brain - brachiocephalic arteries, arteries of the upper and lower extremities, as well as the aorta and its branches.
Classification of the Disease Forms
Atherosclerosis is a systemic disease affecting all arteries, however, depending on the predominance of atherosclerosis severity in one or another group of vessels, it is divided into:
- Atherosclerosis of coronary arteries (causing ischemic heart disease and angina pectoris, the outcome of which may be myocardial infarction).
- Atherosclerosis of brachiocephalic arteries (causing chronic insufficiency of cerebral blood flow, the outcome of which may be a stroke).
- Atherosclerosis of the aorta, iliac arteries, and arteries of the lower extremities (causing intermittent claudication, the outcome of which may be gangrene of the lower limb or fingers).
- Atherosclerosis of the visceral branches of the aorta (impaired blood flow in internal organs, the outcome of which may be intestinal infarction, kidney, etc.).
- Multi-focal atherosclerosis (lesion of several groups of vessels).
Diagnostics of the Disease
- Color duplex scanning.
- Multispiral computed tomography angiography.
- Direct X-ray contrast angiography.
Types of Surgical Treatment
- Removal of an atherosclerotic plaque by open surgery on the vessel.
- Expansion of the vessel lumen from the inside with special instruments and installation of a metal frame to prevent further narrowing.
- In case of complete closure of the vessel lumen by a plaque - bypass surgery (creation of a bypass blood flow).
The decision to prescribe surgical treatment is made when the risk of developing disabling complications without surgery exceeds the development of such complications after surgery.
Important to Know!
Atherosclerotic plaques do not 'dissolve'.
The purpose of surgery for atherosclerosis is to combat serious complications.
Every complaint always has a cause.
Treatment of the Disease
Treatment of atherosclerosis can be done in three ways:
1. Endovascular Interventions
If atherosclerosis affects a vessel over a small distance, narrowing of the artery can be eliminated from the inside. Under local anesthesia, without incisions, special balloons are introduced into the artery through a puncture.
Under pressure, the balloon expands at the site of narrowing, restoring the normal lumen of the artery. To prevent re-narrowing, a permanent metal device - a stent - is placed in the artery.
2. Surgical Treatment
Performed in cases of multiple, extensive atherosclerotic lesions of arteries. Using microsurgical techniques, a new path for blood flow is created around occlusion or stenosis of the artery from the patient's own vein or synthetic prosthesis. This is called bypass surgery.
It is also possible to remove local plaques from the artery - endarterectomy.
In patients with 'clogging' of the vessel for a length of no more than 7-9 cm, removal of the inner altered layer of the artery with an atherosclerotic plaque and blood clots is performed (endarterectomy).
In case of more significant spread of occlusive process, pronounced deposition of calcium in the artery wall, it is indicated to create a bypass blood flow (bypass) or resection of the artery segment with replacement by a synthetic prosthesis or biomaterial (prosthetics).
3. Hybrid Operations
These are operations that combine surgical intervention and endovascular procedures. Hybrid operation is indicated for 'multi-storey' narrowing of arteries at different levels, when there is damage to the arterial bed at different levels. Such procedures are performed in the operating room using contrast angiography.
In case of lesions of the iliac and femoral arteries, a hybrid operation allows for local removal of plaque from the femoral artery (endarterectomy) and simultaneous endovascular expansion of the iliac artery with subsequent stenting, instead of a more traumatic aorto-femoral bypass.
In the presence of an abdominal aortic aneurysm, hybrid techniques allow for endovascular repair of the aorta with a special stent-graft from a small access on the thigh, instead of traditional aorto-femoral bypass surgery through the abdominal cavity.
In case of stenosis of the brachiocephalic arteries, a combination of endarterectomy and stenting is used under conductive anesthesia conditions.