As a vascular surgeon, I operate on blood vessels, called arteries that carry oxygen-rich blood throughout the body. Healthy arteries have smooth inner walls and blood flows through them easily. Sometimes, arteries can become clogged and reduce blood flow to the body. At that point, a medical specialist like me needs to intervene.
What is Plaque Buildup?
Clogged arteries are the result of plaque buildup on the smooth, inner walls of the vessel. Plaque in the arteries is made up of cholesterol, calcium and blood clots. Buildup takes place over time, but due to various factors, including diet, lifestyle habits, high blood pressure, tobacco smoking and even genetics, it can happen at a faster rate and a younger age.
As you can see in the photo, plaque build-up in the arteries looks like fat deposits. The plaque sticks to the arterial walls and decreases the amount of space available for blood flow, or in some cases, blocks the blood flow completely. Plaque buildup leads to two major problems, ruptures and blood clots.
1) Ruptures - Plaque is unstable in the arteries, and can rupture. When this happens, a piece of the plaque can travel through the blood vessel and cause a blockage. This blockage can result in either a heart attack or a stroke. A stroke is the most common result because when blood exits the heart, it goes to the head first.
2) Blood Clots - Plaque buildup can cause the arteries to harden and become so narrow that blood flow slows or stops completely. This process results in the formation of a blood clot which can also lead to a heart attack or stroke.
Lifestyle modification and medication are both excellent options for treating clogged arteries – and should be tried before surgery. However, in some cases, surgery is necessary to address the rupture or blood clot in the artery. The primary goal of surgery is to restore blood flow by either removing the blockage or bypassing it.
Removing the blockage is called endarterectomy, and essentially means that I open the artery and literally peel or scrape out the plaque and any blood clots.
To perform a bypass, I take a vein graft (usually up to 6” long, from the leg) and I use it to go around the blocked area of an artery. I stitch one end of the graft below the blockage and stitch the other end of the graft above the blockage. This allows oxygen-rich blood to resume its normal path.
Health Conditions that Lead to Plaque Buildup
Several health conditions lead to premature artery problems. They include:
• High blood pressure
• High cholesterol (and low “good” cholesterol)
Lifestyle Choices that Lead to Plaque Buildup
There are several lifestyle choices that can also cause early or excessive plaque buildup. They include:
• Smoking. This is, in my experience, the biggest issue for plaque buildup. If you have a smoker and non-smoker with the same risk factors, diet, etc. the smoker’s arteries will almost always look worse. Why? Because smoking causes inflammation in the arteries and arteries that are irritated and inflamed will collect more plaque.
• What we eat. Foods that are high in saturated fat, trans fats, salt and added sugar all create excessive cholesterol and inflammation in our bodies. The plaque is actually made up of surplus fat that our liver has turned into cholesterol.
• Lack of physical activity. Too much food with not enough energy spent leads to being overweight and obese. The result of that is excess fat in the body, as well as inflammation.
Poor food choices and lack of exercise together can lead to the health issues listed above. High blood pressure, high cholesterol, diabetes and obesity are all related to diet and physical activity…and tobacco use only makes all of them worse.
• If you smoke, do everything you can to quit. Also avoid being exposed to secondhand smoke, because it’s just as bad.
• Follow a healthy diet that includes lots of vegetables, fruits, lean meat, fish, nuts and seeds.
• consume omega 3. Anything with omega 3 fatty acids is considered beneficial. We know in particular that they help reduce triglycerides (which are fats floating in the blood stream).
• Exercise 30 minutes at least 5 times a week (for a total of 150 minutes). Walking, bicycling, dancing, etc. all count! And this can be all at once, or in shorter blocks. For example, a fast 15 minute walk at lunch, and then another in the evening, adds up to 30 minutes. Exercising helps prevent a lot of health issues and keeps cholesterol numbers in check.
• If you have a family history of heart disease, early heart attacks or stroke, etc. work with your doctor to help keep your risk factors under control. Sometimes medication is needed, and that’s OK.
For more information about heart health, as well as services offered here at The Heart Hospital, please visit www.deaconess.com/heart