Arterial disease takes different forms and the sooner it is diagnosed, the better the outcome, according to leading consultant vascular surgeon, Michael Gaunt. Mr Gaunt, who runs clinics within hospitals in Cambridge, Bury St Edmunds and Harley Street in London, highlights what to look out for and when to seek specialist advice
What is arterial disease?
The arteries are the main blood vessels in the body and supply oxygenated blood to the body. If they become blocked, then the consequences can be serious. If the arteries to the heart become blocked, you have a heart attack; if the arteries to the brain become blocked, you have a stroke. If the arteries to the legs are blocked, then at the mildest end you can’t walk as far because your muscles run out of oxygen and cramp up. This is called intermittent claudication.
What are the symptoms of this form of arterial disease?
If the arteries are slowly furring up and narrowing, then intermittent claudication, which is a very specific type of pain, could be the first sign. A patient will typically set off on a walk and at a certain distance down the road their calf, thigh or buttock becomes tight and painful and they eventually have to stop. Within a few minutes of stopping, the pain will ease and then they can walk that same distance before it happens again. The person might then notice the distance they are able to walk becomes shorter and shorter over a period of time. Another sign might be if someone gets a small cut that won’t heal. Healing tissue requires 10 times the amount of blood so a wound that won’t heal or develops into an ulcer may indicate an underlying problem with the arteries.
‘The arteries are the main blood vessels in the body and supply oxygenated blood to the body. If they become blocked, then the consequences can be serious’
What are the treatments for this form of arterial disease?
If people come to me as soon as possible then there are lots of things we can do to improve the symptoms. What is important to recognise is that if you have any of these signs then you may well have furring up of all your arteries, including those that go to the heart and brain. Peripheral arterial disease can turn nasty very quickly and if they do nothing about it, 30% of sufferers will be dead from a heart attack or stroke within five years.
Treatment might include statins to reduce cholesterol in the blood; aspirin to decrease the stickiness of the blood to prevent a blockage; or medication to reduce blood pressure. Other options might include angioplasty or stenting. If things get really bad and people can’t walk at all or have developed gangrene, then they might need an operation. In the early stages of claudication, once you have corrected all the risk factors with medication, then an exercise regime and weight loss can improve the symptoms.
Are there other forms of arterial disease to be concerned about?
Yes. The other major problem is where the arteries become weakened and a person develops an aneurysm. The most common one is the abdominal aortic aneurysm and if this ruptures you can die. This is a common cause of sudden death, which is why there is a national screening programme for men over the age of 65. Aneurysms can occur elsewhere in the body too, however.
The problem here can be that you don’t get any other symptoms, which is why having a simple ultrasound scan if you are at risk can be a good idea. There are some people who do have both forms of arterial disease at the same time – the narrowing or blocking of an artery and an aneurysm. Aneurysms can rupture or they can develop a clot inside which then embolises and blocks other arteries.
What is the treatment for an aneurysm?
Surgery is an option, but it is a balance of risk – you have to wait until the aneurysm gets to a certain size (usually 5.5cm) when the risk of rupturing becomes greater than the risk of just leaving it. If people have a high risk because of other medical conditions, then the decision may be taken to watch and wait. Aspirin and statins are again used as treatments here and it is also very important to keep blood pressure low to reduce the risk of rupturing. We also always say it is never too late to stop smoking, improve your diet and start exercising. However, with aneurysms, it is very important not to do any heavy lifting as that increases blood pressure.
Who is at risk of developing arterial disease?
Smokers and those with high cholesterol have a higher risk of narrowing and blocking, but unfortunately this form of arterial disease is also associated with type 2 diabetes, which is linked to obesity. And, although people now smoke less, the level of obesity in society has gone up. Risk factors with aneurysms can be genetic. If a man’s father has had one, then he has a 30 to 50 per cent chance of developing one; in a woman this will be 10 per cent. This is why when you reach middle age, it is well worth having a scan, if someone in the family has had an aneurysm or you are at risk for another reason.
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