PERIPHERAL ARTERIAL DISEASES

By Marisol Jane Jomaya MAN-1

PERIPHERAL ARTERIAL DISEASES
‡ What Is Peripheral Arterial Disease? ‡ Peripheral arterial disease (P.A.D.) occurs when plaque (plak) builds up in the arteries that carry blood to your head, organs, and limbs. Plaque is made up of fat, cholesterol, calcium, fibrous tissue, and other substances in the blood. When plaque builds up in arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis). ‡ Over time, plaque can harden and narrow the arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body. P.A.D. usually affects the legs, but also can affect the arteries that carry blood from your heart to your head, arms, kidneys, and stomach.

‡ Peripheral artery disease is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs. Peripheral artery disease is also likely to be a sign of a more widespread accumulation of fatty deposits in the arteries (atherosclerosis). This condition may be reducing blood flow to the heart and brain, as well as the legs. ‡ When one develops a peripheral artery disease (PAD), the extremities ² usually the legs ² don't receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking (intermittent claudication).

D. . andtransient ischemic attack (³mini-stroke´) is six to seven times greater than the risk for people who don¶t have P. heart attack. If one has a heart disease.A.. you have a 1 in 3 chance of having blocked leg arteries.A.‡ Outlook ‡ If a person has P. the risk for coronary artery disease.D. stroke.

and former smokers (present or remote) ‡ High incidence in patients with chronic kidney disease ‡ High incidence in transplant recipients ‡ Poor public and physician awareness of the disease epidemiology ‡ More than 90% of cases secondary to atherosclerosis .‡ Box 1: Epidemiology of Peripheral Arterial Disease ‡ Affects men and women equally ‡ African Americans have higher incidence than whites ‡ Highest risk for older adults. diabetics.

A. treatments. and having certain diseases or conditions. including gangrene (tissue death) in the leg from decreased blood flow.A.Who are at risk? ‡ Who Is At Risk for Peripheral Arterial Disease? ‡ Peripheral arterial disease (P.A.D.D. The major risk factors for P. ‡ Smoking ‡ Smoking is more closely related to getting P. have symptoms 10 years earlier than nonsmokers who develop P. On average. The for P. complications. than any other risk factor.A.D.A.D.) affects 8 to 12 million people in the United States.A. .D.A. age. Smoking even one or two cigarettes a day can interfere with P. Quitting smoking slows the progress of P.A. smokers who develop P.D.A. are smoking. African Americans are more than twice as likely as Caucasians to have P.D.D.D.D.A. Smokers and people who have diabetes are at highest risk for P. increases four times if one smokes or has a history of smoking.

adults who are older than 50 have P.S.D. increases.A. These include: ‡ Diabetes. ‡ High blood pressure or a family history of it. Genetic or lifestyle factors cause plaque to build in your arteries as you age. ‡ Heart disease or a family history of it. One in three people who has diabetes and is older than 50 is likely to have P.D. About 5 percent of U. ‡ Diseases and Conditions ‡ A number of diseases and conditions can raise your risk for P. ‡ Stroke or a family history of it. 12 to 20 percent may have P.D.D.D. . Older age combined with other risk factors. ‡ High blood cholesterol or a family history of it. also puts you at higher risk. Among adults aged 65 and older.A. the risk for P.A.Who are at risk? ‡ Age ‡ As a person gets older.A. such as smoking or diabetes.A.

PATHOPHYSIOLOGY ‡ The peripheral arterial system delivers oxygen rich blood to the peripheral vascular beds. but the waste products of lactic acid and pyruvic acid build up quickly are extremely toxic. ‡ ‡ Vasodilation has a limited effect because arteries that are deprived of oxygen quicly become maximally dilated. Collateral vessels needed to improve blood supply develop slowly over time. Prolonged reduction in blood flow or the presence of large areas of decreased perfusion initiates vasodilation and promotes the development of collateral arterial pathways and utilization of anaerobic pathways for oxygen demands to be met. Significant increases in these two acids can lead to acidosis. . Cellular anaerobic metabolism tries to meet the basic requirements. These compensatory mechanisms are designed to bring n new blood supplies but are limited in effectiveness. Any alteration in blood flow disrupts the balance between oxygen supply and demand. and are excreted slowly.

and without other intervention. It is a specific manifestation of peripheral arterial disease and results from muscular hypoxia and metabolite accumulation. . legs. tha faster claudication occurs. The client¶s exercise tolerance generally decreases over time.‡ As the compensatory mechanisms prove inadequate to meet peripheral arterial needs. conditions that increase the demand for oxygen by muscles of the legs. episodes of claudication occur with less exertion. The pain is analogous to angina pain and is called intermittent claudication which occurs when a muscle is forced to contract without an adequate blood supply to meet the metabolic needs of exercise. The more rapid the speed or the greater the incline. including muscles in the arms. ‡ ‡ Intermittent claudication is influenced by the speed and incline of the walk. jaw or anywhere that decreased arterial supply exists. Any muscle can claudicate. the eventual result is pain.

