Abdominal Aortic Aneurysm Treatment & Medical Management

What is Abdominal Aortic Aneurysm?

“When we talk about Abdominal Aortic Aneurysm Treatment, try to picture the lower part of your aorta getting bigger and bigger. It if grows too much, then the risk of a rupture increases, and the level of danger is higher.

Your life could be in danger and measures need to be taken.

Professional measures in this case, as in any medical case.

An aneurysm takes place when plaques build up inside artery walls. With age these plaques appear more often, affecting the levels of oxygenated blood that are transported to every single part of your body.

Signs and Symptoms

An aneurysm can grow at a very slow rate, without showing any signs over time. Most are spotted on a checkout with your trusted health professional.

If there is a problem, then you will experience any or several these symptoms:

  • A sharp pain in your chest, abdomen or lower back. This uncomfortable sensation can lasts several hours or days. The pain could span through buttocks or legs.
  • A toe turns black or, maybe, blue.
  • You notice your skin is kind of sweaty
  • You start to feel dizzy or weak
  • Your heart rate increases dramatically
  • Vomit

 

Diagnosis

As in everything related with health, the sooner a diagnosis is done, the better.

The Vascular Group of Naples is an institution that advocates for the use of the best technology available.

These are some of the terms you will find more often:

  • Angiogram: this is the most used term in the field when it comes to diagnose an aneurysm. During an X-Ray procedure, blood clots are exposed thanks to a catheter.
  • Abdominal Ultrasound: This procedure allows the physician to have a clear “picture”, thanks to sound waves that go through body tissue located in the abdomen.
  • CT Scan: Here, a bigger picture is taken, in the sense that images are created not only of the abdomen, as with the Abdominal Ultrasound, but the aorta, heart and blood vessels.
  • MRI (Magnetic Resonance Imaging): This is a big piece of equipment, a magnet to be more precise. Computerized images of heart and vessels are created in a very detailed way.

 

Causes

Most of the causes are related with one thing: your lifestyle.

To be more specific, you avoid it by having a healthy lifestyle.

Chances of suffering an Aneurysm are higher if you are overweight, if your diet includes foods with high presence of fat or if you smoke on a regular basis.

There are also other causes that are not under your control like infections on the aorta or high blood pressure.

Risk Factors

Other risk factors that are out of your control are:

  • If you are over 65 years old.
  • Men have a higher propensity to suffer an abdominal aneurysm.
  • Genes play a role here as well, if there is history in your family, there are a chances of having an aneurysm at a younger age.

Prevention

Even there are some factors that you cannot control directly, there are activities that can help you prevent an aneurysm, and most diseases, just by using a daily discipline:

  • Heart health: stay away from cigarettes. In general, avoid smoking.
  • Medication: if you have being diagnosed and are require taking your medication, try to follow your physician instructions as much as you can.
  • Screening test: to be more certain, scheduled an ultrasound with your physician. It helps to spot any kind of problem right away.

 

Initial Management

Going into more detail, if you are diagnose, this is an overview of how the procedure will be:

– Prehospital care

As with any health procedure, paying attention to details is critical.

You can visualize prehospital care as follows:

  • Breathing is highly important, that is why our professionals makes sure that you don´t have any problem by maintaining a proper oxygenation all the time.
  • The physician in charge may ask some question to know more about the history of the patient.
  • As in any hospital procedure, the patient vital signs will be monitored upon arrival or while on route to the hospital in an ambulance.
  • The physician must pay attention to any symptom that might indicate that the patient could suffer a shock during the intervention.

 

– Emergency department care

When conditions mandate that the patient needs surgical intervention, all the equipment and procedures are set up to deal with things like: hemorrhagic shock, which are dealt with blood transfusions and surgery.

The clinicians must be aware of sudden changes in blood pressure.

Options for Surgical Intervention

Over the last 50 years there have been 2 established procedures:

–          Open Repair

Open repair of AAA has a survival rate of 96%. Cardiac risk is reduced thanks to constant cardiac investigations and beta blockade.

