The carotid arteries in the neck carry blood from the heart to the brain. Carotid artery disease (stenosis or blockage) results from build-up of plaque in the artery called atherosclerosis or arteriosclerosis. Risks factors for plaque formation in the carotid arteries (and also in other arteries of the body) include high blood pressure, high blood cholesterol, diabetes, smoking and family history (similar problems in blood relatives). The plaque can restrict blood flow to the brain. Clot can form on the plaque which can break up and can be carried to the brain by the blood stream and cause ministroke (transient ischemic attack or TIA) or stroke (cerebrovascular accident or CVA). A piece of plaque can similarly separate from the artery and embolize to the brain.
Most of the time carotid plaques do not cause any symptoms. The more plaque that builds up (worst stenosis or blockage) the more likely for symptoms to develop. Symptoms include localized arm, leg or facial tingling, weakness or numbness, loss of vision in one eye for several seconds to minutes with return of normal vision (amarosis fugax, transient monocular blindness or TMB), slurred speech or inability to speak. These symptoms can resolve within 24 hours (TIA) or last for more than 24 hours (CVA). If any of these symptoms develop they should be reported to your doctor immediately.
Carotid blockages are suspected when an abnormal sound is heard over the neck with a stethoscope (bruit), symptoms develop, risks factors listed above are present or blockages are present in other arteries such as the heart, leg or abdominal arteries.
Carotid blockages are diagnosed in the office with an ultrasound examination (duplex scan). This examination can detect plaque in the arteries and also estimate the severity of blockage. Other examinations such as CT angiography and MR angiography may be necessary to further evaluate and confirm stenosis in the carotid arteries.
Treatment of carotid plaques includes treatment of associated problems such as high blood pressure, high cholesterol and diabetes with medications and cessation of smoking. Blood thinners such as aspirin and/or Plavix are used to prevent clots from forming on plaques.
If the blockage is severe without symptoms or moderate with symptoms surgical intervention is required to decrease the probability of future neurological symptoms (TIA or CVA). The main treatment is removal of the plaque and is called carotid endarterectomy. In certain instances placement of a stent through the femoral (groin) artery may be necessary. Treatment for each patient is individualized after thorough evaluation.
Aneurysms are weakness in the arterial wall which cause localized ballooning of the vessel. Aneurysms can occur in many arteries of the body. Commonly they occur in the abdominal aorta, iliac arteries in the pelvis and popliteal arteries (behind knees). Aneurysms can also form in the major branches of the abdominal aorta. Clot is usually found in the aneurysm sacs. Risk factors for aneurysm formation include high blood pressure, high blood cholesterol levels, diabetes, smoking and family history.
Aneurysms normally do not cause any symptoms until they rupture (cause massive bleeding which is often fatal) or embolize distally (clot from aneurysm breaks up and blocks flow (common complication of popliteal aneurysms)).
Aneurysms can be suspected when a pulsating mass is felt on examination. They can be diagnosed easily in the office using ultrasound (sonogram). They can be further evaluated using CT scan, CT angiogram and MR angiogram.
Decision to treat aneurysms depends on location, size and surrounding anatomy. Treatment options include open (traditional) replacement of the weakened blood vessel with synthetic material or leg vein or minimally invasive placement of a stent graft through the femoral artery (groin).
Treatment is individualized for each patient after thorough evaluation.
Arterial plaques (stenosis or blockages) can develop in the arteries from the abdomen to the feet which can narrow the lumen of the blood vessels and diminish blood flow. This is often referred to as peripheral vascular disease (PVD) or peripheral arterial disease (PAD). Risk factors for development of this condition include high blood pressure, high blood cholesterol, diabetes, kidney failure, smoking and family history.
Symptoms of lower extremity arterial and abdominal aortic blockages include leg pains with walking (claudication) which limit walking distance. As the condition worsens pains may develop in the feet without any activity (resting pain), difficult to heal wounds or gangrene. The condition is responsible for most leg amputations.
Blockages in the arteries branches of the abdominal aorta can lead to high blood pressure (kidney arteries) or abdominal pain after eating and wieght loss (intestinal arteries).
Ultrasound can be used to diagnose these conditions. Further testing with MR angiogram, CT angiogram and conventional angiogram may be necessary.
Treatment is individualized after thorough evaluation and may include medication, walking program, angioplasty, stenting and/or surgery.
click here for more disorders »