Arterial Blockage Surgery

Arterial occlusion surgery is a procedure performed to restore blood flow in blocked arteries. It is applied when medical treatment is insufficient and aims to prevent tissue damage and improve circulation. Early surgical intervention reduces complications.

Surgical methods include bypass, endarterectomy, or angioplasty with stenting. The choice of technique depends on the location, severity, and length of the arterial blockage. Individualized planning is essential for optimal outcomes.

Candidates for surgery are typically patients with critical limb ischemia, severe pain, or non-healing ulcers. Preoperative evaluation includes imaging studies and cardiovascular risk assessment to ensure safe intervention.

Postoperative care involves anticoagulant therapy, lifestyle modifications, and regular follow-up. Long-term success depends on adherence to medical advice and management of risk factors such as hypertension, diabetes, and smoking.

What is the problem that requires arterial occlusion surgery?

In simple terms, arteries are the pipes of life that carry the clean, oxygen-rich blood pumped by your heart to the farthest corners of your body. Over time, especially due to factors such as uncontrolled cholesterol, high blood pressure and smoking, a rust-like condition develops on the inner walls of these pipes. In this process, which is called “atherosclerosis” in medicine and “arteriosclerosis” among the people, fat, calcium and various cellular wastes in your blood adhere to the vessel wall and form layers called “plaque”.

As these plaques build up, they gradually narrow the pathway through which blood travels. When the blood flow to your legs is reduced, you develop “peripheral arterial disease”. In fact, this is not just a local problem affecting your legs. When a blood vessel in your body is affected, it is the most important sign that your entire vascular system is at risk. In other words, if there is plaque buildup in the arteries in your legs, it is very likely that a similar process is taking place in the coronary arteries that feed your heart and the carotid arteries that carry blood to your brain. So pain in your legs is actually a warning signal for your whole body.

Which Symptoms are an Alarm Bell for Arterial Blockage Surgery?

A blood vessel blockage usually starts insidiously and may not cause any obvious symptoms for a long time. However, when the narrowing exceeds a certain level, your body starts to send you some signals. Reading these signals correctly is critical to avoid delay in treatment. The main symptoms suggesting that an intervention may be necessary are.

We call “intermittent claudication” pain, cramping or fatigue in your legs, especially in your calves, during an activity that requires effort, such as walking or climbing stairs. This is the most typical early sign of the disease. The situation is similar to this: Just as a car driving uphill misfires when its engine doesn’t get enough fuel, your muscles can’t get the extra blood and oxygen they need during increased exertion through narrowed blood vessels and signal pain. The most important feature of this pain is that it disappears completely within a few minutes when you rest. However, when you start walking again, it usually reappears at the same distance. Initially, it may not affect your life much, but over time your walking distance will shorten and you may not even be able to do your daily tasks.

When the disease progresses, the condition becomes more serious. Rest pain indicates that blood flow is so reduced that your muscles cannot be nourished even at rest. It is a burning, throbbing and quite severe pain in your toes or the back of your feet that usually occurs at night when you lie in bed. Many people even feel the need to lower their leg off the bed to alleviate this pain. This is because gravity provides temporary relief by getting a little more blood flow to the area. The presence of rest pain is a red alert that tissue damage is about to begin and requires urgent intervention.

When blood circulation is at its most critical, wounds caused by even the slightest impact on your toes, heels or legs will not heal. In order for the body to repair a wound, it needs to carry plenty of blood to the area. When blocked blood vessels fail to do this, the wound can remain open for months, become infected and eventually lead to tissue death, which we call “gangrene”. Gangrene is a condition in which the skin turns black, dries up and loses its vitality completely and is irreversible. At this stage, the only way to prevent limb loss (amputation) is to urgently restore blood flow.

In addition to these three main symptoms, there are other physical signs of atherosclerosis. It is important to recognize them:

• A noticeable coldness in the leg or foot compared to the other side
• Changes in skin color (pale when the leg is raised and purple-red when lowered)
• Shiny, taut and slender leg skin
• Hair on the legs and feet falls out or stops growing
• Thickening and very slow growth of toenails
• The emergence of erectile dysfunction in men

After which steps is the decision for arterial occlusion surgery taken?

