Atherosclerosis is a degenerative disease affecting the arteries, with particular involvement of abdominal aorta, carotides and arteries of the lower limbs. Causes include genetic factors such as smoking, cholesterol, diabetes and hypertension.
The arteries spread oxygenated blood in our bodies; the aorta is the largest blood vessel and originates directly from the heart.
Some people experience an irreversible expansion of one or more arteries that can be two to ten times the normal diameter. The risk is a collapse, as in the case of the inner tube of the bicycle when it breaks out.
The aneurysm does not usually give any symptoms before rupture. This manifests itself with severe back pain and shock. Prevention is therefore crucial. Among other things, the examination that controls the state of health of our arteries is not invasive, but nevertheless it is very accurate,” explains Professor Efrem Civilini, Head of Vascular Surgery in Humanitas, in an interview.
The role of surgery
In the case of aneurysm, surgical correction prevents rupture. Prof. Civilini adds: “The aim is to prevent the aneurysm from breaking. Medical therapy alone is not enough. The purpose of the repair is to replace the sick aorta with a synthetic fabric prosthesis that is modeled according to the anatomy of the patient and sutured on the healthy part of the aorta, upstream and downstream of the aneurysm.
Alongside this traditional method, an innovative therapy has been developed, which allows the safety of the aneurysm without the need to cut the abdomen. In this case, an endoprosthesis is used, which has the peculiarity of being compressed into a thin sheath to be introduced from the groin, open like an umbrella and mounted with a modular system in the desired position”.
The vascular surgeon will evaluate the most appropriate approach based on the anatomical characteristics of the aneurysm and the patient’s clinical picture.
Carotid and lower limb disorders
The carotid artery inflows blood into the central nervous system, head and neck. Atherosclerotic plaques can create obstruction and cause a stroke, resulting in the death of certain brain tissues. Today we are doing the intervention in local anesthesia and with an enormous degree of refinement compared to the past. We remove plaques and eliminate the risk of ischemia,” says Prof. Civilini.
The occlusion of the lower limb arteries can cause ischemia with obvious symptoms such as claudication. The severity of the disease becomes evident when every 100-150 meters the patient has to stop and wait for the blood to return to the muscles of the leg and supply the necessary oxygen.
Moreover, in this case, surgery involves the removal of plaques, while “in the most severe cases, however, we must resort to a bypass, a sort of tube that replaces the sick artery”, concludes Prof. Civilini.