Laboratory assessment is one of the first steps that need to be performed as well as a careful examination of the patient history and amplification on some details the clinician might consider of high importance.

Patient current lifestyle needs to be carefully examined to spot possible mental and physical deterioration.

All risk factors are listed and taken in consideration.

–          Endovascular Repair

Also known as EVAR, has become, over the last 30 years, into a wide alternative to Open Repair.

Its minimal invasive techniques and lower preoperative risks made this one of the most used procedures. It has extended, even to elder population.

EVAR consist in accessing the abdominal aorta via small incisions over the femoral vessels.

An endograft is placed within the lumen of the AAA.

Think of these grafts as protection that decreases the pressure of the walls. This way, the risk of aortic rupture is lowered.

Consultations

The support of a radiologist is mandatory to determine if ultrasonography or Magnetic Resonance Imaging.

If the abdominal aorta exceeds a diameter of 3 cm there must be a follow-up with a vascular surgeon.

Over 4 cm a surgical repair is the best approach.

As in any surgery, anesthesia is required along with the necessary personnel to perform a successful surgery.

All professional health assessment needs to be done with precision and quality standards must be followed.

Complications

If it is too late and the AAA is not diagnosed, these problems may arise:

  • Rupture: there is only a 20% survival rate in an emergency situation. Remember that the aorta supplies most of the blood to the body. That´s why is so critical.
  • Blood clots: that bloods flows through the body without any restriction is vital. That´s why a block on any blood vessel can cause troubles.

 

Aneurysm Terminology

Aneurysm Definition: for adult patients, a diameter bigger than 3 cm, is considered aneurysmal.

Less than 4.0 cm, we talk about small aneurysms.

Between 4.0 cm and 5.5 cm we talk about medium aneurysms.

Larger than 5.5 cm, are called larger aneurysms.

An expansion larger than 5.0 cm in a period of 6 months increases the risks.

Aneurysm Repair

Elective AAA repair is not recommended until the risk of rupture exceeds the risks associated with repair. This is a critical point where professional decisions are needed.

Other factors are very important to be considered: the presence of a coexistent peripheral artery disease. Diseases such as: iliac aneurysm and femoral aneurysm.

Observations are key when talking about conservative management. These procedures include clinical evaluation and AAA surveillance

Medical Risk Assessment

As physicians, we look for perioperative complications such as: coronary ischemia, arrhythmias or pneumonia.

Patients with smoking history need a closer observation, since the risk factors are more much higher and there are correlated with other diseases.

Conservative Management

As an accepted rule, AAA smaller than 5.5 cm need to be managed in a more conservative way.

Potentially Beneficial Therapies:

  • Stop smoking: aneurysm is a word with high chances of being mentioned on a regular smoker record.

It is on the patient´s will and discipline to control this behavior. More than control it, it is best to eliminate it definitely.

  • Physical activity: a daily physical activity is a must for patients diagnose with AAA, this a fact accepted not only in the medical community but in society in general.

Moderated physical activity is the first step. It is best if these activities are monitored by a health professional. Otherwise, the risks will be others. Moderation is best.

Professional recommendation also applies for a proper diet.

Statistics

In the paper “Epidemiology of Aortic Aneurysm Repair in the United States from 1993 to 2003”, it is stated that AAA has been described in the medical community over the last 50 years.

To spot trends in mortality, samples were taken between 1993 and 2003 in the United States.

These are their results:

“Overall rates of treated unruptured and ruptured AAAs remained stable (unruptured 12 to 15/100,000; ruptured 1 to 3/100,000). In 2003, 42.7% of unruptured and 8.8% of ruptured AAAs were repaired through an endovascular approach. Inhospital mortality following unruptured AAA repair continues to decline for open repair (5.3% to 4.7%, P = 0.007).

