Diabetics and the elderly at high risk

Vascular disease is a serious, widespread problem. In Greece alone, 300,000 diabetics (about one in three of those with diabetes) will have serious vascular problem at some time in their lives. Vascular complications are the most common reason that put diabetics in hospital and lengthen their stay there. «Apart from the serious damage to their eyes and kidneys,» says Liapis, «diabetics often go to the specialist with what we call diabetic leg, which is gangrene, and wounds that won’t heal on their legs. These start as small lesions which cause major problems.» Timely diagnosis To what do you attribute the growing international interest in informing the public about problems of the aorta? These problems are increasing because the population is aging and their consequences are extremely grave. In a few years, 25 percent of the population will be over 65. In such a population, especially among men, the frequency of aneurysm is around 5 percent. So we have 20,000 aneurysms among adult men alone in Greece. These people seem healthy and are not receiving medical treatment. Most of them will have a ruptured aneurysm and will most probably not even make it to hospital. In places like Scandinavia or France, which have advanced preventive checkup systems, the chances of having a ruptured aneurysm are 15 percent. In Greece, the figure goes up to 40 percent, not including patients who die at home without ever reaching hospital. And since very few autopsies are performed in Greece, we do not have accurate statistics, unfortunately, on the number of people who die suddenly due to an aneurysm. How much better are the chances for a patient with an aneurysm who has planned surgery? The chances of a successful outcome are 95-98 percent at the moment, and better than that in some clinics. By contrast, only half the patients who have emergency surgery for ruptured aneurysms survive. This means that, taking into account the patients who die at home or on the way to hospital, the mortality rate is as high as 75 percent. Of course not every person who has an aneurysm needs an operation, but they must be examined regularly so that treatment can be adjusted. They may need only treatment with statins and anti-platelet drugs. Often, less invasive surgical procedures are used, and patients are very carefully selected for such treatment. Should a vascular test be part of mandatory checkups? After a certain age, and for those with a family history of vascular disease, preventive ultrasound checks are necessary. It is the simplest, cheapest method, and the most reliable. Using intravascular ultrasound, we can see not only the degree of narrowing but also the type of atheromatic plaque which causes sudden death. Now that this technology is widely used and there are many types of exams, we must start certifying the exams in Greece. Ultrasound gives the right results when the machine is good and the operator knows his or her job well. It is easy to use the technology, but it is difficult to apply it properly. And there is nothing more dangerous than a faulty exam that makes you panic or relax for the wrong reason. Can a stroke be avoided? Strokes are usually the result of atherosclerosis, but they are also caused by fibroids or small aneurysms in the brain, which are more common in women, and which cause strokes when they rupture. In recent years, we have been able to locate them easily and without surgery using magnetic angiography. So, with a few symptoms, mainly hypertension, we should be able to see if there are any aneurysms. Isn’t the vascular system unified? And why is there this variety of medical specialization? Indeed, changes in the carotid artery are a timely indicator of vascular problems in the body in general. That is why European Union countries are going in for vascular disease departments in hospitals, like those at the Mayo Clinic, at Harvard and in Germany. Cardiologists, vascular surgeons, lipid specialists and diabetes specialists all work together in such clinics to give patients holistic treatment, instead of each doctor looking at one part of the system separately. The aorta – a ‘medical orphan’ As the population ages and vascular-coronary episodes increase, scientists are making efforts to inform the public about the benefits of preventive checkups. A recent article in the Wall Street Journal described the aorta, the most important blood vessel in the human body, as a «medical orphan» which, because it is covered by most medical specializations, is criminally neglected. «Prevention and systematic treatment is of great importance,» says Liapis, «because strokes rarely give warning signs. Numbness in the arm or leg usually goes unnoticed and doesn’t impel us to seek help, and the stroke comes unannounced. That’s why systematic checkups are needed for people at high risk, either because of their age or their family history.»