chapter  6
Pages 1

Arteriosclerotic disease is a condition where the artery hardens and narrows. Before carrying out any treatment, it is important to assess the patient properly to determine the extent of the arterial disease and whether there is any co-existing medical condition which may be affected by treating the arterial problem; it is then necessary to decide whether the treatment is really indicated. A patient presenting with intermittent claudication (pain in the calves) after walking half a mile would not normally be a candidate for surgical treatment. He would normally be advised to exercise, to walk into the pain, as this will stimulate the opening up of new vessels, to stop smoking and to come back if his condition deteriorates. He would also be told to report immediately to the accident and emergency department if he notices any sudden changes in the colour of his leg, or presents with severe pain. In some patients, operating on them may improve their claudication only to reveal an underlying problem with their heart (angina). There are no absolute rules as to who gets operated on and who does not, but careful attention should be paid to each individual patient’s lifestyle. If a patient’s quality of life is suffering as a result of severe arterial disease, then one might be inclined to operate at an earlier stage. It should be remembered that, even in the best hands, arterial surgery is unpredictable, and that embarking upon one operation may lead in rapid succession to a series of operations, culminating in the loss of a limb.