Mortality after elective endovascular AAA repair also has statistically decreased (2.1% to 1.0%, P =0.024) and remains lower than open repair.

Mortality rates for ruptured AAAs following repair remain high (open: 46.5% to 40.7%, P = 0.01; endovascular: 40.0% to 35.3%, P =0.823).”

This shows certain level of stability for patients treated with elective is Abdominal Aortic Aneurysm, although there is a change in the treatment paradigm where there is a preference for elective endovascular AAA repair.

My Social Media Profiles

To avoid any kind of misrepresentation regarding my name I want my patients to know which my official social media profiles are:

Doximity: one of the biggest healthcare professionals network in the country.

Youtube: I use this network to upload videos with patient testimonials about new procedures.

Dailymotion: This is another video social network I use to share some videos about my practice.

Linkedin: The greatest professional network in the world. I use it to keep in touch with colleagues.

Researchgate: I use this platform to upload many of my academic papers.

DevianArt: I like this network to keep track of beautiful images.

Academia: This is another network I use to upload some research papers.

Tumblr: this is an old blogging account I opened long ago, but I like to keep track of it.

Crunchbase: this is another business network I like to keep track of.

Facebook: this is my official account for the biggest social network in the world.

Onlineprnews: Press release service I use in different occasions.

Soundcloud: This is a profile I opened to enjoy some relaxing tracks.

Naymz: social media reputation management tool.

I will keep updating new profiles on different social networks as they are created.

 

 

Types of Vascular Tests

If you are researching about vascular diseases, chances are that you are interested in the different tests associated with them.

These are the most common test:

Angiogram:

I already made a post about what is an Angiogram. In summary, it can serve well as a diagnostic procedure and as a therapeutic procedure.

By making use of X-Rays it helps your surgeon to decide the best treatment options.

Sedation is usually necessary so be sure to let know your surgeon about your allergies and if you have history with anesthesia.

Ankle-Brachial Index or ABI Test:

Also known as Segmental Pressure Test, Toe Pressure Test, Toe-Brachial Index (TBI)

But, besides the names, what you need to know is that this is a non-invasive test that make use of inflatable cuffs to gauge circulation and to check how is the blood pressure in arteries located in different parts of the body.

This test rarely present complications. The presence of side effects are very rare.

To give as much as information as possible to the technician is strongly advice.

Ask your surgeon about what is the proper clothing you need to bring for more comfort.

Carotid Duplex:

This test focused on the carotid arteries to spot possible blood blockages.

This is a painless and non-invasive procedure that can be performed in any well equipped facility.

Risks in this test are very low.

In 2-3 days the report with the results are ready to be delivered.

Computed Tomography Angiography (CTA) and Magnetic Resonance Angiography (MRA) Tests:

These tests make use of advance technology by making use of images to provide visual information about the current state of the blood vessels and to spot potential issues.

As a result the vascular surgeon has more information about the disease and how to proceed.

Duplex Ultrasound:

Ultrasounds help the vascular surgeon to make an evaluation of the actual state of the blood flow both in arteries and veins.

Unlike other tests, since precision is mandatory, this must be carry on a well-equipped vascular laboratory and a well prepared professional in the field.

In all these tests, ask your vascular surgeon for guidance and advice on how to prepare yourself before the procedure is performed.

How to Spot Peripheral Aneurysms Symptoms

Peripheral Aneurysms Symptoms

Image courtesy of Stuart Miles at FreeDigitalPhotos.net

You might be worry of having an aneurysms and that is why you reach my website. Maybe by searching for Peripheral Aneurysms Symptoms on Google.

Well, let me enlighten you as best as I can.

First, you need to know that there an aneurysms occur in the aorta. It can be the thoracic aorta or the abdominal aorta.

When we talk about a peripheral aneurysm, we are talking about affections in arteries other than the aorta.

The area with the higher chances of suffering this kind of aneurism is in the popliteal artery. This is located in the area in the back of the lower thigh and knee.