It never goes straight to the operating table. The path to this decision goes through a careful evaluation and diagnostic process. This process starts with a sincere conversation with you. Listening to you and understanding your story is the most important part of the diagnosis. We want to know when your pain started, what triggered it and how it affects your life, down to the finest detail. We ask about your risk factors such as smoking, diabetes, blood pressure and family history.

Next comes the physical examination. We ask you to remove your shoes and socks and carefully examine your legs. We look at the color, temperature and moisture of your skin and look for signs of sores or hair loss. One of the most critical steps is a pulse check. With my fingers, I feel the pulse in the arteries running through your groin, behind your knees, ankle and the back of your feet. A weak or absent pulse at one point gives us a valuable clue that the blockage is somewhere higher up.

To confirm these initial findings and quantify the severity of the problem, we use simple and completely painless tests. The most important of these is the Ankle-Arm Index (ABI) test. In this test, blood pressure is measured in both your arms and ankles while lying on your back. The ratio of the blood pressure in your ankle divided by the blood pressure in your arm gives an objective measure of how much blood is flowing to your legs. In a healthy person, this ratio is expected to be 1.0 or above. A value below 0.9 confirms the diagnosis of arterial occlusion, and the lower the value, the more severe the disease.

If your symptoms are serious and we are planning an intervention, we need a road map showing the exact location of the blockage, its length, how narrow it is and its nature (soft or calcareous). The modern imaging methods we use to make this map are:

• Arterial Color Doppler Ultrasonography
• Computed Tomography Angiography (CTA)
• Magnetic Resonance Angiography (MRA)
• Digital Subtraction Angiography (DSA – Classic Angiography)

These tests give us a clear picture of the problem and allow us to decide which treatment method will be the most appropriate and safest for you.

Which Closed (Endovascular) Methods Are Available for Arterial Blockage Surgery?

the word “surgery” may frighten many people, but today, when we think of Arterial Blockage Surgery, we should not only think of classical operations performed with large incisions. One of the greatest blessings that technology offers us is minimally invasive, that is, bypassing artificial vascular grafts that are placed hidden through tiny incisions. In this way; Less pain,

• Shorter hospital stay
• Faster recovery and return to normal life

If there is a short stenosis in a very small segment of the artery, blocking blood flow, a stent can be implanted by non-surgical angiography. Although it is not long-term, it reduces the patient’s complaints. A stent is a small piece of pipe made of stainless steel or special metal alloys in the form of a wire mesh. It acts as a kind of intravascular scaffolding. It is inserted into the same area with the help of a catheter and supports the inner wall of the vessel, ensuring that the bloodway remains permanently open. Today, stents can be coated with special drugs that prevent re-narrowing (drug-eluting stents), which increases the long-term success of the treatment.

In which cases is an open arterial occlusion surgery preferred?

No matter how advanced and comfortable closed methods are, they may not be suitable for every patient and every obstruction. In some cases, the most permanent and reliable solution to the problem is open surgery, which has been used successfully for many years. being an “old” method does not mean that it is “bad”; on the contrary, when applied in the right patient, the results are excellent and very long-lasting. We usually turn to open surgery in the following cases:

• The occlusion covers a very long vessel segment (e.g. a 20-30 cm occlusion)
• The vessel is completely and chronically blocked (hardened to the point that even a wire cannot be passed through it)
• The obstruction is located in mobile areas such as joint areas (groin, back of the knee)
• Aiming for a long-term solution in young patients in good general health

The two most common open surgery techniques are as follows:

Bypass Surgery (Bridging): The idea of this surgery is that instead of using a highway that is completely blocked, a new side road, a ring road, is built that bypasses that road and reaches the destination. In the operation, a “bridge” vessel is sewn between the intact vessel just before the blockage and the intact vessel just after it. This bridge allows the blood to bypass the blocked pathway completely and reach the lower part of the leg via this newly constructed vessel without any problems. There are two types of vessels we use for this bridging procedure. The first and most ideal choice is a superficial vein called “saphenous vein” taken from the patient’s own body, usually from the leg. This is because the patient’s own tissue is the most compatible material and stays open the longest. If the patient’s own vein is not suitable, then we use high-tech artificial veins called “grafts”. Bypass is the most effective and permanent way to restore blood flow, especially in widespread and complex blockages.

