Arterial Disease Treatment Program

Arterial disease encompasses a range of conditions that impair the structure and function of the arteries—the vital blood vessels responsible for transporting oxygenated blood from the heart to tissues and organs throughout the body. When the integrity of the arterial walls is compromised—whether through narrowing, blockage, or structural weakness—it results in impaired perfusion, limiting the delivery of oxygen and essential nutrients to target areas. This disruption in circulation can have cascading effects across multiple organ systems, increasing the risk of tissue ischemia, cellular dysfunction, and progressive organ failure.

A range of modern surgical and endovascular techniques now allow clinicians to restore arterial function, reduce long-term risk, and preserve patient quality of life through targeted, evidence-based interventions. These innovations represent a critical step forward in addressing the complex challenges posed by compromised arterial circulation.

Why Cuba

In Cuba, the treatment of arterial disease is rooted in a proactive, precision-based surgical approach that aims to restore healthy blood flow and prevent critical complications associated with blocked or weakened arteries. Whether managing peripheral arterial disease, carotid artery narrowing, or aortic aneurysms, Cuban vascular specialists prioritize individualized care that balances clinical urgency with patient safety. Surgical decisions are made by evaluating the severity of arterial damage, overall patient resilience, and the long-term benefit of intervention.

Cuban medical teams are equipped to identify the most suitable technique—favoring endovascular solutions when minimally invasive treatment is possible. In cases requiring open surgical intervention, procedures are performed with the same high level of precision and attention to detail. Recovery is carefully managed through an integrated system of follow-up, rehabilitation, and education, enabling patients not only to heal, but to maintain improved vascular health and functionality well into the future.

Types of Arterial Conditions

There are several forms of arterial disease, each affecting different parts of the circulatory system. The most common conditions include:

Peripheral Arterial Disease (PAD)

• PAD occurs when the arteries supplying blood to the limbs—most commonly the legs—become narrowed due to reduced blood flow.
• Common symptoms include intermittent claudication (leg pain while walking), numbness, cold feet, and non-healing wounds on the lower extremities.
• PAD is a progressive condition that can lead to critical limb ischemia, increasing the risk of amputation if not properly managed.
• It is also a marker for systemic atherosclerosis, indicating higher risk for heart attack and stroke.

Carotid Artery Disease

• This condition involves the buildup of plaque in the carotid arteries, which supply blood to the brain.
• It may remain asymptomatic for years but can result in a transient ischemic attack (TIA) or stroke if a clot forms or a plaque breaks off.
• Carotid artery disease is a leading cause of ischemic strokes, particularly in older adults with cardiovascular risk factors.
• Early detection and intervention can significantly reduce stroke risk, especially in high-grade stenosis.

Aortic Aneurysms

• An aneurysm is a localized enlargement or ballooning of the aorta, which can occur in the abdominal or thoracic sections.
• Most aortic aneurysms are asymptomatic until they enlarge or rupture, making screening crucial in high-risk populations.
• Ruptured aneurysms are often fatal, with a high rate of mortality even with emergency surgery.
• Elective repair is considered when the aneurysm reaches a critical size or shows signs of rapid expansion.

Renal Artery Stenosis

• This condition involves narrowing of one or both renal arteries, reducing blood flow to the kidneys.
• It can lead to resistant hypertension, as reduced perfusion stimulates the renin-angiotensin-aldosterone system (RAAS).
• Long-standing renal artery stenosis may cause progressive kidney dysfunction and eventually renal failure.
• It is more common in individuals with generalized atherosclerosis or fibromuscular dysplasia (in younger patients).

Mesenteric Artery Disease

• Caused by narrowing or blockage in the arteries that supply the small and large intestines.
• Chronic cases often lead to postprandial abdominal pain (intestinal angina), fear of eating, and significant weight loss.
• Acute mesenteric ischemia, often due to a sudden arterial blockage, is a surgical emergency with high mortality if untreated.
• Early diagnosis is key to preventing intestinal infarction, which can lead to sepsis and multi-organ failure.

Causes of Arterial Disease

The primary cause of most arterial conditions is atherosclerosis, a process in which fatty deposits (plaques) build up on the inner walls of arteries. Over time, these plaques harden and narrow the arteries, reducing blood flow. Other contributing factors include:

• Smoking
• High blood pressure
• High cholesterol
• Diabetes
• Obesity
• Genetic predisposition
• Sedentary lifestyle

Age and gender can also play a role, with arterial disease more commonly affecting older adults and men, although women are also at risk, particularly after menopause.

When Surgery Is Required

Surgery is typically considered when arterial disease reaches a stage where it threatens organ function, limb viability, or life itself, and conservative treatments (e.g., lifestyle changes and medications) are no longer effective.

Surgery may be necessary in cases such as:

• Severe narrowing or blockages causing pain, non-healing ulcers, or limited mobility
• Aneurysms that exceed a certain size or are at risk of rupture
• Carotid artery narrowing associated with high stroke risk
• Organ-threatening conditions like mesenteric or renal ischemia

Risks of Delaying Surgery:

• Stroke from untreated carotid artery disease
• Limb loss due to critical limb ischemia
• Aneurysm rupture, which can be fatal
• Kidney failure or intestinal damage due to reduced blood flow
• Chronic pain and disability from worsening PAD

Timely surgical intervention can prevent these outcomes and significantly improve long-term prognosis.

