Disorders of Arteries
Arteries are muscular elastic tubes that carry blood away from the heart to all the organs of the body. When you or your health care professional feels for your pulse, it is an artery that is being felt. The anatomy is quite constant and can be easily investigated by palpation (feeling with the hands and fingers), with an ultrasound machine or with x-rays (explained below).
The most common disorder of the arteries is atherosclerosis (sometimes called arteriosclerosis or “hardening of the arteries”). Atherosclerosis is the progressive build-up of blockages in the arteries by plaque. Plaque contains cholesterol, fibrin, platelets and blood clot. When plaque has been present for a long time, it may become calcified and very hard (thus the term: hardening of the arteries). To some extent, atherosclerosis is a consequence of aging - the older the patient, the more likely he or she has some arterial plaque. On the other hand, smoking cigarettes (or other tobacco use), having high blood pressure, having high cholesterol, having diabetes and having a family history of atherosclerosis are all risk factors that make it more likely for an individual patient to suffer from atherosclerosis and have symptoms of arterial blockage. Controlling these risk factors is an important part of the treatment of arterial vascular disorders.
When the plaque is in the heart arteries it is called coronary artery disease and can cause angina (chest pain due to heart artery narrowing). If you suspect you have angina, you should discuss your symptoms with your primary care provider who than may choose to have you seen by a cardiologist. We will limit our discussion here to atherosclerosis other than in the coronary arteries.
Common sites of atherosclerosis and symptoms:
1. Carotid arteries and stroke risk: The carotid arteries travel through the neck into the brain. Just under the jaw there is a major branching, a site that commonly narrows due to arterial plaque. This is a major cause of stroke. Symptoms of carotid narrowing include temporary blindness or other visual disturbance, slurring of speech, weakness on one side of the body (hand or leg or both) and various other more subtle symptoms such as disorientation, double vision, and discoordination. Small, temporary strokes called TIA’s (transient ischemic attacks) are warning signs of a major stroke. Anyone with these symptoms should see their health care provider immediately. If carotid artery narrowing is severe, a relatively simple operation to clean out the plaque may be recommended (carotid endarterectomy). In experienced hands, this operation has a very low complication rate and most patients go home the day after the operation. If your health care provider suspects that you may have carotid artery narrowing putting you at risk for stroke, he or she may order a duplex scan (doppler ultrasound) to confirm whether or not significant plaque is present. There are minimally invasive techniques in development (angioplasty and stent placement) that may, in selected patients, be used instead of open operation.
2. Femoral (leg) artery atherosclerosis: The femoral arteries travel from the groin to the calf and are the most common site of atherosclerosis outside the heart. If the patient is not very active, there may be few symptoms. However, if the femoral arteries are significantly narrowed or blocked, walking may be impaired. The typical symptom is cramping of the calf when walking (especially if going up a hill or walking fast). Fortunately, this rarely results in amputation but can be very annoying and disabling for those people who want to remain active. If your health care provider suspects that you have femoral artery narrowing, he or she may order a duplex scan of your legs and blood pressure measurements to confirm the problem. Treatment options include medication, exercise in the form of walking, balloon angioplasty (dilating the artery narrowing through a catheter) or surgical bypass. Discussion of these options with a vascular surgeon is necessary to decide which option is best in the individual case. Again, we are committed to offering minimally invasive techniques when possible to treat our patients.
3. Arterial aneurysms: Aneurysms of the arteries are areas of dilatation caused by genetic factors (patients are born with the tendency to get an aneurysm) or due to injuries such as trauma or needle puncture. Out side of the brain, the most common site of an aneurysm is the abdominal aorta - the main artery carrying blood from the heart to the pelvis and legs. Aortic aneurysm is a potentially life threatening condition that requires evaluation and in the appropriate patient, repair. Left untreated, an aneurysm can form clots that could lead to amputation or could develop a weak area leading to leak or rupture - a generally lethal event. The diagnosis of an aortic aneurysm is made by physical exam and an ultrasound imaging exam. If the aneurysm is large enough to be dangerous, then repair is indicated. In 1999 the FDA allowed surgeons to start repairing aneurysms with a minimally invasive technique called endoluminal repair. Instead of an operation through a large abdominal incision, the graft material used to repair the aneurysm in positioned through small incisions in the groins. This method is currently used only on select patients, based on health history and other medical problems. One of the benefits is that it allows patients to go home the day after the procedure (rather than a 1 week hospital stay). Although not offered in all hospitals nor performed by all vascular surgeons, this method of repair is offered by Northwest Surgical Specialists.
Summary: Atherosclerosis is a common problem with many and various symptoms caused by smoking cigarettes or having other risk factors such as high blood pressure, high cholesterol or diabetes. Since patients with diabetes are at particular risk for developing symptomatic atherosclerosis - we encourage complete vascular examination and awareness in patients with diabetes - especially if other risk factors are present. All patients with symptoms of arterial vascular disease should undergo evaluation with non-invasive vascular testing with duplex scanning (doppler and ultrasound).