reproducible and not positional. . The lower limbs are more susceptible to arterial occlusive disorders and atherosclerosis than the upper limbs because of the natural collateral system in the upper extremities. This phenomenon occurs as arterioles of the muscles are maximally dilated because of hypoxia. ‡ ‡ The physiologic effect of any given stenosis is variable because it is determined not only by the degree of narrowing but also by the number of collateral vessels that have developed. To meet muscular metabolic needs . ‡ ‡ Paresthesisas with exertion indicate ischemia of the peripheral nerves because of the phenomenon of arterial steal.‡ Claudication response is constant. Reproducible means that the client who walks the same distance at the same speed and incline has manifestations at the same distance each time.these areterioles steal from cutaneous and peripheral nerve vessels which results in coldness and a pins and needles sensation.

the muscles need increased blood flow.A. During physical activity. the muscles won't get enough blood. numbness.D. ‡ About 10 percent of people who have P. These may include pain. When resting. have claudication. These symptoms are called intermittent claudication .A. calves. so the pain goes away.What are the signs and symptoms ‡ Intermittent Claudication ‡ People who have P. aching. Symptoms also may include cramping in the affected leg(s) and in the buttocks. may have symptoms when walking or climbing stairs. . or heaviness in the leg muscles. If blood vessels are narrowed or blocked. ‡ Symptoms may ease after resting. This symptom is more likely in people who also have atherosclerosis in other arteries. the muscles need less blood flow. thighs. and feet.D.

feet. especially among men who have diabetes .What are the signs and symptoms? ‡ Weak or absent pulses in the legs or feet ‡ Sores or wounds on the toes. or legs that heal slowly. or not at all ‡ A pale or bluish color to the skin ‡ A lower temperature in one leg compared to the other leg ‡ Poor nail growth on the toes and decreased hair growth on the legs ‡ Erectile dysfunction. poorly.

.) is diagnosed based on medical and family histories. a physical exam. ‡ P.A. and results from tests. stroke.D.D. An accurate diagnosis is important.D. and transient ischemic attack (³mini-stroke´). are at increased risk for coronary artery disease (CAD). because people who have P.A. heart attack.How is it diagnosed? ‡ Peripheral arterial disease (P.A. often is diagnosed after symptoms are reported.

is getting worse. The test takes about 10 to 15 minutes to measure both arms and both ankles.90 to 1. ‡ A normal ABI result is 1. ABI can show whether P. but it won¶t show which blood vessels are narrowed or blocked.D.30). is affecting the limbs.D.A.A.D.How is it diagnosed? ‡ Diagnostic Tests ‡ Ankle-Brachial Index ‡ A simple test called an anklebrachial index (ABI) is often used to diagnose P.A. The ABI compares blood pressure in your ankle to blood pressure in your arm.0 or greater (with a range of 0. This test shows how well blood is flowing in the limbs. This test may be done yearly to see whether P. .

This will help compare blood flow in the arms and legs before and after exercise. .How is it diagnosed? ‡ Doppler Ultrasound ‡ A Doppler ultrasound is a test that uses sound waves to show whether a blood vessel is blocked. ‡ Treadmill Test ‡ A treadmill test can show how severe your symptoms are and what level of exercise brings them on. He may have an ABI test done before and after the treadmill test.A. This test uses a blood pressure cuff and special device to measure blood flow in the veins and arteries of the limbs. is. This shows whether a person has any problems during normal walking. A Doppler ultrasound can help find out how severe P.D.

This may make you feel mildly flushed. It¶s used to find the exact location of a blocked artery. man-made joint. Some hospitals use a newer method of arteriogram that uses tiny ultrasound cameras that take pictures of the insides of the blood vessels. ‡ If you have a pacemaker. For this test. you might not be able to have an MRA. stent.How is it diagnosed? ‡ Magnetic Resonance Angiogram ‡ A magnetic resonance angiogram (MRA) uses magnetic and radio wave energy to take pictures of blood vessels inside the body. and extent of the blockage in the artery. mechanical heart valve. an x ray is taken. surgical clips. ‡ Arteriogram ‡ An arteriogram provides a "road map" of the arteries. After the dye is injected. The pictures from the x ray can show the location. dye is injected through a needle or catheter (tube) into an artery. or other metallic devices in your body. This method is called intravascular ultrasound. An MRA can find the location of a blocked blood vessel and show how severe the blockage is. Ask your doctor whether an MRA is an option for you. An MRA is a type of magnetic resonance imaging (MRI). . type.

