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Peripheral Arteria Disease Treatments

Treatment for the peripheral vascular system has advanced dramatically in this century, with the development of endovascular treatments such as stent grafts for aortic aneurysm. Percutaneous vasodilation for obstructive arteriosclerosis and stent placement are now also becoming first choice treatments for the pelvic and thigh regions. However, in complicated lesions and in areas below the knee, satisfactory results can not be obtained with endovascular therapy alone. Conversely, by limiting therapy to endovascular alone, there is even a risk of passing over the best treatment and timing,
In our department, various treatment methods such as endovascular treatment, surgical treatment, medication therapy, etc. are possible, and we choose the best treatment method or combination for each patient, aiming to the greatest extent possible for a return to normal life without unnecessary burden.
Lastly, angiogenesis therapy is highly promising as a potential treatment for lower limb ischemia in the future, but at present stable results have not been achieved as a regular form of treatment. Our department has been involved in multiple studies intended to test feasibility of practical use in the near future.

Carotid Stenosis

This is a disease caused by arteriosclerosis in the carotid artery bifurcation in the neck and may cause cerebral infarction. Treatment is necessary when a carotid ultrasonography reveals symptomatic stenosis of 50 to 99%, or 70 to 99% when asymptomatic.

Treatment is with carotid endarterectomy (CEA) or carotid artery stenting (CAS). Safely preventing cerebral infarction is the goal of treatment, and presently CAS has a high perioperative cerebral infarction rate, while CEA is considered much better. However, there are cases where the risk of CEA is high, and it is necessary to select a treatment case-by-case.

Percutaneous angioplasty (CAS)

Visceral Aneurysm

Abdominal Aneurysm

Abdominal visceral aneurysm is a relatively rare peripheral aneurysm, but when exceeding double the normal diameter, the wall will become too thin, leading to rupture, or formation of a thrombus that could shoot out and cause embolism. Although endovascular treatment has been increasing in recent years, bypass surgery may be necessary depending on the location of the aneurysm.

Acute Mesenteric Artery Occlusion

Acute mesenteric artery occlusive disease has few characteristic clinical symptoms. Necrosis and perforation due to extensive ischemia of the intestinal tract occur suddenly, so the survival rate is extremely low. The cause is usually embolism and artery dissection caused by atrial fibrillation. Diagnosis and treatment before intestinal infarction can be treated with a low mortality rate, but the mortality rate reaches 70 to 90% if intestinal infarction occurs.
Recently, there has been a tendency for blood vessel reconstruction to be given priority in areas that can be treated promptly, but intestinal resection is also necessary when intestinal infarction is suspected, so revascularization by bypass surgery may also be performed.

Renal aneurysm

Acute Lower Limb Ischemia

This is a condition in which the blood flow to the lower extremities drops sharply.

It may be caused by a worsening in a chronic vascular lesion (e.g. arteriosclerosis obliterans) leading to total occlusion, or by embolism due to a thrombus formed by atrial fibrillation, or in the central artery. Symptoms include a feeling of coldness, sharp lower limb pain, and when it progresses, sensory abnormalities and motor paralysis occur. Although embolism is more likely to become severe, urgent revascularization is required in both cases.

Depending on the condition, it may be possible to respond with pharmaceutical therapy, but in other cases there is a requirement for revascularization by prompt surgery.

If the ischemia is severe, necrosis, movement disorders, and sensory disturbances may remain.

In our department, in order to respond more quickly, we are working closely with related hospitals to strengthen our network and minimize the time between diagnosis and treatment.

Right lower limb acute ischemia

Peripheral Arterial Occlusive Disease

In recent years, the number of patients with diabetes and chronic kidney disease has increased due to a Westernization of lifestyle habits. Along with this, patients with peripheral arterial disease (PAD) are also increasing.

PAD is a disease in which the arteries of the lower extremities are stenosed or obstructed usually due to arteriosclerosis, resulting in a circulatory disorder. As the blood flow gets worse, symptoms appear, such as gait disturbance, lower limb pain, and intractable ulcers, which seriously affect quality of life (QOL). Symptoms begin with intermittent leg pain, presenting after walking a certain distance, and recovering upon rest. As the condition worsens, the distance grows shorter, until eventually the pain is present even when resting. If the disease progresses further, ulcers and necrosis will occur.

