Symptoms and treatment of carotid artery blockage. Surgeries on the carotid arteries: indications, types, performance, results

All materials on the site were prepared by specialists in the field of surgery, anatomy and related disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

The carotid arteries are responsible for supplying blood to the brain tissue, and therefore Pathologies in these vessels are considered life-threatening conditions.

Urgent surgery is indicated in the following cases:

Deformity with kinking or twisting (tortuosity of the carotid artery);
Violation of the integrity of the vessel (stab or cut injury);
Carotid artery aneurysm (wall dissection with threat of rupture);
Narrowing of the lumen of the vessel, leading to brain hypoxia;
Blockage of the carotid artery by an embolus or thrombus;

Planned operations are performed when atherosclerosis is diagnosed, when cholesterol plaques block the lumen of the vessel, preventing normal blood flow.

Progressive atherosclerosis of the carotid arteries is an irreversible disease and not well studied. Cholesterol deposits (plaques) formed in the vessel do not resolve and do not disappear as a result of conservative treatment, even the most progressive.

Temporary improvement in health after drug therapy is mainly associated with the dilation of vascular walls under the influence of drugs and the partial restoration of blood circulation. After stopping the use of pharmacological agents (or compositions prepared according to folk recipes), attacks of hypoxia (oxygen starvation of the brain) inevitably occur, and the risk of ischemic stroke also increases. Surgery on the carotid artery is the most progressive and effective method of treating vascular pathology.

In most medical cases, a cholesterol plaque in the carotid artery is detected after a stroke, or during an ultrasound examination for neurological disorders (headache, dizziness, decreased visual acuity, fainting, poor coordination, etc.).

Timely use of surgery to restore the functionality of the vessel can prevent ischemic strokes in 60% of cases (according to WHO). The technique for performing surgery for atherosclerosis is selected by the vascular surgeon after duplex scanning and MSCT, which provide a detailed picture of the condition of the carotid arteries and other vessels, and allow an objective assessment of the likely risks of radical treatment.

Reconstructive operations on the carotid arteries

In modern vascular surgery, various methods of reconstructive surgery on the carotid arteries are used, but the access technique is the same in all cases:

When working with the internal carotid artery, extremely careful contact with the vascular walls is required, since any careless movement can lead to plaque destruction, and, as a consequence, to distal embolism. The further course of the operation depends on the condition of the vessels (the degree of parietal calcification, tortuosity, and stretching of the walls is taken into account).

Carotid endarterectomy

Carotid endarterectomy is a classic open surgery on the carotid artery, the purpose of which is to remove cholesterol plaque. A widely used method of reconstruction is vascular patch repair. After administering a direct anticoagulant (most often, heparin is used) and closing the carotid arteries with a clamp, they are dissected along the anterior wall. Elastic shunts are inserted into the lumen to prevent brain hypoxia. Thus, the surgical field is drained of blood, while normal blood supply to the brain tissue is maintained.

carotid endarterectomy (removal of plaque from the carotid artery)

The next stage is the separation of the sclerotic plaque from the walls of the vessel. After circular release of cholesterol formation, the final part of the plaque is crossed, then released upward. In the external and internal carotid arteries, the plaque is peeled off to the intimal layer, which is then sutured to the vessel wall with a special thread.

The third stage of the operation is washing the vessel with saline solution, along with which plaque fragments are removed - this manipulation prevents the formation of a migrating blood clot in the carotid artery.

The final stage is the closure of the surgical opening in the artery. To create a patch, artificial and biological materials (PTFE, xenopericardium or autogenous graft) are used. The type of patch is selected by the doctor, based on the condition of the vessel walls. The flap is sutured with prolene threads, then the shunt is removed, and the tightness of the patch junction is checked.

The clamps are removed and a clamp is installed at the mouth of the internal carotid artery to allow blood flow through the common vessel. After flushing out small thrombotic formations into the external artery, the clamp is removed. In the restored area, a drainage made of elastic silicone is installed in the area of the lower edge of the wound, after which the tissue is sutured layer-by-layer.

