Mr Bernard Allard

Arterial Conditions

Aneurysms of Arteries

Arteries are held together with various layers of tissues including muscles, elastin and collagen. As we get older these layers can develop a natural weakening, or be weakened by an infection or immune inflammation, and the artery will expand like a balloon. If this artery gets too big it can burst. The artery must be repaired before this happens. There are risks also associated with the repair of these arteries, so a repair is only done when the risk of the artery bursting is greater than the risk of the procedure to fix it. Aneurysms of the abdominal aorta are usually repaired when they are close to 5.5 cm in diameter. Aneurysms of the artery behind the knee can cause blood clots to block the arteries below the knee. These aneurysms need to be sealed off from the circulation to prevent these clots rather than to prevent the artery bursting.

Treatments for aneurysm can now be performed by placing a covered stent inside the artery to seal above and below the aneurysm. Not all aneurysms are suitable for this treatment and open aortic surgery may be required. If a stent is placed inside the artery it does need to be monitored regularly in case a leak develops, usually with an annual ultrasound scan.

Carotid Artery Disease

The carotid arteries supply blood to the brain. As our body ages there can be plaque, including cholesterol and other reactive cells, that can narrow the carotid artery. This plaque can break open and send debris into the brain. This is one cause of stroke that may be prevented by cleaning out the carotid artery. A scan may have picked up this narrowing or the patient may have had a warning mini-stroke to make the diagnosis.

Surgery to clean the carotid artery is very effective in preventing further stroke. Stents can also be used to open the carotid artery.

Leg & Foot Ulceration

Ulcers are sores that do not heal by themselves. There are many known causes of ulceration.

These causes include and are not limited to problems with circulation, infections, skin cancers, oedema or fluid retention and other skin and immune system disorders.

To help the body to heal we must first diagnose the cause of the ulcer and contributing factors, because more than one of the above causes may be acting together.

Peripheral Vascular Disease

Disease in the arteries to the legs and arms can develop as we get older. This restricts the blood supply to the muscles and therefore can make it difficult to walk. The muscle will work for a short time with a reduced blood circulation though as the oxygen runs out it will tighten and then stop working. After a few moments rest the oxygen levels will increase and you can walk a short distance agin. This is arterial claudication. If the blood supply is severely restricted, then there may be constant pain, worse with the leg up when you go to bed, know as rest pain.

Treatment for Peripheral Arterial Disease
Treatments can range from simply exercising more and changing lifestyle, such as stopping smoking, to opening the arteries with balloons and placing stents, to bypass surgery. The nature and degree of restriction or disability will determine the treatment of choice.

Dialysis Fistula

The optimal way to be on dialysis is through a connection between an artery and a vein in the arm, called a fistula. This arteriovenous fistula needs to be created surgically and over time may need further surgical or balloon treatments for narrowing and enlargements.

Mesenteric Ischaemia

Just like the heart, the gut can cause pain when you eat due to a blockage in the blood supply. This is called mesenteric ischaemia and can cause severe loss of weight as you will not want to eat because of the pain when food goes into the stomach and bowel. This can be treated by using a balloon or stent to open the arteries, or may need a surgical bypass in the abdomen.

Chemotherapy Port

Chemotherapy is usually given by an intravenous infusion. When chemotherapy is given over a period of time the veins need to have needles put in every time. The veins can become difficult to put needles into or become scarred. A device can then be surgically implanted that passes into a central vein and can be directly connected for chemotherapy. Commonly a Port is used that sits completely under the skin of the chest wall. This port has a reservoir with a rubber stopper in the top and a tube or catheter that goes into the vein and travels to just before the heart. When chemotherapy is given a needle is placed through the skin and the rubber stopper into the reservoir to give the treatment. When the chemo dose is finished the needle is removed and nothing is left through the skin. These Ports can stay in the body for up to several years until they are no longer needed and are removed.

Are you affected by any of these issues?