Vascular Conditions & Treatments Danville
An aneurysm is a bulge in the artery wall. The vessel wall is weakened by hypertension, hardening of the arteries (atherosclerosis), tobacco use, trauma, or other causes, which causes it to balloon outward from the pressure of the blood flow. If an aneurysm bursts, it can cause heavy and life-threatening internal bleeding. Aortic aneurysms can also lead to blood clots, heart attack, stroke, and leakage of blood. Aneurysms can form in arteries anywhere in the body, but most often occur in the aorta. The aorta is the body’s largest blood vessel; it starts in the heart and continues through the chest and abdomen to the legs. If an aneurysm occurs in the lower section of the aorta, it is called an abdominal aortic aneurysm. If it occurs in the portion of the aorta in your chest, it is called a thoracic aortic aneurysm.
Symptoms of an Aortic Aneurysm
An aneurysm may expand slowly or quickly, or may stay the same size for many years. They often develop without any warning signs. Sometimes people experience symptoms from an aneurysm that may include:
- Pulsing sensation in the abdomen
- Stomach pain or tenderness
- Back pain
A ruptured aneurysm is an urgent medical emergency. Some signs of a burst aneurysm are:
- Intense, sudden pain in the abdomen
- Low blood pressure
- Fast pulse
An aortic aneurysm is most often detected during a routine exam or while testing for another condition, like an ultrasound or X-ray. If you suspect you have an aneurysm, your doctor will confirm the diagnosis with an aortic ultrasound or echocardiogram. Smokers and patients over the age of 60 are more at risk for this condition and should be regularly screened for an aortic aneurysm. It is important to closely monitor aortic aneurysms when they are diagnosed, however they often remain small and never rupture. If your aneurysm is quickly growing, very large, leaking, or painful, it might require surgery. Aneurysms that are at high risk of rupturing or that have already ruptured will immediately be operated on. There is a much more successful outcome before the vessel has already burst.
Treatment of an Aortic Aneurysm
The treatment will depend of the size and severity of the condition, as well as the health of the patient. Initial treatment may be to prescribe medication to lower blood pressure and relax blood vessels, which will reduce the risk of a rupture. Some of the more common medications are beta blockers and calcium channel blockers.
Aortic Endovascular Stent Grafting
This procedure includes an implantation of a small metal cylinder called a stent into the artery to provide a strong new vessel wall. A thin tube called a catheter is guided up the aorta to the aneurysm site. A small balloon on the end of the catheter widens the vessel to help the stent fit into place. The catheter is then removed, and over time the aneurysm will shrink around the stent.
Open Aneurysm Repair
For this procedure, an incision will be made in the abdomen to remove the diseased section of the artery and replaced with a synthetic tube graft.
Innovative new laparoscopic techniques allow minimally invasive approaches that only require small incisions in the groin for femoral artery access. A thin tube with a camera is placed into the artery and guided up to the site of the aneurysm so the surgeon can see the inside of the vessel, which eliminates the need for traditional open surgery. Your doctor will determine the right course of treatment for you based on a thorough evaluation of your health and your condition.
Prevention of an Aortic Aneurysm
Aortic aneurysms are not always preventable, but there are certain steps that patients can take to lessen their risk. These steps include:
- Avoid or quit smoking
- Exercise regularly
- Maintain a healthy blood pressure
- Lower cholesterol and fat
Abdominal Aortic Aneurysm
An aneurysm is an enlarged, balloon-like area in a blood vessel that is caused from weak vessel walls. The abdominal aorta is the part of the aorta (the largest blood vessel in the body) that lies under the diaphragm and carries blood from the heart to the legs. Most aortic aneurysms are abdominal and often occur beneath the kidneys and may continue into the arteries of the legs.
Complications of Abdominal Aortic Aneurysms
The weak blood vessel walls are at risk of rupturing, which causes severe pain, bleeding, and is often fatal. Half of all untreated abdominal aortic aneurysms end in rupture and death within five years. Abdominal aortic aneurysms are the 13th leading cause of death in the U.S. A certain kind of leakage through the inner lining into the vessel wall called aortic dissection can occur, and blood clots can form within the aneurysm and can travel to other parts of the body and block blood flow. Infection and blockage of the aorta can also occur.
Causes and Risk Factors of Abdominal Aortic Aneurysm
Aortic aneurysms are most often caused by genetic predisposition, hypertension, and smoking. A particular type of the condition called a degenerative aneurysm is caused by atherosclerosis.
- Deformity from birth
- Trauma or vessel injury
- Advanced syphilis
- Fungal infection
- Inflammation due to disease
If a patient has an aortic aneurysm, the patient’s family should also be screened as it is likely that they could have the condition as well. Men are also more likely to develop abdominal aneurysms. Those over the age of 60 are also at increased risk.