) include lifestyle changes.D. risk factors. are to reduce symptoms.A.TREATMENT ‡ How Is Peripheral Arterial Disease Treated? ‡ Treatments for peripheral arterial disease (P. Treatment is based on your signs and symptoms. and prevent complications. ‡ The overall goals of treating P. and results from a physical exam and tests.A. medicines.D. and surgery or procedures. improve quality of life. .

and low-fat dairy products. trans fat. increases four times if you smoke.A. ‡ Lowering blood pressure. . and sodium (salt). saturated fat.D. and kidney disease. Lowering cholesterol can delay or even reverse the buildup of plaque in the arteries. heart attack. ‡ Getting regular physical activity.TREATMENT ‡ Lifestyle Changes ‡ Treatment often includes making long-lasting lifestyle changes. ‡ Lowering high blood cholesterol levels. Eat more fruits. such as coronary artery disease (CAD). ‡ Follow a healthy eating plan that¶s low in total fat. ‡ Lowering blood glucose levels if on has diabetes. heart failure. cholesterol. Smoking also raises the risk for other diseases. such as: ‡ Quitting smoking. vegetables. This lifestyle change can help avoid the risk ofstroke. Your risk for P.

Antiplatelet aggregates) ‡ Help ease leg pain that occurs when you walk or climb stairs (Analgesics) . Anti hypertensive agents) ‡ Thin the blood to prevent clots from forming due to low blood flow (Anticoagulants.TREATMENT ‡ Medicines ‡ Thevdoctor may prescribe medicines to: ‡ Lower high blood cholesterol levels and high blood pressure (Antilipemic agents.

‡ ‡ Angioplasty ‡ During this procedure.TREATMENT ‡ Surgery or Procedures ‡ Bypass Grafting ‡ One may be recommended for bypass grafting surgery if blood flow in the limb is blocked or nearly blocked.A. Some stents are coated with medicine to help prevent blockages in the artery. the doctor uses a blood vessel from another part of the body or a man-made tube to make a graft. The balloon is then inflated. A stent (a small mesh tube) may be placed in the artery during angioplasty. which pushes the plaque outward against the wall of the artery. This widens the artery and restores blood flow.. .D. For this surgery. a catheter with a balloon or other device on the end is inserted into a blocked artery. This graft bypasses (goes around) the blocked part of the artery. A stent helps keep the artery open after angioplasty is done. but it may increase blood flow to the affected limb. which allows blood to flow around the blockage. This surgery doesn¶t cure P.

or acute compartment syndrome. aortic dissection. or acute compartment syndrome. an embolus. ‡ Acute peripheral arterial occlusion may result from rupture and thrombosis of an atherosclerotic plaque. . an aortic dissection. an embolus from the heart or thoracic or abdominal aorta.ACUTE PERIPHERAL ARTERIAL OCCLUSION ‡ Peripheral arteries may be acutely occluded by a thrombus.

Sometimes portion of a blood clot. more than half the emboli lodge in either the superficial femoral or popliteal artery.PATHOPHYSIOLOGY ‡ Acute occlusion of a limb¶s main artery may be caused by trauma. the wall of the artery is often healthy. and RHD. can initiate a thrombus. IN arterial embolism. Arterial thrombosis is usually superimposed on the atherosclerosis and consequently develops in a damaged vessel. ‡ Causes include atrial fibrillation. the obstruction in the artery arises most frequently form a thrombus within the heart. embolism or thrombosis and may occur in a healthy or diseased artery. MI. In the lower extremity. . such as platelet emboli that form at points of tubulence and then lodge at a bifurcation.

In a normal artery blood flow is restored by collateral channels. collateral vessels have not had time to develop. Acute arterial thrombosis is usually caused by arterial obstruction from a blood clot that forms in an artery that has been damaged by atherosclerosis. . with acute emboli.‡ Arterial occlusion produces a fall in mean and pulse pressure in the distal arteries and a decrease in tissue perfusion and oxygenation. ‡ It is important to differentiate between arterial thrombosis and arterial embolism.

and pulselessness. at the popliteal bifurcation when the popliteal pulse is palpable). pallor. at the common femoral bifurcation when the femoral pulse is palpable. After 6 to 8 h. polar sensation (coldness). . Severe cases may cause loss of motor function. The occlusion can be roughly localized to the arterial bifurcation just distal to the last palpable pulse (eg. muscles may be tender when palpated.Symptoms and signs are sudden onset in an extremity of the 5 P's: severe pain. paresthesias (or anesthesias).