Pre-Surgery Diagnosis and Evaluation

Before proceeding with surgery, a comprehensive evaluation is essential to ensure accurate diagnosis and proper treatment planning. This typically includes:

• Duplex Ultrasound: Non-invasive test to assess blood flow and vessel structure.
• CT Angiography (CTA) or MR Angiography (MRA): Detailed imaging of arteries.
• Ankle-Brachial Index (ABI): Measures blood flow in the legs.
• Cardiac Evaluation: To assess surgical risk and fitness for anesthesia.
• Laboratory Tests: To evaluate kidney function, coagulation status, and inflammation.

These tests allow the surgical team to develop a personalized approach tailored to the patient’s condition and risk profile.

Minimally Invasive vs. Open Surgical Approaches

When treating arterial disease, surgeons may choose between minimally invasive techniques and traditional open surgery, depending on the patient’s condition, anatomical factors, and overall health status.

Minimally Invasive (Endovascular) Procedures

• Performed using catheters and guidewires through small incisions (usually in the groin).
• Shorter recovery time, reduced pain, and lower risk of complications.
• Common in treating PAD, aortic aneurysms (EVAR), and certain carotid or renal artery conditions.

Open Surgical Procedures

• Involve larger incisions and direct access to the affected artery.
• Preferred in complex or advanced cases, such as large aneurysms or multi-level arterial disease.
• Often used when endovascular techniques are not feasible or have failed.

The choice between open and endovascular surgery depends on the patient’s anatomy, overall health, and the nature of the disease.

Types of Arterial Procedures

Depending on the condition, vascular surgeons may choose from a range of procedures designed to restore or improve blood flow:

Angioplasty and Stenting

• This is a minimally invasive endovascular procedure typically performed under local anesthesia.
• A balloon catheter is inserted into the narrowed artery and inflated to compress plaque and widen the vessel.
• A metal stent (mesh tube) is often placed at the site to prevent re-narrowing (restenosis) and keep the artery open.
• Commonly used in peripheral arterial disease, coronary artery disease, carotid stenosis, and renal artery stenosis.
• Recovery is generally quick, with most patients resuming normal activities within a few days.

Endarterectomy

• This is an open surgical procedure that involves direct access to the affected artery.
• The surgeon removes atherosclerotic plaque from the inner lining of the artery to restore normal blood flow.
• Most commonly performed as a carotid endarterectomy, which significantly reduces the risk of stroke in patients with moderate to severe carotid artery narrowing.
• The procedure may also be used in femoral or iliac arteries when plaque buildup is localized and surgical access is favorable.
• It is typically performed under general or regional anesthesia and may require an overnight hospital stay.

Bypass Surgery

• In this procedure, a graft (either synthetic or autologous vein) is used to create a new route for blood to flow around a blocked artery.
• It is commonly used in lower extremity revascularization (e.g., femoral-popliteal bypass) or in coronary and renal artery disease when stenting is not suitable.
• Bypass surgery is invasive and usually reserved for patients with advanced disease or complex blockages.
• Recovery may take several weeks, and patients are closely monitored for graft patency and wound healing.
• Long-term success is highly dependent on risk factor modification, such as quitting smoking and managing diabetes.

Endovascular Aneurysm Repair (EVAR)

• EVAR is a minimally invasive alternative to open aneurysm repair, typically used for abdominal or thoracic aortic aneurysms.
• A stent graft is inserted via a catheter through small incisions in the groin and guided to the aneurysm site using imaging.
• Once deployed, the graft seals off the aneurysm from inside, reducing the risk of rupture.
• EVAR is associated with lower perioperative risk, shorter hospital stays, and faster recovery than open repair.
• However, long-term surveillance is required to monitor for complications like endoleaks or graft migration.

Open Aneurysm Repair

• This is a traditional, open surgical procedure typically used when EVAR is not an option due to anatomy or in cases of ruptured aneurysm.
• The surgeon makes a large incision in the abdomen or chest, removes the aneurysmal portion, and replaces it with a synthetic graft.
• Open repair is more invasive and carries a longer recovery time, but it may offer more durable results in some patients.
• It is the gold standard for certain complex aneurysms and may be necessary when the aneurysm involves arterial branches.
• Intensive post-operative monitoring is required, particularly for cardiac, renal, and respiratory function.

Recovery and Outcomes

Recovery time varies depending on the type of procedure and the patient’s overall health. Minimally invasive procedures typically allow patients to return to normal activities within a few days to a week, while open surgeries may require a longer recovery period of several weeks.

Post-operative care focuses on:

• Wound management
• Pain control
• Monitoring for complications
• Gradual return to physical activity
• Lifestyle changes and medications to prevent recurrence

With timely treatment and proper follow-up, most patients experience significant improvement in symptoms, circulation, and quality of life. Long-term outcomes are best when surgery is combined with lifestyle modification and medical therapy.