Eversion carotid endarterectomy

This type of surgical intervention is indicated for stenosis of the internal carotid artery in the area of the mouth, if the plaque does not exceed 2 cm in diameter, and if the condition of the internal vascular tissues is satisfactory. After selecting a site bifurcations blood vessels, tests are carried out to determine the body’s reaction to clamping of the carotid artery (assessment is made based on blood pressure readings and blood flow velocity in the middle cerebral artery). If there is tolerance to the clamping of the vessel, then proceed to the main part of the operation:

The internal carotid artery is cut off from the glomus, then dissected at the mouth;
The transected artery is clamped with thin tweezers;
The intima is peeled off together with the middle shell (using a scalpel and a surgical spatula);
The outer shell of the vessel is grabbed with tweezers and twisted in the opposite direction (in the same way as a stocking is removed);
The plaque peels off along the entire length of the artery - to the area of the normal lumen of the vessel.

The inverted artery is inspected to identify intimal detachments, then saline solution is pumped into the vessel. If branched intimal fibers do not appear in the lumen after washing with a jet under pressure, then you can proceed to the final stage of the operation.

If fragments of vascular tissue visible in the lumen are detected, further reconstruction cannot be performed. In this case, prosthetics of the carotid arteries is performed.

After removing cholesterol formations and blood clots from the internal artery, the surgeon proceeds with endarterectomy from the common carotid artery. The final stage is suturing the vessel walls with a 5-0 or 6-0 thread.

Blood flow is restored strictly according to the following scheme:

The clamp is removed from the internal carotid artery (for a few seconds);
The internal artery is clamped a second time at the anastomosis;
The fixator is removed from the external carotid artery;
The clamp is removed from the common artery;
The repeated clamp is removed from the internal carotid artery

Stenting

Stenting is an operation to restore the lumen of a vessel using a tubular dilator (stent). This surgical technique does not involve removing the plaque from the dissected vessel. The intra-arterial formation, which narrows the lumen, is pressed tightly against the vessel wall with a stent tube, after which blood flow is restored.

The operation is performed under local anesthesia and under the control of an X-ray machine. A catheter is inserted through a puncture in the thigh (or arm) and directed to the site of carotid artery stenosis. A mesh filter basket, which catches fragments of random cholesterol plaque, is installed just above the operated area (this is necessary to prevent emboli or blood clots from entering the brain).

To increase the effectiveness of the operation, balloon stents are used, which increase in volume at the site of narrowing of the artery. The inflated balloon presses the plaque tightly against the wall. After the normal lumen is restored, the balloon is deflated and removed through the catheter along with the catching filter.

Carotid artery replacement

Arterial replacement is indicated for extensive damage to the walls of the internal carotid artery in combination with severe calcification. It is not advisable to use stenting and open carotid endarterectomy in this case. The vessel is cut off at the mouth, the affected tissue is resected and replaced with an endoprosthesis that matches the diameter of the internal artery.

For a carotid artery aneurysm, the following operation scheme is used: the vessel is clamped and the affected area is excised, after which a shunt with a graft is inserted into the lumen. After the anstomosis is formed, the shunt is removed, air is removed from the lumen of the vessel and the graft, and the clamps are removed.

Operations for tortuosity of the carotid arteries

Congenital deformation of the carotid arteries (tortuosity) is one of the common causes of ischemic stroke and cerebrovascular accident. According to statistics, every third patient who died from a stroke had tortuous carotid or vertebral arteries.

various forms of arterial tortuosity

The surgical technique is chosen depending on the nature of the vascular pathology:

Bending at an acute angle (kinking);
Loop formation (coiling);
Increasing the length of the artery.

The tortuous fragment of the vessel is resected, after which the vessel is straightened (redressed).

Complications after surgery on the carotid artery

The following complications are possible after carotid endarterectomy:

Myocardial infarction or stroke;
Relapse of the disease (re-formation of plaque);
Difficulty breathing;
Increased blood pressure;
Nerve damage;
Wound infection.

Complications after stenting are much less common, But even with a sparing operation, negative consequences are possible, among which the most serious is the formation of a blood clot. Other unpleasant moments that surgeons have to deal with include: internal bleeding, trauma in the area where the catheter is inserted, damage to the arterial wall, an allergic reaction, and displacement of the stent inside the vessel. In the first days, there is difficulty swallowing, hoarseness, “lump in the throat,” and rapid heartbeat. Gradually, the unpleasant symptoms disappear completely.