Also, it happens that if you are diagnosed with peripheral aneurysm in one leg, it is very likely that you also have the same condition in your other leg.

This are the peripheral aneurysms symptoms you need to watch out:

You need to know that 65% of patients might not notice any physical symptom.

If that is not your case or you are suspicious, and depending of their location, you might have experimented something similar to:

  • A lump you feel pulsating
  • After performing a physical activity, you feel leg or arm pain
  • While resting, you experience leg or arm pain
  • Sudden pain in toes or fingers
  • Numbness in your arms or legs
  • In an extreme case, gangrene or death tissue.

There is the risk of a stroke if the carotid artery is involve.

Now, hopefully, you are not suffering any of this symptoms. But you might be interested in know what causes a peripheral aneurism.

There isn´t certainty about a definitive cause.

Several researches link this condition to atherosclerosis. As our bodies age, your arteries narrow and get weaker. It is a natural process.

What you can do is to watch out not to speed up the process. How you might be wondering?

Just stay away from the following:

  • High levels of cholesterol
  • Smoking
  • High levels of blood pressure
  • Obesity
  • Your family history

I hope you have now a clear picture of how to spot peripheral aneurysms symptoms.

If after reading this info you think you might be suffering peripheral aneurysm, don´t hesitate and go to visit your most trusted physician.

For deeper information, I recommend to visit VascularWeb.org 

Varicose Veins: Early Symptoms

Varicose veins early symptoms

Image courtesy of Stuart Miles at FreeDigitalPhotos.net

If you are looking for varicose veins (VV) and its early symptoms I can give you some info.

Causes

It is all related with high blood pressure in your superficial leg veins.

It you are suspicious you might suffer this condition, check your family history. There are high chances of you experiencing varicose veins if someone or several members of your family suffer it.

Lack of physical exercise, over weight and a sedentary way of life facilitates and increase the chances of you suffering varicose veins. Also, Deep Vein Thrombosis is a factor that influences VV.

According to VascularWeb.org, women are more likely to develop this condition.

Varicose veins early symptoms

The first signals you need to look for are: constant feeling of heaviness in your legs. Also, some leg ache. Watch out for night cramps, it is not only the pain they bring, but a feeling of mental tiredness cause by the lack of proper sleeping. It is not only the physical element you need to think about, your mind will be also stress out by this new situation.

The skin of your legs might change its natural color as well. Formation of sores should be expected.

Test

As a vascular surgeon, I make some questions to get to know more about your medical history. Then, a physical exam is performed. Mainly, I have to look at your superficial veins, to check for their color and texture.

It there is not an early treatment, the chances of your condition to get worse is much higher.

One easy treatment is to prop your feet up above the level of your heart 3 to 4 times every day. The use of compression stockings is recommended if you are in an advance stage. This option can play out to be very effective. Also, it can be something to wear for life.

If the previous treatments fail, there might be the need for a minimally invasive treatment, depending the condition of your varicose veins.

About Deep Vein Thrombosis (DVT).

About Deep Vein Thrombosis

Image courtesy of hyena reality at FreeDigitalPhotos.net

As a vascular surgeon, one of the most frequent request I receive is about deep vein thrombosis (DVT).

What is DVT?

Think of your arteries, what goes through them? Well, you arteries facilitate that your oxygen-rich blood travel from your heart to reach the rest of your body. In return, through your veins, you receive blood with a lower level of oxygen back to your heart. It sounds like some kind of trade, doesn´t it?

You have veins known as superficial veins and deep veins. Deep veins are the ones you need to watch when thinking about Deep Vein Thrombosis (DVT). This, because blood clots may appear in such veins. The location of the clot may differ. Normally, pelvis and thigh are the places to look for, at first.

Pulmonary embolism is one the biggest dangers you might face with DVT. In this case, your lungs might be affected. This, in short time, can be fatal.

If you are suspicious about having this condition, go and pay a visit to your physician.

What are the symptoms?

