May occur as saphenous aortic stenosis or obstruction, and the most common cause is the atherosclerosis (stiffness of the vessel).
Causes of Atherosclerosis:
The factors causing atherosclerosis include,
- High blood cholesterol level,
- Family history of cardiovascular diseases,
- Diabetes mellitus.
- Saphenous aortic stenosis or obstructions may not present any symptoms in early stages.
It mostly presents with lower-leg, femoral and hip pain when you walk, go up the stairs and run. This pain is relieved when you take a rest. The walking distance becomes shorter in time and then pain occurs while you are resting. The next stage is non-healing wounds and gangrene of toes. If left untreated, it may lead to amputation of the related leg or foot at some level.
Diagnostic and Treatment Methods:
First of all, the complaints of the patient must be listened to carefully. Then the pulse of saphenous artery should be taken. Imaging methods should be utilized in required patients. The most common methods used include Color Doppler ultrasonography, MRI or CT angiography, or classical conventional angiography. Although the angiography is the widely used method to diagnose vascular disease, today’s modern MRI and Tomography devices are able to deliver almost perfect results. In these methods, the patient needs to get inside the MRI or tomography device as short as 15 to 20 minutes. It is not necessary to make an inguinal access by a needle as with the classical angiography; the imaging drug is injected in the brachial vein then distributed over the entire body. The images of required section obtained in the computer environment are converted into angiography. This imaging technique is used to decide the treatment method. It can be a medical treatment, endovascular method, or open surgery depending on the patient.
Some part of patients is monitored periodically under medical treatment (pharmacotherapy). The risk factors must be removed in this group of patients.
- Smoking must be ceased,
- If cholesterol values are high, normal values must be
achieved by a diet or drugs (statins),
- Overweight patients should lose weight,
- Blood sugar should be regulated in diabetics.
- Patients are encouraged to do regular exercises under pharmacotherapy.
2. Endovascular Method:
Saphenous aortic stenosis or short segment obstructions can be treated by endovascular method (with a balloon or stent guided through the vessel). In this method, the inguinal artery is accessed by a needle. General anesthesia is not required; only the needle site is locally anesthetized. An angiography is taken to identify the location and length of stenosis or obstruction. Then stenosis or obstruction is enlarged by a specific balloon or stent (metal tubes inserted in the vessel) in appropriate patients. This method is also used for treatment of stenosis or obstruction of brachial vessels, internal vessels (supplying the kidneys and intraabdominal organs), and carotid as well as saphenous arteries.
The patient needs to stay overnight in the hospital. After being discharged, the patient should be able to go back to work in 2 to 3 days.
3. Bypass (Bridging):
A bypass (bridging) operation is required when an obstruction involves a longer segment or is unable to open by endovascular methods. Spinal or epidural anesthesia can be used for such operations. The patients with severe cardiac and pulmonary diseases can easily be operated without the risk of general anesthesia. An artificial vessel or the patient’s own vein can be used for bypass depending on the patient. The purpose here is to establish a new pathway for blood flow and supply the tissues beyond the stenosis with adequate blood. The patient needs to stay in the hospital for 3 to 5 days after these operations. After being discharged, the patient should be able to go back to work in 10 to 15 days.
After the Treatment:
Any patients who have received or undergone either a medical treatment or endovascular method or open surgery need to periodically come for control examinations.