Atherosclerosis
Disease Description
Atherosclerosis is a chronic disease of elastic and muscular-elastic arteries that develops as a result of impaired lipid metabolism and is characterized by the deposition of cholesterol and certain lipoprotein fractions in the inner lining (intima) of blood vessels.
These deposits form atheromatous plaques. Subsequent growth of connective tissue within the plaques (sclerosis) and calcification of the vessel wall lead to deformation and narrowing of the arterial lumen, potentially resulting in complete obstruction (occlusion).
Causes of the Disease
Atherosclerosis is a disease affecting the arterial system of the human body. It has a complex nature and is based on genetic predisposition to cholesterol metabolism disorders and its deposition in vessel walls. Cardiovascular diseases caused by atherosclerosis are the leading cause of mortality and disability among the adult population worldwide.
Atherosclerosis is a process in which cholesterol accumulates within the vessel wall, forming atherosclerotic plaques that narrow the artery. This leads to reduced blood supply to organs (ischemia) and may progress to thrombosis with complete arterial occlusion. When blood flow stops, part or all of the affected organ may be damaged or die.
All arteries are susceptible to atherosclerosis. Most commonly affected are:
- Coronary arteries supplying the heart muscle
- Brachiocephalic arteries supplying the brain
- Arteries of the upper and lower extremities
- The aorta and its major branches
Classification of Disease Forms
Atherosclerosis is a systemic disease that affects all arteries. However, depending on which vascular territories are predominantly involved, it is classified into the following forms:
- Coronary artery atherosclerosis, leading to ischemic heart disease and angina, potentially resulting in myocardial infarction.
- Brachiocephalic artery atherosclerosis, causing chronic cerebral ischemia and potentially leading to stroke.
- Atherosclerosis of the aorta, iliac arteries, and lower limb arteries, leading to intermittent claudication and potentially to gangrene of the lower limb or toes.
- Atherosclerosis of the visceral branches of the aorta, resulting in impaired blood flow to internal organs and potentially leading to intestinal or renal infarction.
- Multifocal atherosclerosis, involving multiple vascular territories simultaneously.
Diagnosis
- Color duplex ultrasound scanning
- Multislice computed tomography angiography (CT angiography)
- Conventional contrast-enhanced angiography
Treatment
Atherosclerosis can be treated using three main approaches:
1. Endovascular Interventions
When atherosclerosis affects a short segment of a vessel, arterial narrowing can be corrected from within the vessel. Under local anesthesia and without surgical incisions, special balloon catheters are introduced into the artery through a small puncture.
The balloon is inflated at the site of narrowing, restoring the normal arterial lumen. To prevent recurrent narrowing, a permanent metallic device called a stent is implanted in the artery.
2. Surgical Treatment
Surgical treatment is performed in cases of multiple or extensive atherosclerotic lesions. Using microsurgical techniques, a new pathway for blood flow is created around the stenosis or occlusion using the patient’s own vein or a synthetic graft. This procedure is known as bypass surgery.
Localized plaques may also be removed directly from the artery — a procedure known as endarterectomy.
Learn more about Endarterectomy
In patients with arterial occlusion limited to approximately 7–9 cm, removal of the diseased inner arterial layer containing the atherosclerotic plaque and thrombotic material (endarterectomy) may be performed.
In cases of more extensive occlusion or severe arterial wall calcification, bypass surgery or resection of the affected arterial segment with replacement by a synthetic or biological graft (arterial prosthesis) is indicated.
3. Hybrid Procedures
Hybrid procedures combine open surgical techniques with endovascular interventions. They are indicated for multilevel arterial disease, where arterial lesions are present at different anatomical levels. These procedures are performed in an operating room equipped for contrast angiography.
In cases involving the iliac and femoral arteries, hybrid surgery allows local removal of plaque from the femoral artery (endarterectomy) combined with simultaneous endovascular dilation and stenting of the iliac artery, avoiding more invasive aortofemoral bypass surgery.
In patients with abdominal aortic aneurysm, hybrid techniques enable endovascular aortic repair using a stent graft through a small femoral access instead of traditional open aortic replacement via laparotomy.
For stenosis of the brachiocephalic arteries, a combination of endarterectomy and stenting under regional anesthesia may be used.
Types of Surgical Treatment
- Open surgical removal of an atherosclerotic plaque from the artery
- Endovascular dilation of the arterial lumen with placement of a metallic stent to prevent re-narrowing
- Bypass surgery to restore blood flow when the artery is completely occluded
Surgical treatment is recommended when the risk of severe, disabling complications without surgery exceeds the potential risks associated with surgical intervention.
Important to know
Atherosclerotic plaques do not resolve or “dissolve” on their own.
The goal of surgery in atherosclerosis is to prevent life-threatening complications.
Every symptom has an underlying cause.