DIAGNOSTICS AND TREATMENT ‡ Diagnosis is clinical. and guide therapy. thrombolysis. . the extent/location of the thrombus. The decision to perform surgical thromboembolectomy vs thrombolysis is based on the severity of ischemia. ‡ Treatment consists of embolectomy (catheter or surgical). Immediate angiography is required to confirm location of the occlusion. and the general medical condition of the patient. or bypass surgery. identify collateral flow.

TREATMENT ‡ A thrombolytic (fibrinolytic) drug. About 20 to 30% of patients with acute arterial occlusion require amputation within the first 30 days. especially when given by regional catheter infusion. is most effective for patients with acute arterial occlusions of < 2 wk and intact motor and sensory limb function. depending on severity of ischemia and signs of thrombolysis (relief of symptoms and return of pulses or improved blood flow shown by Doppler ultrasonography). A catheter is threaded to the occluded area. Tissue plasminogen activator and urokinase are most commonly used. Treatment is usually continued for 4 to 24 h. . and the thrombolytic drug is given at a rate appropriate for the patient's size and the extent of thrombosis.

If irritation or infection are present. socks or shoes. brown. between the toes where the toes rub against one another or anywhere the bones may protrude and rub against bed sheets. ‡ The base of an arterial or ischemic ulcer usually does not bleed. It has a yellow. The borders and surrounding skin usually appear as though they have been punched out. grey.‡ ARTERIAL ULCERS Arterial (ischemic) ‡ Arterial ulcers are usually located on the feet and often occur on the heels. . Arterial ulcers also occur commonly in the nail bed if the toenail cuts into the skin or if the patient has had recent aggressive toe nail trimming or an ingrown toenail removed. tips of toes. or black color. there may or may not be swelling and redness around the ulcer base.

The patient may instinctively dangle his/her foot over the side of the bed to get pain relief. The patient usually has prior knowledge of poor circulation in the legs and may have an accompanying disorder. especially at night. ‡ Arterial ulcers are typically very painful. .‡ There may also be redness on the entire foot when the leg is dangled. this redness often turns to a pale white/yellow color when the leg is elevated.

often caused by arteriosclerosis ‡ Venous insufficiency (a failure of the valves in the veins of the leg that causes congestion and slowing of blood circulation in the veins) ‡ Other disorders of clotting and circulation that may or may not be related to atherosclerosis ‡ Diabetes ‡ Renal (kidney) failure ‡ Hypertension (treated or untreated) ‡ Lymphedema (a buildup of fluid that causes swelling in the legs or feet) .Causes arterial ulcers ‡ Poor circulation.

scleroderma or other rheumatological conditions ‡ Other medical conditions such as high cholesterol.‡ Inflammatory diseases including vasculitis. heart disease. lupus. high blood pressure. bowel disorders ‡ History of smoking (either current or past) ‡ Pressure caused by lying in one position for too long ‡ Genetics (ulcers may be hereditary) ‡ A malignancy (tumor or cancerous mass) ‡ Infections . sickle cell anemia.

.DIAGNOSIS ‡ First. CT scans and noninvasive vascular studies to help develop a treatment plan. A wound specialist will examine the wound thoroughly and may perform tests such as Xrays. MRIs. the patient's medical history is evaluated.

speed recovery and heal the wound. endovascular therapy or bypass surgery to restore circulation to the affected leg. medical condition and ability to care for the wound.TREATMENT ‡ The goals of treatment are to relieve pain. ‡ Arterial ulcer treatments vary. Depending on the patient's condition. depending on the severity of the arterial disease. Non-invasive vascular tests provide the physician with the diagnostic tools to assess the potential for wound healing. Each patient's treatment plan is individualized. the physician may recommend invasive testing. based on the patient's health. .

‡ The goals for arterial ulcer treatment include: ‡ Providing adequate protection of the surface of the skin ‡ Preventing new ulcers ‡ Removing contact irritation to the existing ulcer ‡ Monitoring signs and symptoms of infection that may involve the soft tissues or bone .

Frequently. especially for people with diabetes. special shoes or orthotic devices must be worn. . Regular debridement (the removal of infected tissue) is usually necessary before a neurotrophic ulcer can heal. Detecting and treating foot and skin sores early can help you prevent infection and prevent the sore from getting worse. Foot and skin care guidelines ‡ Inspecting your skin and feet is very important.‡ Treatment for neurotrophic ulcers includes avoiding pressure and weight-bearing on the affected leg.