Contraindications for surgery on the carotid arteries

Absolute contraindications include:

The operation is not performed if the patient’s general condition is severe or if there are incurable chronic diseases of the hematopoietic organs.

Rehabilitation

After the operation, the patient is placed in the intensive care unit. Bed rest is indicated for three days. After four days, you can get up and take short walks under the supervision of a doctor. For two weeks, physical activity, squats, bends, and other sudden movements are prohibited. The head and neck are in a static, but not tense state. Turn your head with great care. It is necessary to strictly follow the doctor's recommendations regarding diet and lifestyle (alcoholic drinks and smoking are excluded).

Surgeries on the carotid artery are performed using well-developed surgical techniques, under the control of high-precision medical equipment, which significantly reduces the risk of complications. In most medical cases, radical surgical treatment is a more effective method compared to conservative therapy. After discharge, patients are examined at the clinic where the operation was performed every six months.

Video: carotid endarterectomy

Carotid artery occlusion- partial or complete obstruction of the lumen of the carotid arteries supplying blood to the brain. It may have an asymptomatic course, but is more often manifested by repeated TIAs, clinical signs of chronic cerebral ischemia, and ischemic strokes in the middle and anterior cerebral arteries. The diagnostic search for occlusion of the carotid arteries is aimed at establishing the location, genesis and degree of obstruction. It includes ultrasound of the carotid vessels, cerebral angiography, magnetic resonance angiography, CT or MRI of the brain. The most effective surgical treatment consists of endarterectomy, stenting the affected area of the artery, or creating a vascular bypass graft.

Modern research in the field of neurology has shown that in most patients suffering from cerebral ischemia, the extracranial (extracranial) sections of the blood vessels supplying the brain are affected. Intracranial (intracranial) vascular changes are detected 4 times less often. At the same time, occlusion of the carotid arteries accounts for about 56% of cases of cerebral ischemia and causes up to 30% of strokes.

Occlusion of the carotid arteries can be partial, when only a narrowing of the lumen of the vessel occurs. In such cases, the term “stenosis” is more often used. Complete occlusion is an obstruction of the entire diameter of the artery and, in acute development, often leads to ischemic stroke, and in some cases to sudden death.

Anatomy of the carotid artery system

The left common carotid artery (CCA) starts from the aortic arch, and the right one starts from the brachiocephalic trunk. Both of them rise vertically upward and in the neck area are localized in front of the transverse processes of the cervical vertebrae. At the level of the thyroid cartilage, each CCA is divided into the internal (ICA) and external (ECA) carotid arteries. The ECA is responsible for the blood supply to the tissues of the face and head, other estracranial structures and part of the dura mater. The ICA passes through a canal in the temporal bone into the cranial cavity and provides intracranial blood supply. It nourishes the pituitary gland, frontal, temporal and parietal lobes of the brain of the same side. The ophthalmic artery arises from the ICA, providing blood supply to various structures of the eyeball and orbit. In the region of the cavernous sinus, the ICA gives off a branch that anastomoses with the branch of the ECA, passing to the inner surface of the base of the skull through the foramen of the sphenoid bone. Collateral circulation occurs through this anastomosis during obstruction of the ICA.

Causes of carotid artery occlusion

The most common etiological factor for occlusion of the carotid arteries is atherosclerosis. An atherosclerotic plaque is located internally on the vascular wall and consists of cholesterol, fats, and blood cells (mainly platelets). As the atherosclerotic plaque grows, it can cause complete occlusion of the carotid artery. A blood clot can form on the surface of the plaque, which moves further along the vascular bed with the blood flow and becomes the cause of thrombosis of intracranial vessels. With incomplete occlusion, the plaque itself can tear away from the vascular wall. Then it turns into an embolus, which can lead to thromboembolism of smaller cerebral vessels.