There isn`t a list a symptoms, it is more like where in your body and the size of the blood clot. Swelling, leg pain or your skin turning into red or blue.

Main causes

When you are experiencing a poor flow in your blood, the risk of DVT increases. Living a sedentary lifestyle opens a window of opportunity for this kind of conditions. Not only can happen for people who spend most of the time sitting on a chair. If you spend most of your day standing, you are not necessary moving.

Other than work related activities, events such as a mayor operation where you need to lie back most of the day.

Obesity is a condition that can propel DVT as well as events such as heart failures.

Tests

Of course, as physicians, we have to ask regular questions about your health, activities and actual condition. To check your overall health history is mandatory.

After this, a venogram test or a duplex ultrasound test are required.

The good thing is that DVT can be treated with minimally invasive treatments and medications. Surgery is very rarely to happen.

Rajasinghe Vascular Research and Education Foundation, inc

Rajasinghe Vascular Research And Education Foundation, Inc. it´s an initiative I have been working since the year 2014 and it is something I feel very passionate and committed about.

I know how though medical school can be, not only taking in perspective all the effort it implies, but also the financial challenges an average medicine student may face.

That is why I decided, with the help of some close colleagues, to run a foundation focused on helping talented and high potential students through scholarships and other types of support underserved children and youngsters in the Collier County to help them in their path in careers related with science and medicine.

We will be looking to make alliances with other non-profit organizations and institutions that are focused, solely, in educational and charitable purposes.

Also, we will looking to provide internships and/or volunteer opportunities for some of such students. All aiming to bring the best practical experience possible for the future medical students who will bring a positive impact in our society.

This a videos from Duke medical students expressing their gratitude at the Duke Medical Annual Fund.

Disorders of Blood Vessels

What happens when Arteries are affected?

Arterial disorders of blood vessels represent the most common cause of morbidity and mortality in the Western countries. Much of this occurs due to obstruction of the arteries because of the formation of a plaque in blood vessels, most commonly involving the blood vessels of the heart and brain, but can also occur acutely as a result of emboli/ clot or trauma. The plaque or atheroma is a cholesterol deposit within the arterial walls that gradually increases in size.

Symptoms of Obstruction of an Artery

The symptoms and signs produced relate to the organ supplied by the artery for example in heart- angina and heart attack, in brain- stroke. In limbs, it causes Intermittent Claudication at first which is cramp-like pain felt in the muscles during exercise and relieved by rest. It progresses to Rest Pain which occurs even with the limb in rest and is characteristically worse at night and exacerbated by elevation of the foot. The limb involved might also be cold, numb with skin changes and weak distal pulses.

How is an Arterial Obstruction Diagnosed?

In case of a chronic obstructive disease, blood glucose and lipid metabolism is investigated along with electrocardiography (ECG) for disorders of blood vessels of the heart. A hand-held Doppler ultrasound and Duplex scanning is done to detect abnormal arterial blood flow and to calculate ankle-brachial pressure index (ABPI). Ankle-brachial pressure index is a ratio of blood pressure at the ankle to that of the arm and a value below 0.9 indicates some degree of arterial obstruction. Sometimes, an angiography, also called arteriography, might be required if surgery is planned. It involves the injection of a radio-opaque dye into the blood vessel to visualize the point of obstruction. New techniques such as magnetic resonance angiography and computerized tomography (CT) angiography are now replacing classical angiography.

What should you do if you have an Arterial Obstruction?

Patients of chronic arterial occlusion are advised to continue walking though pain which helps in development of new collateral vessels. Exercise is encouraged and cessation of smoking is essential. Overweight patients are given dietary advice to reduce weight and a plan for an active healthy lifestyle.

What is the treatment for an Arterial Obstruction?