Use a mirror to view the leg or foot if necessary. ingrown toenails. or have a family member look at the area for you. Do not rub your skin or area between the toes. ‡ Every day.‡ Gently wash the affected area on your leg and your feet every day with mild soap (Ivory Snow or Dreft) and lukewarm water. examine your legs as well as the tops and bottoms of your feet and the areas between your toes. . Gently and thoroughly dry your skin and feet. Washing helps loosen and remove dead skin and other debris or drainage from the ulcer. increased warmth. cuts. cracks. Look for any blisters. Also check for redness. scratches or other sores. including between the toes. corns and calluses.

calluses or other foot problems.‡ Once or twice a day. use the moisturizing cream more often. If the skin is extremely dry. Do not apply lotion between your toes or on areas where there is an open sore or cut. Cut toenails straight across and smooth with an emery board. ‡ Don't wait to treat a minor foot or skin problem. Cut your toenails after bathing. ‡ Do not self-treat corns. . ‡ Care for your toenails regularly. when they are soft. apply a lanolin-based cream to your legs and soles and top of your feet to prevent dry skin and cracking. Go to a podiatrist to treat these conditions.

PREVENTION ‡ Quit smoking ‡ Manage your blood pressure ‡ Control your blood cholesterol and triglyceride levels by making dietary changes and taking medications as prescribe ‡ Limit your intake of sodium .

‡ Manage your diabetes and other health conditions. if applicable ‡ Exercise .start a walking program after speaking with your doctor ‡ Lose weight if you are overweight ‡ Ask your doctor about aspirin therapy to prevent blood clots .

.

. often fatal. causing dangerous. Arteries are blood vessels that carry oxygen-rich blood from the heart to other parts of the body.ANEURYSM ‡ An aneurysm is an abnormal bulge or ³ballooning´ in the wall of an artery. bleeding inside the body. ‡ An aneurysm that grows and becomes large enough can burst.

. An aneurysm that occurs in the aorta in the chest is called a thoracic aortic aneurysm. The aorta comes out from the left ventricle of the heart and travels through the chest and abdomen. An aneurysm that occurs in the aorta in the abdomen is called an abdominal aortic aneurysm.‡ Most aneurysms occur in the aorta. The aorta is the main artery that carries blood from the heart to the rest of the body.

neck. intestine.000 Americans die each year from ruptured aortic aneurysms. spleen. it causes a stroke. heart. back of the knees and thighs. If an aneurysm in the brain bursts. ‡ About 15.‡ Aneurysms also can occur in arteries in the brain. . Ruptured aortic aneurysm is the 10th leading cause of death in men over age 50 in the United States. and in other parts of the body.

‡ Experts recommend that men who are 65 to 75 years old and have ever smoked (at least 100 cigarettes in their lifetime) should be checked for abdominal aortic aneurysms. . it is important to look for them in people who are at the highest risk.‡ Many cases of ruptured aneurysm can be prevented with early diagnosis and medical treatment. Because aneurysms can develop and become large before causing any symptoms.

‡ When found in time. This can reduce the risk of rupture. aneurysms can usually be treated successfully with medicines or surgery. ‡ Large aortic aneurysms. if found in time. If an aortic aneurysm is found. the doctor may prescribe medicine to reduce the heart rate and blood pressure. The outlook is usually excellent. . can often be repaired with surgery to replace the diseased portion of the aorta.

. resulting in an aneurysm. the artery walls become thick and damaged and lose their normal inner lining. As atherosclerosis develops. ‡ An aneurysm also can develop from constant high blood pressure inside an artery.CAUSES OF ANEURYSM ‡ An aneurysm can result from atherosclerosis(hardening and narrowing of the inside of arteries). ‡ This damaged area of artery can stretch or ³balloon´ from the pressure of blood flow inside the artery.

‡ A thoracic aortic aneurysm can result from an injury to the chest (for example, an injury that occurs from an auto crash). Certain medical conditions, such as Marfan syndrome, that weaken the body¶s connective tissues, also can cause aneurysms. ‡ In rare cases, infections such as untreated syphilis (a sexually transmitted infection) can cause aortic aneurysms. Aortic aneurysms also can occur as a result of diseases that cause inflammation of blood vessels, such as vasculitis.

Who is at risk
‡ Men are 5 to 10 times more likely than women to have an abdominal aortic aneurysm (AAA)²the most common type of aneurysm. The risk of AAA increases as you get older, and it is more likely to occur in people between the ages of 60 to 80. ‡ A peripheral aneurysm also is more likely to affect people ages 60 to 80. Cerebral (brain) aneurysms, though rare, are more likely to occur in people ages 35 to 60.

