Medical Conditions | Dr Duncan Anderson

Abdominal Aortic Aneurysms

An abdominal aortic aneurysm is where the main blood vessel inside the abdomen slowly starts to enlarge. Different factors including increase in male gender, age, smoking, high blood pressure and family history of abdominal aortic aneurysms increases the risk of the elastic fibres of the artery wall becoming damaged. This prevents the arterial wall from recoiling after the blood has been pushed out into the aorta from the heart. The blood vessel then swells or becomes aneurysmal and enlarges. Just like a balloon; the larger the aneurysm becomes; the thinner the wall become until there is a risk of rupture or it bursts.

An unruptured or asymptomatic aneurysm is only surgically treated when its reaches a certain size (more than 5 cm in women and 5.5 cm in men), rapidly enlarging or if they become symptomatic such as tender to the touch. A CT angiogram of the abdomen is then done to determine if there are any signs of rupture or impending rupture. If there is, then it is classified as treatment of a ruptured aortic aneurysm and this is an emergency.

The repair of an asymptomatic aneurysm can be done by a device called an EVAR or FEVAR, depending on the extent of the aneurysm. These can only be performed on stable patients.

The open repair of an abdominal aortic aneurysm is done in younger fitter patients, because although this procedure has higher complications and mortality; it also has a better durability. In the event of a rupture, an open repair is the dominant option as the devices need to be custom ordered and or made.

Buerger Disease

Bueger's Disease; also known as thromboangiitis obliterans; is a rare disease which often presents in younger males between the ages of 20 - 45 years of age. It affects the blood vessels in the body, more commonly in the arms, legs, feet and hands, becoming inflamed, making it difficult for blood to travel through. Due to this sluggish blood flow, clots form which worsen the condition by narrowing the blood vessels further. This results in tissue damage, pain and discolouration of the tips of your fingers or toes. It is most commonly found in patients who smoke or chew tobacco, marijuana and nicotine and stopping this, is the best way to make the symptoms better.

Initial symptoms may include burning and tingling of the hand and feet, sores on the tips of toes and fingers. Ankle, foot or leg pain when walking, Raynaud's syndrome, and skin colour and texture changes. Later symptoms include muscle cramps, blood clots, red, blue or pale fingers or toes, numb feet or hands and finally skin ulcers and gangrene.

Although there is no cure, this condition can be managed with best medical therapy and healthy lifestyle changes. Cessation of smoking completely significantly helps to prevent progression of this disease. For more information come see Dr Anderson.

Diabetes the deadly disease

Diabetes mellitus (commonly known as diabetes or sugar disease) is one of two major forms of diabetes. As this is the most common form, it will be discussed here. Diabetes Mellitus has two types, type 1 and type 2, which is determined from its onset.

Diabetes occurs when the pancreas doesn't produce enough of a hormone called insulin, or the insulin it produces isn't effective in keeping your sugar / glucose levels within normal fasting ranges (3.9 - 5.5mmol/L). Fasting levels between 6-7 are known as prediabetic or insulin resistant and a fasting level over 7 or 8 normally indicates diabetes. However, a blood test alone does not make a diagnosis, your doctor will make a diagnosis based on a full clinical assessment.

Glucose (sugar) mainly comes from carbohydrates in your food and drinks. It’s your body’s go-to source of energy. Your blood carries glucose to all your body’s cells to use for energy. When glucose is in your bloodstream, it peaks after meals and needs help to move into the cells to be used when your blood sugar levels fall. This help comes in the form of insulin (a hormone). If your pancreas isn’t making enough insulin or your body isn’t using it properly, glucose builds up in your bloodstream, causing high blood sugar (hyperglycemia). Most forms of diabetes are chronic, but can be managed with lifestyle changes and medications if necessary.

If diabetes is not well controlled, hyperglycemia causes serious health conditions, including blindness, severe kidney disease, stroke, heart attack, sores in your feet, gangrene (dead infected tissue), renal failure, blindness, amputations and/or death. While hypoglycemia (low blood sugar levels) can result in irritability, unconsciousness, coma and death.

These risks can be lowered by working with your doctor to maintain good control of your glucose levels by following a strict diet and taking medication as necessary, while increasing exercise and losing weight (please see our healthy lifestyle advice under patient information).