Obstruction of the carotid arteries can also be caused by other pathological processes of the vascular wall, for example, with fibromuscular dysplasia, Horton's disease, Takayasu's arteritis, and moyamoya disease. Traumatic occlusion of the carotid arteries develops as a result of TBI and is caused by the formation of a subintimal hematoma. Other etiofactors include hypercoagulable states (thrombocytosis, sickle cell anemia, antiphospholipid syndrome), homocystinuria, cardiogenic embolism (with valvular acquired and congenital heart defects, bacterial endocarditis, myocardial infarction, atrial fibrillation with the formation of blood clots), tumors.

Factors contributing to stenosis and obstruction of the carotid arteries are: features of the anatomy of these vessels (hypoplasia, tortuosity, kinking), diabetes mellitus, smoking, unhealthy diet with a high content of animal fats in the diet, obesity, etc.

Symptoms of carotid artery occlusion

The clinical picture of carotid artery obstruction depends on the location of the lesion, the rate of development of occlusion (suddenly or gradually) and the degree of development of vascular collaterals that provide alternative blood supply to the same areas of the brain. With the gradual development of occlusion, a restructuring of the blood supply occurs due to collateral vessels and some adaptation of brain cells to the current conditions (reduced supply of nutrients and oxygen); a clinic of chronic cerebral ischemia is being formed. The bilateral nature of the obstruction has a more severe course and a less favorable prognosis. Sudden occlusion of the carotid arteries usually leads to ischemic stroke.

In most cases, occlusion of the carotid arteries manifests itself as a transient ischemic attack (TIA) - a transient disorder of cerebral circulation, the duration of which, first of all, depends on the degree of development of vascular collaterals in the affected area of the brain. The most typical symptoms of TIA in the carotid system are mono- or hemiparesis and sensory disturbances on the opposite side (heterolateral) in combination with monocular visual impairment on the affected side (homolateral). Typically, the onset of an attack is the occurrence of numbness or paresthesia of half the face and fingers, the development of muscle weakness in the entire arm or only in its distal parts. Visual disturbances range from the sensation of spots in front of the eyes to a significant decrease in visual acuity. In some cases, retinal infarction is possible, triggering the development of optic nerve atrophy. More rare manifestations of TIA with obstruction of the carotid arteries include: dysarthria, aphasia, facial paresis, headache. Some patients report dizziness, lightheadedness, swallowing problems, and visual hallucinations. In 3% of cases, local convulsions or major seizures are observed.

According to various data, the risk of ischemic stroke within 1 year after the onset of TIA ranges from 12 to 25%. In approximately 1/3 of patients with carotid artery occlusion, a stroke occurs after one or more TIAs, and in 1/3 it develops without previous TIAs. Another 1/3 are patients in whom ischemic stroke is not observed, but TIAs continue to occur. The clinical picture of ischemic stroke is similar to the symptoms of TIA, but it has a permanent course, i.e., the neurological deficit (paresis, hypoesthesia, visual disturbances) does not go away over time and can only decrease as a result of timely adequate treatment.

In some cases, manifestations of occlusion do not have an abrupt onset and are so unexpressed that it is very difficult to assume the vascular origin of the problems that have arisen. The patient’s condition is often interpreted as a clinical picture of a cerebral tumor or dementia. Some authors indicate that irritability, depression, confusion, hypersomnia, emotional lability and dementia can develop as a result of occlusion or microembolism of the ICA on the dominant side or on both sides.

Obstruction of the common carotid artery occurs in only 1% of cases. If it develops against the background of normal patency of the ECA and ICA, then the collateral blood flow going through the ECA to the ICA is sufficient to avoid ischemic brain damage. However, as a rule, atherosclerotic changes in the carotid arteries are multi-level, which leads to the symptoms of occlusion described above.

The bilateral type of occlusion of the carotid arteries with well-developed collaterals may have an asymptomatic course. But more often it leads to bilateral strokes of the cerebral hemispheres, manifested by spastic tetraplegia and coma.

