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Arterial Pathology

Symptoms and signs, diagnosis and treatment of several arterial diseases, overwhelmingly dominated by one arterial pathology: atherosclerosis.


Atherosclerotic obstructive arterial diseaseChronic lower limb ischaemiaExtracranial cerebrovascular diseaseAortic and peripheral aneurysms
A Atherosclerosis is the main cause of suffering and disability of the peripheral vascular disease patient, making it a significant part of vascular surgery care and intervention. It is a progressive disease. Arteries harden and narrow, so that in some areas blood circulation is completely blocked. Cerebrovascular disease; mesenteric ischaemia; renovascular hypertension; upper and lower limb ischaemia.
When affected the arteries of the lower limbs the patient may experience intermittent claudication (pain in legs when walking), hair loss, atrophy of nails and muscles and even impotence. Critical conditions may arise in advanced stages, such as non-healing ulcers which may culminate in cases of gangrene in the limbs. Many patients require revascularization procedures on the limbs, which may take the form of direct surgery (unblocking of arteries, bypass) or endovascular procedures (angioplasty/stenting).
Extracranial cerebrovascular disease and consequent revascularization surgery, from the carotid and supra-aortic trunks, may help avoid a significant number of strokes before cerebral infarction occurs. Carotid arteries and vertebral arteries, located in the neck, provide the bloodflow to the brain. The clogging (stenosis) of these arteries may cause stroke. Symptoms may include visual disturbance, transient paralysis and fainting (transient ischaemia attack) or neurological deficit (cerebral infarction). When these symptoms are observed, their causes must be identified as soon as possible in order to begin treatment. To this end, there are various additional diagnosis methods available, such as the carotid Doppler ultrasound scan, CT scan, MRI and arteriography. Treatment may be medical or surgical, depending on the degree of clogging of the arteries and the seriousness of the clinical situation.
Aortic and peripheral aneurysms are also manifestations of degenerative atherosclerosis of the artery wall. The definition of aneurysm is the abnormal and permanent dilation of a certain segment of the artery. Any artery may be affected by this disease, however it is the infra-renal segment of the aorta which is most commonly affected by this condition. Aortic aneurysm is generally asymptomatic. The main complication is rupture, a situation which is always extremely serious and which may culminate in the patient’s death. The growth of the aneurysm is progressive, but the rhythm with which it occurs is unpredictable. The appearance of symptoms, especially pain, may predict the occurrence of rupture. Diagnosis of aortic aneurysm is based on clinical data and requires a high level of suspicion supported by a complete and detailed physical examination. Elective treatment, whether by conventional surgery or endovascular approach (both good options depending on the patient), leads to minimal complications. Peripheral aneurysms are much less common than aortic aneurysms, but occasionally they occur in association with aortic aneurysms, especially with aneurysms of the popliteal artery. Timely treatment avoids serious complications such as thrombosis leading to acute lower limb ischaemia, rupture and compression of adjacent structures.



Aortic dissection
Aortic dissection, which is closely linked to arterial hypertension, is a very complex and serious condition. The key points regarding this disease are the need for timely recognition of the clinical situation and the adoption of a multidisciplinary approach in the different stages of the progression of the disease.
Arterial embolism
Arterial embolisms is, in the vast majority of cases, secondary manifestations of a cardiovascular disease. Their occurrence always constitutes a major emergency requiring immediate therapeutic attention. The clinical complexity of the patient demands versatile care far beyond the simpler methods associated with timely resolution of the acute condition.
Angiitis, inflammatory arteriopathy and degenerative arteriopathy
Angiitis, inflammatory arteriopathy and degenerative arteriopathyare rare clinical conditions whose treatment and follow-up involve various medical specialists. Vascular surgery normally treats complications involving clogged arteries and aneurysm.
Vascular compression syndromes
Vascular compression syndromes, the most common of which is thoracic outlet syndrome, are normally accompanied by neurological symptomatology resulting from compression of the nervous structures in contiguity with arteries. The normal method of treatment is medical, with surgical intervention reserved for cases where medical therapy proves ineffective.
Vascular malformation
Vascular malformations, classified as arterial malformation, arteriovenous malformation and venous malformation, are extremely complex clinical conditions with ill-defined pathogenesis, sometimes causing extensive and serious general repercussions. Treatment is discussed individually and is rarely surgery.