RISK FACTORS
‡ Atherosclerosis, a buildup of fatty deposits in the arteries. ‡ Smoking. You are eight times more likely to develop an aneurysm if you smoke. ‡ Overweight or obesity. ‡ A family history of aortic aneurysm, heart disease, or other diseases of the arteries. ‡ Certain diseases that can weaken the wall of the aorta, such as: Marfan syndrome (an inherited disease in which tissues don¶t develop normally) Untreated syphilis (a very rare cause today) Tuberculosis (also a very rare cause today)

This increases the risk for a cerebral aneurysm. . ‡ Severe and persistent high blood pressure between the ages of 35 and 60.‡ Trauma such as a blow to the chest in a car accident. ‡ Use of stimulant drugs such as cocaine.

It is often not until an aneurysm ruptures or grows large enough to press on nearby parts of the body or block blood flow that it produces any signs or symptoms. and whether it has ruptured or is interfering with other structures in the body. location. Aneurysms can develop and grow for years without causing any signs or symptoms.SIGNS AND SYMPTOMS ‡ The signs and symptoms of an aneurysm depend on its type. .

Types of Aneurysm .

‡ True aneurysm means that the artery wall is intact and this can balloon out symmetrically for form a 'fusiform' aneurysm or there can be a local 'blow-out' to form a 'saccular' aneurysm. trauma or at the join between a graft and the artery. . They arise after angiogram.‡ The figure below shows how aneurysms are classified: ‡ A false aneurysm refers to the situation where blood leaks out of a small hole in the artery and forms a 'haematoma' (collection of blood). angioplasty. This becomes encased in scar tissue and can continue to grow.

. It happens when the blood stream forces its way into the artery wall and causes it to stretch.‡ A 'dissecting' aneurysm is an uncommon event. These aneurysms can cause problems by rupturing or blocking off the normal channel in the artery.

. The two types of aortic aneurysm are thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA). The aorta comes out from the left ventricle of the heart and travels through the chest and abdomen. The aorta is the main artery that carries blood from the heart to the rest of the body.According to Location: Aortic Aneurysm ‡ Most aneurysms occur in the aorta.

.

.

One in four aortic aneurysms is a TAA. TAAs are identified more often now than in the past because of chest computed tomography (CT) scans performed for other medical problems. even when they are large. Only half of all people with TAAs notice any symptoms.‡ Thoracic Aortic Aneurysm ‡ An aortic aneurysm that occurs in the part of the aorta running through the thorax (chest) is a thoracic aortic aneurysm. . ‡ Most TAAs do not produce symptoms.

.

. Then the valve between the heart and the aorta cannot close properly and blood leaks backward into the heart.‡ In a common type of TAA. A TAA in this location can result from and injury to the chest such as from an auto crash. the walls of the aorta become weak and a section nearest to the heart enlarges. a TAA can develop in the upper back away from the heart. ‡ A thoracic (chest) aortic aneurysm may have no symptoms until the aneurysm begins to leak or grow. Less commonly.

.

Signs and Symptoms ‡ Pain in your jaw. upper back (or other part of your back) ‡ Chest pain ‡ Coughing ‡ hoarseness ‡ trouble breathing . neck.

Three in four aortic aneurysms are AAAs. About 1 in 5 AAAs rupture. . ‡ An AAA can grow very large without producing symptoms.Abdominal Aortic Aneurysm ‡ An aortic aneurysm that occurs in the part of the aorta running through the abdomen is an abdominal aortic aneurysm.

.

numbness. or tingling in your feet due to blocked blood flow in the legs .Most abdominal aortic aneurysms (AAAs) develop slowly over years and have no signs or symptoms until (or if) they rupture. a doctor can feel a pulsating mass while examining a patient's abdomen. When symptoms are present. they can include: ‡ Deep penetrating pain in the back or the side of the abdomen ‡ Steady gnawing pain in the abdomen that lasts for hours or days at a time ‡ Coldness. Sometimes.

severe pain in your lower abdomen and back. Shock is a life-threatening condition in which the organs of the body do not get enough blood flow. and a rapid heart rate when standing up. clammy. lightheadedness. . nausea and vomiting.‡ If an AAA ruptures. symptoms can include sudden. sweaty skin. Internal bleeding from a ruptured AAA can send you into shock.

.

‡ A ruptured cerebral aneurysm causes a stroke. and the person¶s age and overall health. or death. sudden weakness in an area of the body.Cerebral Aneurysm ‡ Aneurysms that occur in an artery in the brain are called cerebral aneurysms. or rupture. Most cerebral aneurysms produce no symptoms until they become large. begin to leak blood. extremely severe headache. and even loss of consciousness. coma. vomiting. Signs and symptoms can include a sudden. stiff neck. They are sometimes called berry aneurysms because they are often the size of a small berry. nausea. . sudden difficulty speaking. The danger of a cerebral aneurysm depends on its size and location in the brain. whether it leaks or ruptures.