Diagnosis of carotid artery occlusion

In diagnosis, along with a neurological examination of the patient and the study of medical history, instrumental methods for studying the carotid arteries are of fundamental importance. The most accessible, safe and quite informative method is ultrasound scanning of the vessels of the head and neck. With occlusion of the carotid arteries, ultrasound examination of extracranial vessels usually reveals accelerated retrograde blood flow along the superficial branches of the ECA. Under conditions of occlusion, blood moves through them to the ophthalmic artery, and through it to the ICA. During ultrasound examination, a test is performed with compression of one of the superficial branches of the ECA (usually the temporal artery). A decrease in blood flow through the ophthalmic artery with digital compression of the temporal artery indicates occlusion of the ICA.

Angiography of cerebral vessels allows you to accurately determine the level of occlusion of the carotid arteries. However, due to the danger of complications, it can be performed only in difficult diagnostic cases or immediately before surgical treatment. MRA - magnetic resonance angiography - has become an excellent and safe replacement for angiography. Today, in many clinics, MRA in combination with MRI of the brain is the “gold standard” for diagnosing carotid artery occlusion.

Ischemic damage to cerebral structures is visualized using MRI or CT of the brain. Moreover, the presence of “white” ischemia indicates the gradual atherosclerotic nature of obstruction of the carotid arteries, and ischemia with hemorrhagic impregnation indicates an embolic type of lesion. It should also be taken into account that in approximately 30% of patients with ischemic stroke, focal changes in the brain tissue are not visualized in the first days.

Treatment of carotid artery occlusion

With regard to occlusion of the carotid arteries, it is possible to use various surgical tactics, the choice of which depends on the type, level and degree of obstruction, and the state of collateral circulation. In cases where the operation is performed 6-8 hours after the onset of progressive ischemic stroke, the mortality rate of patients reaches 40%. In this regard, surgical treatment is advisable before the development of a stroke and has a preventive value. As a rule, it is performed in the intervals between TIAs when the patient’s condition is stabilized. Surgical treatment is carried out mainly for extracranial type of occlusion.

Among the indications for surgical treatment of stenosis and obstruction of the carotid arteries are: recent TIA, completed ischemic stroke with minimal neurological impairment, asymptomatic occlusion of the cervical portion of the ICA of more than 70%, the presence of sources of embolism in extracranial arteries, syndrome of insufficient arterial blood supply to the brain.

For partial occlusion of the carotid arteries, the operations of choice are: stenting and carotid endarterectomy (eversion or classic). Complete obstruction of the vascular lumen is an indication for creating an extra-intracranial anastomosis - a new blood supply route, bypassing the occluded area. If the lumen of the ICA is preserved, subclavian-general prosthetics are recommended; if it is obstructed, subclavian-external prosthetics are recommended.

Prognosis and prevention

According to generalized data, asymptomatic partial occlusion of the carotid arteries up to 60% in 11 cases out of 100 is accompanied by the development of stroke within 5 years. When the lumen of the artery is narrowed to 75%, the risk of ischemic stroke is 5.5% per year. In 40% of patients with complete occlusion of the ICA, ischemic stroke develops in the first year of its occurrence. Carrying out preventive surgical treatment can minimize the risk of developing stroke.

Measures aimed at preventing arterial occlusion include getting rid of bad habits, proper nutrition, combating excess weight, correction of the blood lipid profile, timely treatment of cardiovascular diseases, vasculitis and hereditary pathologies (for example, various coagulopathies).

The carotid arteries are the most important vessels that provide blood flow to the brain structures and are responsible for the blood supply to most of the cerebral hemispheres. A person has two carotid arteries located in the neck, on the right and on the left.

A phenomenon such as partial narrowing of an artery – stenosis or its complete blockage – occlusion is often noted. Carotid artery stenosis leads to circulatory problems, impaired brain activity, and also increases the risk of ischemic stroke.

Complete blockage of this important vessel leads to a number of severe consequences and can also cause instant death of the patient.

Characteristics of the disease

Stenosis is a disease of the cardiovascular system, characterized by partial narrowing of the lumen of a vessel. This is fraught with the possibility of its subsequent complete closure (occlusion).

The left common and right carotid arteries are located in front of the transverse processes of the cervical vertebrae. Each of them is divided into an internal artery and an external one.

When stenosis develops, brain tissue experiences oxygen starvation, and the vital processes of cells are disrupted. Blockage of blood flow to the brain leads to ischemic stroke and death.

