Symptoms We Treat

Abdominal Aortic Aneurysm

An aneurysm is a localized, balloon-like expansion in a blood vessel caused by weak vessel walls. The aorta is the artery that carries oxygen-rich blood from the heart to the legs. When a bulge occurs in the abdominal section of the aorta, between the diaphragm and the legs, it is called an abdominal aortic aneurysm. Most aortic aneurysms occur in the abdomen, and most abdominal aortic aneurysms occur beneath the kidneys and may continue into the iliac, or leg, arteries.

Treatment of Abdominal Aortic Aneurysm

Surgery is recommended for arteries at great risk for rupture: those over six centimeters wide, and those four to six centimeters wide in patients otherwise in good health. Surgery is performed immediately on arteries that threaten imminent rupture or have already ruptured, although success is far less likely once the vessel has burst.

While an abdominal aortic aneurysm presents a grave danger, when it is repaired before rupture the prognosis is quite good. Recovery from the surgery, however, may take several months.

Traditional surgery involves making an incision to open the abdomen, then removing the aneurysm and replacing the excised vessel piece with a synthetic tube. Minimally invasive laparoscopic techniques require only small incisions, typically made in the femoral artery in the thigh, through which a thin tube with a camera is inserted so the surgeon can see inside the patient’s body without the need for open surgery.

Angina

Angina is chest pain caused by reduced blood flow to the heart, as a result of coronary heart disease. When plaque forms on the inner walls of the coronary arteries, blood flow is slowed. As this plaque builds, the heart must work harder to ensure blood flow. This buildup of plaque, known as atherosclerosis, causes the heart to gradually become oxygen-starved, producing pain in the surrounding tissue. Angina may feel like pressure or a squeezing pain in the chest and is often associated with a range of other symptoms, including shortness of breath, dizziness sweating, nausea, and fatigue.

Types of Angina

There are several different types of angina that vary based on severity and duration of symptoms.

Stable Angina

The most common form of angina, symptoms of stable angina occur on a regular basis and are predictable after certain activities. In most cases of stable angina, symptoms occur after physical exertion and usually last less than five minutes.

Unstable Angina

Unstable angina is a more serious form of angina. Symptoms are more severe and unpredictable and appear to get worse over the duration of the episode. Symptoms of unstable angina tend to be more frequent and can occur at any time. Previously stable angina may become unstable, possibly signaling a heart attack.

Variant Angina

Also known as Prinzmetal’s angina, variant angina is a relatively rare subtype of angina similar to unstable angina except that it occurs in cycles. It is caused by a spasm in the smooth muscle of the coronary arteries and not necessarily by atherosclerosis.

Chest pain may be a sign of a serious condition and should always be checked by a doctor.

Treatment of Angina

Treatment for angina may include simple lifestyle modifications such as quitting smoking, losing weight, controlling stress and managing any underlying medical conditions, such as diabetes. In addition to lifestyle changes, treatment may include the following medication:

  • Nitrates
  • Aspirin
  • Anti-clotting drugs
  • Beta blockers
  • Statins
  • Calcium channel blockers

In severe cases, surgery may be recommended to treat angina. Surgical procedures such as angioplasty, stenting and coronary artery bypass surgery may be performed to open arteries and improve blood flow to the heart.

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Aortic Aneurysm

An aneurysm is a bulge in the artery wall. Arteries are blood vessels that carry blood and oxygen from the heart to other parts of the body. Arteries may become weakened by a condition called atherosclerosis, which is the hardening and narrowing of the arteries due to the buildup of plaque. Smoking and high blood pressure also damage and weaken the walls of the aorta, possibly leading to an aortic aneurysm. A family history and certain genetic conditions may put some people at risk for developing an aortic aneurysm.

An aortic aneurysm can form in arteries throughout the body, but most occur in the aorta. Starting in the heart and continuing through the chest and abdomen to the legs, the aorta is the body’s largest blood vessel. An aneurysm that occurs in the lower section of the aorta is known as an abdominal aortic aneurysm. If the aneurysm occurs in the portion of the aorta in the chest, it is called a thoracic aortic aneurysm. If an aneurysm bursts, it can cause dangerous, life-threatening internal bleeding.

Treatment of an Aortic Aneurysm

Treatment for an aortic aneurysm depends on the size and severity of the condition, as well as the patients overall health. Medications are often prescribed as an initial treatment to help lower blood pressure, relax blood vessels and reduce the risk of rupture. Beta blockers and calcium channel blockers are most commonly prescribed for an aortic aneurysm. In some cases, surgical repair may be necessary.

Aortic Endovascular Stent Grafting

In an endovascular stent-grafting procedure, a small metal cylinder called a stent is implanted in the artery to provide a strong new vessel wall. During the procedure, a thin tube called a catheter is guided up the aorta to the site of the aneurysm. A balloon on the end of the catheter helps fit the stent into place. The catheter is then removed. The aneurysm generally shrinks around the stent as time passes.

Open Aneurysm Repair

Open aneurysm repair is a surgical procedure used to treat an aneurysm. It involves making an incision in the abdomen or chest, removing the section of the artery with the aneurysm, and replacing the excised segment with a graft made of a synthetic tube.

Endovascular Repair

In endovascular repair, the doctor uses a catheter to insert a graft into the aorta to strengthen it. This is a less-invasive procedure that does not require surgically opening the chest or abdomen.

If other heart-related problems are contributing to the aneurysm, a doctor may recommend additional surgery to repair or replace damaged heart valves to stop the aneurysm from worsening.

Aortic Dissection

An aortic dissection occurs when the inner wall of the aorta tears, creating two channels: one in which blood continues to flow and another in which its flow is stopped. The aorta is the major artery that brings blood from the heart to the rest of the body. The danger of the dissection is that the dysfunctional channel may enlarge, creating pressure on the functional channel and reducing blood flow, possibly causing a ballooning of the large blood vessel. Such an abnormal ballooning is known as an aneurysm. If an aneurysm ruptures, the resulting hemorrhage is life-threatening.

Treatment of an Aortic Dissection

Treatment of an aortic dissection may vary, depending on which part of the blood vessel is affected. An aortic dissection of the ascending aorta must be corrected surgically, while minor dissections in the distil, or descending, aorta may be left to heal on their own. In all cases, hypertension must be controlled with medication. Speed is essential in treating an aortic dissection in order to avoid blood vessel rupture. For at least 2 years following an aortic dissection, patients must be monitored closely since they are still at risk.


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