Medications like aspirin maybe prescribed to thin the blood along with drugs to control diabetes and hypertension. The disease may be treated by inserting a balloon catheter into the artery and inflating it to dilate the narrowed part of the artery in a procedure called Percutaneous Transluminal Angioplasty (PTA) or a graft of blood vessel maybe applied on either side of the narrowed part to bypass it. In case of an acute disorder of blood vessel, the blood clot is dissolved by giving medications or removed by surgery. If gangrene occurs, which is the death of a part of limb, it must be removed by amputation.

What are some other Arterial disorders of blood vessels?

Sometimes the walls of the arteries become weak mostly due to high blood pressure and may expand to form a dilated part in the artery called an aneurysm. Common sites include the chest, abdomen and the blood vessels of brain. An aneurysm might cause no symptoms, or might rupture and become fatal in 50% of ruptured abdominal aneurysms.

In certain disorders, the body produces factors that attack its own blood vessels and cause inflammation. These diseases are called the autoimmune disorders of blood vessels and occur in rheumatoid arthritis, systemic lupus erythematous and polyarteritis nodosa.

Some disorders of blood vessels in the skin might exist since birth. These include a capillary hemangioma which appears as raised red swelling anywhere on the body, mostly on the head or neck, and regresses with age. Other vascular birthmarks include ‘salmon patch’ which disappears within a year after birth and ‘port wine stain’ which is associated with several syndromes.

What happens when Veins are affected?

Venous disorders of blood vessels include varicose veins which are tortuous dilated veins of the skin affecting 5% of adult population most commonly the legs. The veins become dilated either because of the backflow of blood in the veins due to incompetent valves or secondary to an obstruction impeding the normal venous blood flow.

Symptoms of Varicose Veins

It commonly presents with pain in the legs at the end of the day or after prolonged standing. Other symptoms include itching, swelling of the leg or ulcers.

How is Varicose Veins Diagnosed?

A standard Doppler examination or a Duplex venous scan can easily visualize the blood flow within the veins or if any clot/ thrombus are obstructing the blood flow. Sometimes a venography might be done which allows detailed mapping of the veins and is an extremely useful test for patients with recurrent varicose veins or those with complex anatomy.

What should you do if you have Varicose Veins?

Patients of varicose veins are advised to wear compression stockings, elevate their legs and avoid standing for long hours, sometimes even requiring a change in occupation.

What is the treatment for Varicose Veins?

It can be treated by injecting a detergent chemical (sodium tetradecyl sulphate) in the wall of the vein either directly or mixed with air to form foam to destroy the vein. Surgically, the affected vein maybe tied at a high point in the leg and the rest stripped off. Newer techniques of endovascular laser and radiofrequency ablation to destroy vein are less invasive and preferred.

What are some other Venous disorders of blood vessels?

Other venous disorders of the blood vessels include formation of a clot- Deep Vein Thrombosis which causes pain, swelling and eventual discoloration of the leg. The clot maybe dissolved by medications or removed by surgery.

 

Image courtesy of Stuart Miles at FreeDigitalPhotos.net

Great infographic with facts about your heart

Hello to all my readers and patients

As a surgeon, I like to read all interesting info I can find in my field of work. Reading medicine papers and doing some research can be exhausting, the terminology might not be easy to understand for people not related with the health industry.

Today, I want to share a very instructional and easy to understand infographic created by the Cleveland Clinic on their blog post title: 21 Amazing Facts About Your Heart (Infographic)

Enjoy it!

Two things to watch after a vascular surgery

Nowadays, having a surgery has far less risks than it had decades ago. With new technologies available for physicians around the country, we can focus on the procedure and not so much on the tools anymore.

Anyhow, there are precautions to consider, especially after the surgery.

Even if the procedure lasts only a couple of hours, keep in mind that the human body needs time to fully recover.

The first thing to watch out after a vascular surgery is if you feel any loss of sensation or movement in any part of your body.

Second, keep special care if you notice any kind of swelling. Especially in your legs.

If any of this events happen, please get in touch with your vascular surgeon. Do not let too much time to pass. Report these troubles right away.

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