Men are more prone to developing this pathology.

The danger of arterial stenosis is the asymptomatic period of the initial stage, when the lumen of the vessel is slightly narrowed. It can last more than a year, and the patient does not even suspect the presence of such a pathology.

Factors contributing to the development of the disease

The following pathologies and abnormalities are related to narrowing of the carotid artery:

atherosclerosis, in which plaques begin to form in the vessels. They narrow or block the lumen, complicating or stopping blood circulation;
rheumatoid diseases caused by immune disorders;
elevated blood cholesterol levels;
the appearance of excess weight;
genetic predisposition (presence of atherosclerosis, stroke, coronary artery disease in close relatives);

diabetes;
injuries (bruises, fractures, spinal osteochondrosis);
Nonspecific aortoarteritis is an autoimmune disease. With it, large arteries become inflamed;
thrombophlebitis;

Other predisposing factors include the presence of bad habits, old age, lack of physical activity, and poor diet.

When carotid artery stenosis occurs, the symptoms of which develop slowly, a person does not immediately notice the ailment.

Signs of pathology

The first symptom of carotid artery stenosis is recurrent ischemic attacks or the development of a micro-stroke. In cases where the blood supply to individual brain structures decreases for a short time, the following signs of pathology occur:

headache localized on one side;
severe dizziness that can lead to fainting;
attacks of vomiting without feeling nausea;
decreased coordination of movements;
visual disturbances – blurriness and clouding;
fatigue and weakness;

numbness;
tingling sensation in one of the upper or lower extremities;
short-term amnesia and memory loss;
decreased ability to perceive information;
paralysis of the part of the body on the side of which the pathology develops;
imbalance;
decreased swallowing reflex.

Angioplasty with stenting for stenosis of the right or left artery is a more gentle method of treatment. The operation is carried out as follows:

a balloon catheter is inserted into the vessel, and the process is controlled by an angiograph;
the catheter is directed to the place where the lumen of the artery decreases;
the balloon inflates and expands the artery in the desired area.

The manipulation takes place under local anesthesia, while the patient's blood pressure and pulse are constantly monitored.

The operation promotes blood flow to the brain in the required amount.

Contraindications to this type of surgery are heart rhythm disturbances, complete blockage of the carotid artery, intolerance to drugs used during surgery, and cerebral hemorrhages.

Despite the benefits of surgical interventions, they can have complications that develop in the postoperative period:

the occurrence of bleeding;
cerebral stroke;
vascular thrombosis;
the occurrence of allergic reactions to drugs used during surgery;
complications of an infectious nature.

Although timely correction of blood flow during stenosis has a favorable prognosis, there is no guarantee that the vessel will not be affected again.

After the operation, the patient must take antiplatelet agents and thrombolytics for some time. He is prohibited from drinking alcohol and smoking.

If pain occurs at the incision site, you can apply ice to it for a few minutes. You can take a shower only 2 days after the operation, and a bath only after 2 weeks.

Until the body is completely restored, it is necessary to avoid going to the sauna and bathhouse.

To reduce the risk of developing stenosis you need to:

adhere to the principles of a healthy lifestyle;
provide at least a minimum level of physical activity;
control blood sugar and cholesterol levels;
to refuse from bad habits;
maintain weight within normal limits.

Carotid artery stenosis often leads to irreversible changes, and in some cases, to the death of the patient. To prevent this from happening, you must contact a specialist in a timely manner.

Occlusion (vascular obstruction) is a serious manifestation of vascular insufficiency

Cardiovascular pathologies firmly occupy a leading place among diseases leading to death or permanent disability of a person. A decrease in the conductive capacity of large blood vessels can paralyze the functioning of many organs and systems of the body. One of the most terrible manifestations of vascular insufficiency is vascular occlusion.

What is occlusion and why does it occur?

Occlusion is a sudden obstruction of blood vessels due to the development of pathological processes in them, blockage by a blood clot, or due to traumatic causes.

It is imperative to know the causes of this phenomenon and its symptoms, since in most cases the time to take emergency measures is extremely limited - literally hours and minutes count.