Usually, because the ischemic state involves pain, PAD is discovered before progressing to ulceration or necrosis, but in patients with diabetes the pain sensation may be dulled by peripheral nerve disorder, so PAD may not be discovered until after necrosis.

Also, arteriosclerosis is a systemic disease, and is often associated with coronary artery disease and cerebrovascular disease, and so discovery shortens life expectancy.

Catheter treatment


Left : Lower limb artery bypass surgery (femoral-popliteal artery)

Right: Distal bypass surgery (femoral-posterior tibial artery)

Peripheral Aneurysm

This is a condition in which the artery of an extremity becomes lumpy. Unlike aortic aneurysms, there is a high risk of becoming a thromboembolic source due to the risk of rupture, and in some cases preventive treatment may be required.

In general, it is difficult to deal with using endovascular treatment, and it is necessary to visit a facility where vascular surgical treatment is possible. We and our related facilities have plenty of experience in dealing with these problems.

  • Popliteal aneurysm

  • Adventitial cyst

  • Popliteal artery entrapment syndrome

Thoracic Outlet Syndrome

This disease has a series of symptoms caused by pressure on blood vessels and nerves at the space between the collarbone and first rib (thoracic outlet). It is said to be cause by anatomical change due to an external trauma such as in a traffic accident, or in sports. It is divided into three types, nervous (97%), venous (2%), and arterial (1%), and there is a possibility that neurological disabilities will not improve if it progresses to a blood circulation disorder, so early diagnosis and treatment are necessary.
Tenderness of anterior scalene muscles, increasing pain in the arm when raised to 90°, and attenuation of the pulse in the radial artery are some of the observed symptoms. Diagnosis is by simple x-ray examination for the presence of cervical ribs, dysplasia, or callus formation on the clavicle or ribs. Treatment involves removing some of the bone causing the compression, or bypass surgery to relieve the compression site.

Deep Vein Thrombosis

Not visible on the surface of the skin, these deep veins exist around organs, and in the arms and legs. Blood clotting (thrombosis) in these vessels is known as deep vein thrombosis (DVT). For anatomical reasons, it is most likely to occur in the lower limbs. When DVT occurs, it causes a disturbance to blood flow, leading to swollen feet, pain, and redness. DVT occurs suddenly, but there are a number of factors known to increase the risk, including surgery, long periods of immobility, hormone or steroid therapies, and diseases that increase the likelihood of blood clotting, such as hereditary thrombophilia and collagen diseases.

Deep vein thrombus in the thigh (CT image)

Lower Extremity Varicose Veins

Varicose veins in the lower limbs is a condition in which the blood vessels on the surface of the legs and feet bulge out. It is commonly observed in pregnant women, and patients who must stand for long periods at work.

It causes symptoms such as swelling, heaviness, and cramps in the legs and feet. Although even untreated for many years it is not life-threatening, the skin may become discolored and hard, sometimes leading to ulceration. Therapy involves a reduction in standing time, and use of tight elastic stockings. If there is no improvement in symptoms, surgery may be necessary. Recently a catheter-based procedure known as endovenous ablation has become available.

Post-procedure, the patient may even be discharged on the same day, and be able to quickly return to their normal lifestyle.

Varicose veins

Vascular Access for Peripheral Aneurysm

There are currently more than 300,000 dialysis patients, most of whom are treated by haemodialysis. It is of great importance to achieve and maintain sufficient vascular access to continue haemodialysis treatment safely.
Treatment of dialysis patients who are troubled by vascular access related complications such as steal syndrome (DASS) and venous hypertension can be handled at associated hospitals, so please do not hesitate to consult us.
In our department and associated hospitals we are working to achieve vascular access, to the greatest extent possible, using blood vessels taken from the patient themselves.

ASSOCIATED HOSPITALS

Suita Tokushukai Hospital –Dept. of Vascular Surgery

Osaka Rosai Hospital –Dept. of Peripheral Vascular Surgery

Toyonaka City Hospital –Dept. of Cardiovascular Surgery

JCHO Hoshigaoka Medical Center

Japan Seafarers Relief Association Hospital (Kobe) –Dept. of Surgery

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