Treatment of Arterial Occlusion of Legs

Arterial occlusion of legs treatment - stent placement - catheters - Dr. Hossam El Mahdy

Occlusive disease of the arteries in the leg is called peripheral artery disease (PAD). It may be similar to what happens when the arteries of the heart are blocked, in which blood flow to the leg stops.

What is the function of the arteries?
Arteries are a type of blood vessel responsible for pumping blood from the heart to various parts of the body. The peripheral arteries supply the leg with food and oxygen needed to perform vital functions, strengthen the immune system, resist microbes, and regenerate tissues.

How does leg artery blockage occur?
The inner lining of the arterial walls helps in blood flow easily to the organs due to its smooth nature. In a blockage of the arteries in the leg, fatty substances, cholesterol and harmful low-density lipoprotein (LDL) fats accumulate on the inner lining of the artery, causing the artery to narrow and block. Perfusion decreases and blood flow to the limb decreases. This impedes the normal blood flow to it, which is known as atherosclerosis.

Causes of leg arteries occlusion:
People usually get blockage of the arteries in the leg as a result of hardening and narrowing of the arteries, which may happen for the following reasons:
- Smoking.
- Getting old.
- Hypertension.
- Hypercholesterolemia.
- Diabetes, because it increases blood vessel problems.
- Vasculitis is a less common cause.
- Genetics and weight gain.
- A leisurely life, free from movement and general activity.

When do you visit a vascular surgeon?
Arterial occlusion occurs gradually and sometimes the patient does not have any symptoms at the beginning of the disease, but the lack of blood perfusion in the leg causes several symptoms that are an alarm bell for the presence of problems in the blood vessels; Therefore, you should go to see a doctor in the following cases:
- Leg pain during walking that increases over time.
- Facing extreme difficulty while climbing stairs.
- Leg muscle spasms.
- Feeling of pain during activity, then the disappearance of pain when resting.
- The severity of the pain varies from mild to severe, causing intermittent limping and difficulty walking.
- Ulcers in the toes or other injuries that do not heal.
- Toes appear blue or black.
- Frequent wounds and infections.
- Intermittent sleep hours as a result of the patient feeling pain during sleep.

It should be noted the importance of visiting a doctor and not neglecting the symptoms that the patient feels, as early diagnosis contributes to better treatment and improvement of the case, and the patient avoids complications from occlusion of the arteries of the leg, the most important of which is dry or wet gangrene due to the death of tissue completely, which may develop to the necessity of leg amputation.
Diagnosis of an occlusion in the arteries of the leg:
Leg artery occlusion is diagnosed through the following procedures:
- Physical examination and knowledge of the patient’s medical history.
- Conducting medical tests to measure cholesterol and harmful lipids in the blood.
- Ultrasound examination.
- CT scan to find out the area and degree of blockage.
- Ankle-brachial index to assess blood flow in the leg.
- Magnetic resonance imaging.

How is the procedure of dilating the arteries of the leg done?
Leg artery occlusion is treated by a non-surgical procedure, in which the occlusion inside the blocked artery is removed, through the following steps:

1- The patient is subjected to local anesthesia as there is no need for the patient to be given general anesthesia, due to the simplicity of the procedure and the absence of the need for a surgical incision.

2- Prof. Dr. Hossam El-Mahdy inserts the therapeutic catheter through a very small incision in the thigh area, using the guide wire, which allows the doctor to see the entire artery from the inside. This is because it is equipped with a high-resolution camera to transfer all the details into high-definition images. These images are displayed on a large screen display; This allows for better vision than with the naked eye.

3- A special opaque dye is injected into the blood because it contains iodine. This allows imaging of the arteries to facilitate access beyond the blockage area. However, the integrity of kidney functions must be ensured before dealing with this substance, because the kidney is the organ responsible for excreting the iodine pigment outside the body; So it is not suitable for patients suffering from kidney failure.
Kidney patients can be treated using carbon dioxide gas that is pumped into the artery and dissolved in the blood through a pump, to be an alternative to the dye, as it contributes to providing a good picture of the arteries, without affecting the kidneys, as it is decomposed into carbonic acid that is excreted outside the body through the lung as carbon dioxide.
In some cases, Prof. Dr. Hossam El-Mahdy relies on the use of a duplex (ultrasound) only during the dilation of the arteries of the leg.

4- Then the dilation step begins by placing a balloon connected to the catheter and inflating it, to open the blockage and restore blood flow again. The balloons used have certain sizes to fit the size of the multiple arteries.

5- Some cases need to place one or more metal stents, to remain inside the artery to keep it open and to prevent the blockage from occurring again; This ensures that the blood flows to the limbs at a normal rate. The stent is first guided into the contraction position, and then extended into the occlusion site.

6- Finally, Prof. Dr. Hossam El-Mahdy removes the catheter and the balloon from the same hole in the thigh while keeping the stent inside the artery until it remains open after making sure that the blood is completely flowing by making a final ray before completing the procedure.

Vascular stents:
The decision to place a stent goes back to Dr. Hossam El-Mahdy, Professor of Vascular Surgery and Treatment of Leg Arteries Occlusion at Cairo University, after studying the case well and the patient may need to place more than one stent according to the size of the blockage he suffers from. Medical stents are usually made of metal or plastic and can be described as small mesh tubes.
Catheterization has been able to skip internal vascular surgery with several advantages:
In the past, cases of leg artery blockages were painful to deal with, because they could only be treated through endovascular surgery that relied on endarterectomy to clean the artery directly, or the diversion of the blood by turning to restore the flow to the post-blockage using another artery or artificial artery.

But there are many complications and disadvantages of going for open vascular surgery, including the following:
- Exposing the patient to the risk of infection or the need for a blood transfusion.
- The development of blood clots.
- Heart and lung problems.
- The patient feels pain at the surgical site.
- Specific preparations and the necessity of fasting before undergoing surgery to undergo general anesthesia and the continuation of the surgery for hours.
- The presence of wounds and surgical scars that affect the aesthetic appearance of the leg.
There are significant pathological obstacles that prevent the anesthesia step for surgery, including hypertension and diabetes.
- The duration of the recovery period and the inability to carry out the burdens of daily life until after a short period of time.

Prevention of leg arteries occlusion:
- Quitting Smoking.
- Doing regular exercise.
- Eating healthy foods and avoid foods rich in fats, which raise the level of cholesterol in the blood.
- Losing excess weight.
- Controlling negative emotions and feelings and practicing relaxation exercises such as yoga.