Occlusion using the example of a hand

Depending on their location, there are different types of occlusion - venous or arterial, affecting the great vessels that feed organs, limbs, and the central nervous system. They can be caused by a number of circumstances:

Another vulnerable spot is the vertebral artery, the development of occlusion in which leads to damage to the occipital part of the brain.

Harbingers of the formation of large areas of stroke are the so-called. This can be expressed by extraterrestrial numbness of the limbs up to temporary paralysis, frequent dizziness, memory loss, speech and vision disorders, and periodic fainting.

Occlusion of the eye, or more precisely, of the vessels supplying its retina, can appear completely suddenly and absolutely painlessly, but, as a rule, leads to complete immediate loss of vision in the affected eye. Men who have reached the age of 50-70 years are more susceptible to this disease.

In order not to push your body to extremes, you must definitely maintain your vascular system in normal condition by performing a set of preventive measures:

Critical ischemia of the NK.

In case of stenosis (occlusion) of the main arteries of the lower limb and the absence of collateral blood flow, is surgery performed to restore blood circulation to the NK or is amputation of the NK necessary?

Answer: In most cases, blood flow in the leg can be restored. Send the data from the study of the blood vessels of the legs by mail Angiocliniс@yandex.ru

Cerebral aneurysm

Where and how to carry out treatment and how much coiling will cost.

Answer: Please send CT angiography of the brachiocephalic arteries by email [email protected]

You have not answered the main question - is a repeat stroke possible due to 100% blockage?

Answer: If the other carotid artery or vertebrae is bad, then there is such a possibility. But it makes no sense to restore the blocked carotid artery, since it is thrombosed to the brain.

100% blockage of the carotid artery

Hello! My mother is 79 years old, had a right-sided ischemic stroke in November, now she moves on her own and takes care of herself. During rehabilitation, an ultrasound scan showed 70% blockage of the carotid artery, a repeat ultrasound was performed...

Answer: If the blockage is complete, surgery is not necessary.

my leg is rotting

Hello! We have such a problem. My grandfather's legs from the knee to the foot turned into what is called an elephant's leg. They rot and are covered with purulent crusts. At night some kind of...

Answer: Hello. Your grandfather urgently needs to undergo ultrasound duplex scanning of the veins and arteries of the lower extremities. Consultation with a cardiologist is also essential. This can be done at one of our medical centers. Research data...

about the possibility of rehabilitation of diabetic feet of a 90-year-old woman with stage 2 diabetes

Is it possible to rehabilitate a 90-year-old woman, according to her passport (actually 91), with sore feet on both legs and stage 2 diabetes mellitus. Left leg: all toes are immobilized, on which there is dry (black gangrene),...

Answer: There is not enough information to answer. You need a photo of your leg and vascular studies.

colateral blood flow along the dorsum of both feet

What to do in such cases, blood flow is reduced. Cold 4.7 HDL 1.1 LDL 2.9 VLDL 0.6 anthrogenic factor 3.3

Answer: An attempt must be made to restore the main blood flow. We are doing this successfully. Describe the patient's complaints and send vascular examination data (ultrasound of the leg arteries or angiography of the leg arteries) by email [email protected]

Is it necessary to perform stenting of the carotid artery during such CT angiography?

Is it necessary to perform stenting of the carotid artery during such CT angiography? where to send an angiography epicrisis

Answer: Hello. Send all the data from the MSCT disk to the “correspondence with the doctor” section or by email. Tell me what worries the patient, have there been strokes or TIAs?...

Gangrene of the fourth finger

Hello, my father's right leg was amputated above the knee due to diabetes. Now gangrene has started on the fourth toe on the left foot and has begun to spread to the foot and little toe. We are from Kazakhstan...

Answer: Good afternoon. Send a photo of your leg in several projections and data from a study of the blood vessels of the leg (ultrasound, arteriography, CT angiography of the arteries of the leg) by email [email protected]

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My husband had a skin graft on his foot after surgery to remove his little toe and was diagnosed with diabetic foot, type 2 diabetes. Question - what can be recommended for the fastest healing of the wound - while...

Answer: It is difficult to answer without knowing the state of blood circulation and the type of wound. Send examination data and photographs of your leg in the correspondence with the doctor section.