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How can atherosclerosis be treated?

It is important to control the factors that we know will cause atherosclerosis. There is little we can do about our genetic predisposition. The most important thing to do is not to smoke. Looking for and treating diabetes, high blood pressure and a high cholesterol level is also very important. With treatment, atherosclerosis may stop getting worse and may even improve as long as you don't smoke.

Many patients benefit from taking aspirin regularly and there are effective medications for angina, high blood pressure, high cholesterol and diabetes. Take advice from your doctor about taking any medication.

Sensible exercise is very beneficial, although you shouldn't exercise beyond "the pain barrier". If it hurts, you should stop.

These measures are all that many patients require as treatment for their atherosclerosis. In a small proportion however, these measures are not enough and some other form of treatment has to be considered. It is your General Practitioner, medical specialist or surgeon who will help you decide if you are one of the people who need additional treatment.

If you do need additional treatment, an important step in most cases is an "angiogram". This is an X-ray test that involves injecting dye into your arteries through a needle in your groin or arm. The angiogram gives a "road map" of your arteries and shows exactly where the narrowing and blockages causing your symptoms are. Some narrowing and blockages can be widened with a balloon inserted into your arteries through a needle. The balloon is placed across the narrowing and inflated – this is called an angioplasty.

AngioplastyAngioplasty - Widening a blockage in an artery using a balloon.

In other narrowing and blockages which are not suitable for angioplasty the treatment is then bypass surgery.

A vascular bypass can be thought of as a new road built around a congested town. The congested town is your narrowed or blocked artery while the new road is the vascular bypass.  The narrowed or blocked artery is not generally removed and the bypass is joined onto the side of the healthy artery above and below the affected area.

The diagram below shows how this is done.

Restricted blood flow(a) The blood flow is restricted through the artery   Bypass(b) A bypass is sutured into place above and below the affected area and normal blood flow is resumed.

The choice of material for the bypass depends on the exact site in your body that needs a bypass. A prosthesis (artificial bypass) is almost always chosen for bypasses from the abdomen to the legs and to repair aneurysms. In these positions, a prosthesis can be expected to work well for many years. Bypasses from the groin to sites further down the leg are often made with your own vein that can be used as a "spare part". The further down your leg your bypass has to go, the more likely it is that your surgeon will try to use your own vein as this is the best material to use in these circumstances. Some bypasses in the leg work just as well with a synthetic graft, however, and in these cases your surgeon will decide which is best for you. If you have no available vein in your leg because of previous bypass surgery or because of varicose veins, your surgeon may choose to use a prosthesis instead.

How vascular grafts work

A vascular graft is medical science's substitute for your body's natural artery. It works in a similar way to the one with which you were born. It provides a tubular bypass for arteries that have become narrow or blocked due to disease processes.

Vascular grafts are sophisticated materials made into tubes of variable length, shape and diameter. Every component is made of the highest quality materials and receives a thorough visual and functional inspection. Each component and completed graft is tested during every stage of production and meticulously manufactured using advanced knitting, weaving or ePTFE technologies. Sterility is guaranteed and there are no risks of passing on diseases with the use of a prosthesis.

The vascular prosthesis has inbuilt reserves of strength and stability, far above that of the natural artery. It is designed to be a permanent part of your vascular system whose function is affected more by other factors, such as age and disease, than by material from which the prosthesis is made.

FUTURE OUTLOOK - Bypass Longevity

There is a possibility that a bypass may not work forever. This is due to a number of factors such as how severe the atherosclerosis was in the first place, how quickly it progresses after the bypass operation, whether you continue to smoke and how well the other factors which influence atherosclerosis are controlled.

Bypasses onto small arteries in the legs (especially below the knee) and arms tend to last longer if they were made with your own vein as this is a living material that helps to keep the blood flowing.

If a prosthesis should block, it is highly unlikely to be due to prosthesis failure, and is normally due to the changes brought about by advancing years and further disease.

We hope this information will help you to understand more about your vascular system and your prosthesis. Hundreds of thousands of men and women of all ages have prostheses and continue to lead full, enjoyable and productive lives.

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Scotland UK

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