Endarterectomy: In this procedure, instead of creating a new pathway, we remove the obstruction blocking the existing pathway. The surgeon makes an incision at the site of the blockage, opens the vessel and carefully peels off the plaque that has adhered to the inner wall of the vessel. Just like scraping the lime scale off the inside of a pipe, the inner surface of the vessel is completely cleaned. The vessel is then expanded and repaired, usually with a patch. This patch prevents the vessel from narrowing after it has been repaired. Endarterectomy is a very effective procedure for short, dense plaques in more superficial and easy-to-reach vessels, such as the femoral artery (femoral artery) or the carotid artery (carotid artery) to the brain. Carotid artery surgery in particular has a life-saving role in reducing the risk of stroke.

How to Decide on the Right Arterial Blockage Surgery Method for Me?

This is perhaps the question that patients are most curious about. “Doctor, what is best for me?” The answer lies not in a standard prescription but in a personalized assessment. The main factors we consider when making this decision are:

• Where the blockage is located (in the groin, behind the knee, in the calf?)
• Length and extent of the blockage
• The nature of the plaque (is it soft, calcareous and hard?)
• Your age and general health (whether you have any additional problems such as heart, lung or kidney disease)
• The urgency of your complaints (is it only walking pain, or is it rest pain or sores?)

By combining all of these factors, we create a personalized treatment plan for you that offers the highest chance of success and carries the lowest risk. Sometimes this plan may even include a combination of two procedures (hybrid procedures). For example, we may clear a blockage in the groin with an open endarterectomy and open a lower stenosis with a balloon or stent in the same session. The goal is always to achieve the best and most lasting result for you.

What awaits me during the recovery period after arterial occlusion surgery?

The period after the surgery is as important as the surgery itself. Your recovery period will vary depending on the type of procedure you have had.

After Closed (Endovascular) Methods:

If your treatment was performed with a closed method such as a minimally invasive bypass, your recovery will be fast and comfortable:

• You usually only need to stay in the hospital for 2-3 days.
• Since the procedure is performed through a small incision, you will have almost no postoperative pain.
• You may have a slight tenderness or bruising in the groin or arm area where the procedure was performed, which may last for a few days.
• You can usually return to your normal daily activities within 3-5 days and start your job within a week.
• It is important to avoid heavy lifting and strenuous movements during the first week to allow the insertion site to heal.

Why is Life After Arterial Blockage Surgery Important?

This is the most important thing to focus on. A successful arterial occlusion surgery opens the blocked artery and removes the symptoms of the problem. However, this does not mean that the main underlying disease, atherosclerosis, is completely cured. Unless you change your lifestyle, this disease will continue to threaten other vessels in your body, especially your heart and brain vessels. Surgery gives you a clean slate, a second chance for a healthy start. It is up to you to turn this chance into a lasting success. There are lifelong rules you must follow to make the surgery long-lasting and to maintain your overall health.

Your medicines are your protective shield:

It is vital that you take the medicines prescribed by your doctor for the rest of your life, without missing a day:

• Blood thinners (Aspirin, Clopidogrel etc.)
• Cholesterol-lowering drugs (Statins)
• Blood pressure medication (if you have high blood pressure)
• Diabetes medicines (if you have diabetes)

Let Your Table Be Your Medicine:

• You need to radically change your eating habits.

Keep it on your table:

• Foods high in fiber (vegetables, fruits, legumes, whole grains)
• Healthy fats (olive oil, avocado, walnuts, hazelnuts)
• Fish at least twice a week
• Plenty of water

The ones you should stay away from:

• All packaged and processed foods
• Solid and trans fats (margarine, fried foods, pastries)
• Products containing excess salt and sodium
• Sugary and carbonated drinks
• Limiting red meat consumption

Your Life Rhythm Must Change:

• Even a single cigarette after surgery can undo all the work that has been done and cause your artery to quickly become blocked again. This is the most important non-negotiable rule.
• Make regular walking a part of your life. A brisk 30-45 minute walk every day is the most effective vascular medicine.
• Maintain your ideal weight. Excess weight puts extra burden on your entire vascular system.
• Learn to manage stress. Rest your mind with yoga, meditation or hobbies that are good for you.

Remember that treating atherosclerosis is a journey. Surgery is an important stop on this journey, but it is not the destination. The ultimate goal is to live a healthy, active and pain-free life. This can only be achieved through a strong partnership with your doctor and by taking care of your own health.