.

‡ Small aneurysms have a diameter of less than 15 mm. ‡ Larger aneurysms include those classified as large (15 to 25 mm.). Saccular aneurysms are the most common form of cerebral aneurysm. giant (25 to 50 mm.). .Types of and Location of Cerebral Aneurysms ‡ Cerebral aneurysms are classified both by size and shape.) ‡ Saccular aneurysm refers to any aneurysm with a saccular outpouching including berry aneurysms. and super giant (over 50 mm.

. ‡ A fusiform aneurysm describes an aneurysm without a stem. is a type of saccular aneurysm with a neck or stem resembling a berry.‡ Berry aneurysm.

.

and involve the internal carotid arteries and their major branches that supply the anterior and middle sections of the brain. Approximately 85% of aneurysms develop in the anterior part of the circle of Willis.‡ Cerebral aneurysms usually occur at the bifurcations and branches of the large arteries located at the Circle of Willis. .

.

MOST COMMON SITES include the: ‡ Anterior Communicating artery (30 35%) ‡ Bifurcation of the Internal Carotid and Posterior Communicating artery (30 35%) ‡ Bifurcation of Middle cerebral (20%) ‡ Basilar artery bifurcation (5%) ‡ Remaining posterior circulation arteries (5%) .

stiff neck. Any of these symptoms require immediate medical attention. Signs of a stroke are similar to those listed above for cerebral aneurysm. but they usually come on suddenly and are more severe. nausea and vomiting. loss of consciousness.SIGNS AND SYMPTOMS ‡ ‡ ‡ ‡ ‡ A droopy eyelid Double vision or other changes in vision Pain above or behind the eye A dilated pupil Numbness or weakness on one side of the face or body ‡ If a cerebral aneurysm ruptures. . severe headache. symptoms can include a sudden. and signs of a stroke.

Peripheral Aneurysm ‡ Aneurysms that occur in arteries other than the aorta (and not in the brain) are called peripheral aneurysms. the main artery in the groin (femoral artery). and the main artery in the neck (carotid artery). . ‡ Common locations for peripheral aneurysms include the artery that runs down the back of the thigh behind the knee (popliteal artery).

.

or leg ‡ Leg or arm pain. or cramping with exercise ‡ Painful sores on toes or fingers ‡ Gangrene (tissue death) from severely blocked blood flow in your limbs . arm.SIGN AND SYMPTOMS ‡ A pulsating lump that can be felt in your neck.

‡ If a clot breaks loose and travels through the bloodstream. and numbness in the knee and leg. weakness. Blood clots can form in peripheral aneurysms. it can lodge in the arm. . leg.‡ An aneurysm in the popliteal artery (behind the knee) can compress nerves and cause pain. or brain and block the artery.

an aneurysm is found by chance during an x ray. ‡ With an abdominal aortic aneurysm (AAA). ‡ . or computed tomography (CT) scan performed for another reason. More often.How Is an Aneurysm Diagnosed? ‡ An aneurysm may be found by chance during a routine physical exam. If one is overweight or obese. ultrasound. the doctor may feel a pulsating mass in your abdomen. A rapidly growing aneurysm about to rupture can be tender and very painful when pressed. it may be difficult for the doctor to feel even a large abdominal aneurysm. such as chest or abdominal pain.

The ultrasound scan may be repeated every few months to see how quickly an aneurysm is growing. . A chest x ray provides a picture of the organs and structures inside the chest. It shows the size of an aneurysm. lungs. and blood vessels. if one is detected. ‡ Ultrasound.Diagnostic Tests and Procedures ‡ Chest x ray. This simple and painless test uses sound waves to create a picture of the inside of the body. including the heart.

. ‡ A liquid dye that can be seen on an x ray is injected into an arm vein to outline the aorta or artery on the CT scan. A CT scan provides computergenerated. x-ray images of the internal organs.‡ CT scan. The CT scan images can be used to determine the size and shape of an abdominal aneurysm more accurately than an ultrasound. ‡ A CT scan may be performed if the doctor suspects a TAA or AAA.

. and the arteries of the aorta that are involved. An angiogram shows the amount of damage and blockage in blood vessels. ‡ Angiography. ‡ Aortogram. MRI uses magnets and radio waves to create images of the inside of the body. It is very accurate in detecting aneurysms and determining their size and exact location. Angiography also uses a special dye injected into the blood stream to make the insides of arteries show up on x-ray pictures. An aortogram is an angiogram of the aorta. It may show the location and size of an aortic aneurysm.‡ MRI.

