Arterial Surgery

This is a summary of arterial surgery. For more detailed information go to the Arterial Advice Sheets.

There are two main problems that occur in the arterial system. One is narrowing or blockage of the blood vessel, the other is aneurysm formation. The first is known as occlusive disease and it results in a lack of blood reaching the organ that is supplied. In aneurysmal disease the wall of the blood vessel thins so that it enlarges and may eventually burst with the loss of much blood. Rupture of an abdominal aortic aneurysm (AAA) is very serious and is the best known example.

Aging, smoking and diabetes are the main risk factors for both occlusive and aneurysmal disease of the arteries. High blood pressure, cholesterol and heredity also contribute. It is difficult to do much about ageing or your genes but you can stop smoking!

Occlusive disease in the lower limbs : blocked or narrowed arteries supplying the lower limbs may lead to intermittent claudication (pain in calf, thigh or buttock muscles on walking), severe pain in the foot at rest (‘rest pain' or ‘night pain') and ultimately gangrene for which there may be no alternative to amputation.

The commonest reason for referral to an arterial clinic is intermittent claudication. Most patients require advice about lifestyle rather than angioplasty, stenting or operation. For more information go to the Advice Sheets.

Occlusive disease in the upper limbs is less common . The most frequent event is a clot (embolus) travelling from the heart in an elderly person who has atrial fibrillation (irregular heart beat). Urgent surgery may be required to remove the obstruction and restore blood supply.

Aneurysms

An aneurysm of the abdominal aorta, the main artery coming from the heart, is the most common problem. It is about 10 times more common in men than women, unusual before 65 and mainly occurs in smokers. Surgery is only contemplated when the aneurysm is more than 5.5cm in diameter. When it is less than 5.5cm the risk of surgical intervention exceeds the very small risk of rupture of a small aneurysm.

Patients with AAA need careful investigation and often just monitoring. About 80% of these operations in Brighton are now done by the endovascular technique (EVAR). For more information go to the Advice Sheets.

Stroke and TIA

TIA's are transient ischaemic attacks or ‘mini-strokes', meaning that the symptoms are transient (fully recovered within 24h). Urgent investigation and treatment are essential as there is a serious risk of major stroke and permanent disability. Stroke and TIA can be caused by disease in the carotid arteries in the neck, supplying the brain. In some patients timely carotid endarterectomy can stop the TIA's and prevent major stroke. The operation involves opening the artery in the neck and clearing out the disease (atheromatous plaque) to improve the channel and enhance blood flow to the brain.