Symptoms of Abdominal Aortic Aneurysm
The condition may occur without symptoms, but some warning signs are:
- Pain in lower back
- Deep abdominal pain
- Pulsing sensation in the abdomen
- Dry mouth and skin
- Excessive thirst
- Clammy skin
- Light-headedness and fainting when upright
- Rapid heart rate when standing
- Impaired concentration
Diagnosing and Treatment for an Abdominal Aortic Aneurysm
An aneurysm that is at great risk for rupture will require surgery. Those that have a life-threatening risk of imminent rupture or those that have already ruptured will have surgery performed immediately. The outcome is far more successful if the vessel has not yet burst.
Traditional surgeries involve an incision in the abdomen to remove the aneurysm and replace the vessel with a synthetic tube graft. Most aneurysms can be treated with an endovascular stent graft. This approach only requires small incisions in the groin for access to the femoral artery, through which a stent will be threaded through and placed at the sight of the aneurysm. This minimally invasive technique leads to a quick recovery. Your doctor will evaluate your health and degree of the condition to determine the best course of treatment.
Risks of Surgical Repair include:
- Aortic rupture or dissection
- Hypovolemic shock
- Blood clot
- Insufficient circulation
- Kidney damage or failure
- Myocardial infarction
Aortic dissection is a tear or leak in the inner layer of the aorta, the largest blood vessel in body that carries blood from the heart from the rest of the body. The tear causes the inner layer of the vessel to separate, or dissect, as blood flows through. It creates an area in the vessel that is highly susceptible to rupture, which can be fatal. Early detection and quick treatment can save your life.
Causes of an Aortic Dissection
The weakened area of the aorta can be a result of:
Aortic dissection is uncommon, but men between the ages of 50 and 70 are most at risk.
Symptoms of an Aortic Dissection
Warning signs for this condition may be:
- Sudden chest pain
- Shortness of breath
Treatment of an Aortic Dissection
Once diagnosed, an aortic dissection usually requires immediate treatment. Surgery is typically the best course of treatment, as the separated aorta is removed to stop leaking through the aortic wall. A stent or graft may be used to repair the vessel. Medications for blood pressure and chest pain are usually administered to prevent complications and to treat the dissection.
Carotid Artery Disease
The carotid arteries are blood vessels in the neck that carry blood from the heart to the brain. Carotid artery disease occurs as a result of atherosclerosis, or plaque build-up that hardens the arteries and restricts blood flow, increasing the risk of stroke. Carotid artery disease gradually develops and is not always diagnosed until a stroke or TIA (transient ischemic attack) has occurred.
Symptoms of Carotid Artery Disease
This condition does not always have clear symptoms, but some people experience mini strokes, or TIAs, as a result of carotid artery disease. Symptoms of a TIA include:
- Numbness or loss of control on one side of the body
- Slurring of speech
- Loss of vision in one eye
These symptoms usually disappear within an hour, but are serious and should be reported to your doctor immediately. If these symptoms last more than a day, you may have had a stroke.
Treatment of Carotid Artery Disease
Surgery is typically performed to clear the blockage and bring back proper blood flow to the brain. Carotid surgery may be an endarterectomy or an angioplasty with stent placement.
Carotid Endarterectomy Procedure
This procedure surgically removes diseased materials and clogged parts inside of the artery to restore proper blood flow, which is called and endarterectomy. This prevents the occurrence and recurrence of stroke.
This procedure involves implantation of a stent to hold an artery open so blood can continue to flow through. The method of placing a stent is called a balloon angioplasty; a catheter with a small balloon is placed in the vessel through access in the groin is and inflated to widen the vessel to make room to place the stent, which ensures the vessel stays open. Stenting is usually the best option for those with severe stenosis, or blockage.
Acute and Chronic Mesenteric Ischemia
Ischemia means a decrease in oxygen supply and mesenteric refers to the mesenteric arteries that supply blood to the stomach, small intestine, and large intestine. Mesenteric ischemia is a condition in which oxygen to these areas is restricted, which results in difficult digestion or causes parts of the intestines to die. Atherosclerosis or a blood clot called embolus can cause a blockage that leads to this condition, which is life-threatening and requires immediate medical attention.
Treatment of Mesenteric Ischemia
Chronic mesenteric ischemia can be treated surgically. The blocked segment of the arteries can be surgically altered with a graft for by removing the affected section. In some scenarios, surgery on acute mesenteric ischemia is an emergency procedure if the lack of blood flow to the intestines is significant. This condition can also be treated before it becomes severe enough to need surgery with supplements, exercise, and hormonal treatments.
Peripheral Artery Disease
Peripheral artery disease, also known as PAD, is a vascular disease that is characterized by the buildup of plaque within the arteries of the limbs (usually feet and legs). The plaque is made up of calcium, cholesterol, and fat as well as other substances in the blood. These substances gather in the blood vessels and can severely limit blood flow to the body. PAD can also be a symptom of atherosclerosis, a disease in which plaque in the arteries is more widespread throughout the body.