´ .Treatment (by Type of Aneurysm) Aortic Aneurysm ‡ Experts recommend that men who have ever smoked (at least 100 cigarettes in their lifetime) and are between the ages of 65 and 75 should have an ultrasound screening to check for abdominal aortic aneurysms. ‡ Treatment recommendations for aortic aneurysms are based on the size of the aneurysm. Small aneurysms found early can be treated with ³watchful waiting.

³watchful waiting´ and a followup screening in 5 to 10 years may be all that is needed. the patient should return to the doctor every year for an ultrasound to see if the aneurysm has grown. ‡ If the aorta is between 3 and 4 cm in diameter. as determined by the doctor. .‡ If the diameter of the aorta is small²less than 3 centimeters (cm)²and there are no symptoms.

testing should be repeated every 6 months.‡ If the aorta is between 4 and 4. . ‡ If the aorta is larger than 5 cm (2 inches around or about the size of a lemon) or growing more than 1 cm per year.5 cm. surgery should be considered as soon as possible.

Two main types of surgery to repair aortic aneurysms : open abdominal/ open chest repair endovascular repair. General anesthesia is needed with this procedure. ‡ It involves a major incision in the abdomen or chest. . ‡ The traditional and most common type of surgery for aortic aneurysms is open abdominal or open chest repair.

‡ The surgery takes 3 to 6 hours. More than 90 percent of patients make a full recovery.‡ The aneurysm is removed and the section of aorta is replaced with an artificial graft made of material such as Dacron® or Teflon®. . ‡ Open abdominal and chest surgeries have been performed for 50 years. and the patient remains in the hospital for 5 to 8 days. ‡ It often takes a month to recover from open abdominal or open chest surgery and return to full activity.

.

.

Then. but a graft is inserted into the aorta to strengthen it. . ‡ To perform endovascular repair.‡ In endovascular repair. watching on x ray. The graft reinforces the weakened section of the aorta to prevent the aneurysm from rupturing. The graft is then expanded inside the aorta and fastened in place to form a stable channel for blood flow. the aneurysm is not removed. the doctor first inserts a catheter into an artery in the groin (upper thigh) and threads it up to the area of the aneurysm. This type of surgery is performed through catheters (tubes) inserted into the arteries. it does not require surgically opening the chest or abdomen. the surgeon threads the graft (also called a stent graft) into the aorta to the aneurysm.

ENDOVASCULAR STENT GRAFT .

Not all aortic aneurysms can be repaired with this procedure. and the stent graft is released from the catheter. ‡ Endovascular repair surgery reduces recovery time to a few days and greatly reduces time in the hospital. a catheter is inserted into an artery in the groin (upper thigh). It is then threaded up to the abdominal aorta. ‡ In figure B.‡ In figure A. . The procedure has been used since 1999. The exact location or size of the aneurysm may prevent the stent graft from being safely or reliably positioned inside the aneurysm. the stent graft allows blood to flow through the aneurysm.

Cerebral Aneurysm ‡ Treatment for cerebral (brain) aneurysms depends on the size and location of the aneurysm, whether it is infected, and whether it has ruptured. A small cerebral aneurysm that hasn¶t burst may not need treatment. ‡ A large cerebral aneurysm may press against brain tissue, causing a severe headache or impaired vision, and is likely to burst.

‡ If the aneurysm ruptures, there will be bleeding into the brain which will cause a stroke. If a cerebral aneurysm becomes infected, it requires immediate medical treatment. Treatment of many cerebral aneurysms, especially large or growing ones, involves surgery, which can be risky depending on the location of the aneurysm.

Peripheral Aneurysm ‡ Most peripheral aneurysms have no symptoms, especially if they are small. They seldom rupture. ‡ Treatment of peripheral aneurysms depends on the presence of symptoms, the location of the aneurysm, and whether the blood flow through the artery is blocked. Blood clots can form in a peripheral aneurysm, break loose, and block the artery. ‡ An aneurysm in the back of the knee that is larger than 1 inch in diameter usually requires surgery. An aneurysm in the thigh also is usually repaired with surgery.

Plaque is a fatty buildup that narrows the arteries. ‡ Control high blood pressure(eating a low-salt diet helps). ‡ Get regular physical activity.PREVENTION ‡ Quit smoking. ‡ Control high cholesterol. ‡ Eat a low-fat. . low-cholesterol diet to reduce the buildup of plaque in the arteries.

ht ml ‡ http://www.heart.com/health/peripheralarterial-disease/DS00537 .in/diseases/aneurysm.mayoclinic.org.REFERENCES: ‡ http://www.