Diabetes is linked to several vascular diseases:

Retinopathy, which is an abnormal growth of blood vessels in your retina which could lead to blindness
Nephropathy, a disease that damages the tiny filtering units of the kidney which may lead to kidney failure
Neuropathy, a condition causing a loss of sensation in the feet and toes which may result to increased sores, infection, burns and gangrene of your toes and feet
Atherosclerosis which may result in heart problems or inability to walk far without pain in your calves (claudication)
Stroke, exhibited by the sudden onset of: numbness or weakness in the face, arm, or leg, especially on one side of the body; confusion, trouble speaking, or difficulty understanding speech. Sudden trouble seeing in one or both eyes and or sudden trouble walking, dizziness, loss of balance, or lack of coordination.
Peripheral Vascular Disease (PVD), which causes narrowing in your blood vessels and may lead to gangrene and amputation.

Learn more about Diabetes

Peripheral Vascular disease

Peripheral vascular disease (PVD) is when there is reduced blood supply to a part of the body. This is common in the lower legs, but can also happen in the upper limbs. This is caused by an accumulation of plaque (fats and cholesterol) in the arteries found in your legs or arms. This causes a narrowing or blockage of the artery which takes blood from your heart to the distal parts of your body. This prevents oxygenated blood from getting through to the tissues, causing them to die resulting in gangrene. This commonly occurs in your toes and feet first; however, this is occurring throughout your body increasing your risks of stroke and heart attacks.

PVD generally takes time to progress, which is why a healthy lifestyle and exercise throughout your life is so important. However, it is never to late to start improving your lifestyle by exercising, eating less fat and giving up products containing nicotine (please see our advice under patient information - healthy lifestyle).

The different stages of peripheral vascular disease include

stage 1- which is asymptomatic (without symptoms).
stage 2a - which includes mild claudication (leg pain during exercise)
stage 2b - moderate to severe claudication
stage 3 - Ischemic rest pain (pain in your legs when you’re at rest)
stage 4 - Ulcers or gangrene which result in amputations.

It is therefore very important to come and see a vascular surgeon as soon as you realise that you have leg pain during exercise, as vascular disease caught early, can prevent amputations.

Unfortunately, diabetic patients often don't experience pain like other patients, which may result in a late presentation. They may only realize there is a problem when they find a burning or aching pain in their feet and toes while resting, especially at night while lying flat. Cool skin on their feet with redness or other color changes of the skin. They also find skin and soft tissue infections (usually on feet or legs) and finally toe and foot sores don’t heal.

Vascular disease can be treated with medications, lifestyle changes and possible surgical intervention. The sooner the presentation to a vascular surgeon and a commitment to improve their lifestyle with exercise and diet, the better the prognosis. Please see our advice regarding a healthy lifestyle under our patient information.

Raynaud's Disease

Raynaud's disease occurs due to poor blood flow in the small arteries in the hands and feet. This is most common, although cases involving the nose, lips, ears and nipples have also been recorded. This disease is thought to be brought on by smoking, cold temperatures and stress. When the blood flow to the affected parts is severely limited, this causes them to change colour (white or blue) and is often associated with pain. The extremity also feels cold and becomes numb. When warmed the affected limb may throb and turn red again as blood flow improves.

Vasospastic (primary) Raynaud's disease does not result from another medical condition, but presents by itself. It is often mild and most patients do not seek treatment as it goes away on its own, particularly with cessation of all smoking.

Occlusive (secondary) Raynaud's develops due to another disease such as Bueger's Disease, connective tissue diseases (such as lupus, Sjogren's syndrome or rheumatoid arthritis), carpal tunnel syndrome, trauma to extremities, work related overuse injuries, atherothromboembolism from proximal arterial aneurysms, arterial thoracic outlet syndrome and certain medications.

Varicose Veins

The venous system is responsible for taking the blood back to the heart after it has been pumped all over the body. It is a low pressure system when compared to the arterial system as there is no pump (heart) to move the blood up against gravity back to the heart. Therefore, the veins have thinner walls and use the skeletal muscles like the calf muscles to help pump the blood. This is assisted by little valves which open and close throughout the veins and let the blood move upwards, but prevent the blood from "falling" down again with gravity.

If these valves are weakened or damaged, then the blood can flow downwards again, collecting in the distal part and the collective pressure causes the veins to swell and enlarge (varicose). There are a number of factors which increase the likelihood of you developing varicose veins; these include being female, older, overweight, have a genetic predisposition (family history) for varicose veins, or having an job which results in sitting or standing for prolonged periods of time. Varicose veins also commonly appear or worsen during pregnancy due to hormonal changes and increased blood volume.

Symptoms of varicose veins include heavy, swollen or achy legs; veins which are dark purple or blue and may appear twisted and bulging, darkening of the skin around the lower leg (hyperpigmentation) with itchiness or sores of the lower leg. Spider veins are smaller and milder than varicose veins and appear and thin red lines close to the surface of the skin.

Complications include blood clots, ulcers and bleeding which occurs when a vein close to the skin bursts.

More information to follow

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