Causes of PAD
The risk factors and causes of PAD include:
- Lack of exercise
- High cholesterol
- Family history of circulatory issues
- Increasing age
- High levels of homocysteine
Symptoms of PAD
PAD may have no clear symptoms, but some symptoms to the affected area may include:
- Pain/cramping when walking (claudication)
- Pain when resting (ischemic rest pain)
- Weak pulse or coldness to the touch
- Discoloration/change of texture of the skin
- Weakness, numbness, or cramping
- Sores that do not heal
- Erectile dysfunction in men
- Hair loss
Diagnosis of PAD
Your physician can diagnose PAD with the following methods:
- Physical exam
- Doppler ultrasound
- Blood testing
- Ankle-brachial index (ABI)
Treatment of PAD
Rapid treatment of PAD is important to prevent the spread of atherosclerosis, since this condition increases the risk of heart attacks and stroke. Treatments for PAD will likely include:
- Lifestyle changes
When one has PAD, changing some habits can be lifesaving. The most important of these is for those who smoke to quit smoking. Eating a healthier diet, getting regular exercise, reducing stress, and losing weight will also be beneficial. Sometimes specific exercise regimens will be recommended to PAD patients.
Your physician may suggest medications, which may include:
- Medications to lower blood pressure
- Anticoagulants to increase blood flow
- Medications to control glucose (diabetic patients)
- Statins to lower cholesterol
- Medications to relieve symptoms
- Thrombolytics, or injected medications to dissolve clots
- Surgical Interventions
Surgery may be necessary to treat PAD. Your surgeon may perform an angioplasty to reopen blocked vessels, or bypass surgery to circumvent the blocked artery with a synthetic graft or a vessel from another part of the body.
Risks of Surgery for PAD
PAD procedures are generally very safe, all surgical procedures have risks. Some risks may include:
- Allergic reaction to anesthesia or medications
- Breathing problems
- Heart attack
- Incapacity of blood vessels
- Impermanence of the bypass
- Leg issues
Recovery from Surgery for PAD
The wound in the groin where the catheter was inserted will need care. Patients should do some light walking, but should avoid strenuous exercise for a period of time recommended by the doctor. All prescribed medications should be taken as instructed. Maintaining a healthy lifestyle is the most important step in recovery; patients who do not make lifestyle changes often have recurring blockages, called restenosis.
Thoracic Outlet Syndrome
Thoracic outlet syndrome (TOS) involves the compression of blood vessels and nerves in the space between the collarbone and ribs. Most often, this condition occurs from trauma or from recurring injury to the area. TOS can mainly affect the brachial plexus nerve, the artery, or the vein, which may result in clotting. Nerve compression is most common and makes up over 90% of TOS cases. The vessels and nerves coming from the spine going to the arms pass through a narrow area in the shoulder/armpit that may not provide enough space. Compression or pressure on these nerves and vessels typically results in symptoms in the arms and hands.
Symptoms of Thoracic Outlet Syndrome
Symptoms can vary depending on the patient, but symptoms typically include:
- Pain in shoulder and neck
- Weak grip
- Discoloration of hand
- Pain and swelling in arm
- Throbbing pain in collarbone
- Numbness/tingling in the fingers
Causes and Treatment of Thoracic Outlet Syndrome
For TOS affecting the artery or vein, surgery is usually the best method of treatment. Pain medication may also be prescribed. Physical therapy is typically the best course of treatment for nerve compression, but surgery may also be recommended if there is a limited response from physical therapy. Types of surgical procedures may include bypass surgery to circumvent circulation around the compressed area, angioplasty to widen a blocked blood vessel, or the removal of a segment of a rib or muscle to relieve pressure.
Venous Disease/Venous Insufficiency
Veins carry oxygen-lacking blood back to the heart after delivering oxygen and nutrients to the body. These blood vessels have valves that help to maintain circulation in the correct direction. If these valves become blocked or leaky, blood can flow backwards and accumulate in the veins. This causes a rise in blood pressure and a weakening of the veins, which makes the veins balloon outward. Venous disease can affect any type of vein the body. Venous insufficiency or disease can result in skin ulcers, blood clots, spider veins, and varicose veins. Common symptoms include spider veins at the ankles, leg ulcers, and skin discoloration or thickening.
Venous Disease/Insufficiency Treatment
Venous insufficiency can be diagnosed with blood tests, ultrasound, X-rays, and CT or MRI scans. Courses of treatment may include compression stocking with leg elevation to improve blood flow and blood thinners to treat or prevent clots. Surgical options include the removal of superficial veins; subfascial endoscopic perforator surgery (SEPS); or valve repair, valve transplant, or vein bypass of deep veins.