Abdominal Aortic Aneurysm

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What is abdominal aortic aneurysm?

Your arteries deliver oxygen-rich blood from your heart to other parts of your body. The aorta, the largest artery in your body, runs from your heart, down through your chest, and into your abdomen (called the abdominal region). The abdominal region of the aorta is responsible for delivering blood to your legs, GI tract, and kidneys. An abdominal aortic aneurysm (AAA) occurs when the wall of the aorta progressively weakens and begins to bulge. An AAA may continue to enlarge and eventually rupture if left untreated, causing severe internal bleeding and possibly death.

In addition to concerns about rupture, clots or debris may also develop within an AAA. These substances can be carried to other areas in the body and block circulation, causing severe pain or possibly limb loss if blood flow is cut off for too long.

AAA can be safely treated with early diagnosis. Nearly 200,000 people in the United States are diagnosed with AAA annually; approximately 15,000 die each year from a ruptured AAA.

Causes and risk factors

Most aortic aneurysms are caused by a breakdown in the proteins that provide structural strength to the wall of the aorta. Some risk factors that contribute to this structural breakdown include:

• Age — individuals over 60 years are most likely to develop the condition
• Gender — males are more prone to the condition than females
• History of atherosclerosis (hardening of the arteries)
• Family history of AAA
• Smoking
• High blood pressure
• Chronic lung disease

Symptoms

Most people feel no symptoms, and an AAA is often detected when tests are conducted for other unrelated reasons. Those with symptoms describe them as:

• A pulsing feeling in their abdomen
• Unexplained, severe pain in their abdomen or lower back
• Pain, discoloration, or sores on their feet (this is a rare symptom)

Diagnosis

If you experience symptoms of AAA, or if unrelated tests reveal AAA may be present, see a vascular surgeon. They are the only physicians treating vascular disease today who can perform all the treatment options available, including medical management, minimally invasive endovascular stent graft procedures, or open AAA repair. Only when you see a vascular surgeon who can perform all potential treatments will you be assured of receiving the care that is most appropriate to your condition.

Medicare Screening Benefit

Medicare offers a free, one-time AAA ultrasound screening for qualified seniors as part of their Welcome to Medicare physical during the first 12 months of their enrollment. Men who have smoked sometime during their life and men and women with a family history of AAA are eligible for this benefit.

Treatment

The most important factor determining the treatment of AAA is its size. It may require lifestyle changes, such as quitting smoking, lowering blood pressure, and taking medication. For large AAAs, or those that have been increasing in size over time, repair may be carried out either by placement of an endovascular stent graft or by open bypass grafting. Your vascular surgeon will diagnose and prescribe the best treatment for your condition.

Vascular surgeons are the only physicians treating vascular disease today who can perform all treatment options available, including medical management, minimally invasive endovascular procedures including balloon angioplasty, atherectomy, and stent procedures, and open surgical repair including bypass.

Only when you see a vascular surgeon who offers all treatment modalities will you be assured of receiving the care that is most appropriate to your condition.

For more information visit VascularWeb.org

Carotid Artery Disease

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What is carotid artery disease?

Your arteries are responsible for delivering oxygen-rich blood from your heart to other parts of your body. Your carotid arteries are two main arteries that carry blood from your heart, up through your neck, to your brain. Healthy carotid arteries are smooth and unobstructed, allowing blood to flow freely to the brain and provide oxygen, glucose, and other nutrients that your brain cells need. Typically with age, the carotid arteries build up plaque, a sticky substance made up mostly of fat and cholesterol. Plaque narrows the passageway within the arteries and causes them to become stiff. Carotid artery disease results when the carotid arteries become too narrow or obstructed and limit the blood flow to the brain.

Strokes result either from obstruction of blood flow to the brain by the plaque or when bits of plaque and clots break off from the plaque and flow to the brain. If left untreated, carotid artery disease may lead to stroke, where lack of oxygen and other essential nutrients cause damage to the brain. Depending on its severity, a stroke can be fatal. In fact, strokes are the third leading cause of death in the United States and the leading cause of permanent disability in older adults.

Causes and risk factors

Most aortic aneurysms are caused by a breakdown in the proteins that provide structural strength to the wall of the aorta. Some risk factors that contribute to this structural breakdown include:

• Age
• Hypertension (high blood pressure)
• Diabetes
• Smoking
• High cholesterol
• Obesity
• Lack of exercise
• Family history of atherosclerosis (hardening of the arteries) and/or stroke
• Irregular heartbeat, particularly atrial fibrillation (a diagnosed condition where the heart chambers quiver and beat ineffectively)

Symptoms

There may be no symptoms in the early stages of carotid artery disease, and stroke could be the first sign of the condition. Stroke, however, typically has warning signs, referred to as mini-strokes or transient ischemic attacks. Mini-stroke symptoms are usually temporary, lasting a few minutes to a few hours, and should be treated as serious medical emergencies requiring immediate treatment because they are strong predictors of future stoke. Some symptoms of stroke include:

• Weakness, numbness, or tingling on one side of the body
• Inability to control movement of a body part
• Loss of vision or blurred vision in one or both eyes
• Inability to speak clearly
• Difficulty talking or comprehending what others are saying
• Dizziness or confusion

Diagnosis

The diagnosis of carotid artery disease can be confirmed, and its severity established, by a noninvasive Duplex ultrasound examination. If you experience symptoms of a mini-stroke (as described above), see a vascular surgeon. They are the only physicians treating vascular disease today who can perform all the treatment options available, including medical management, minimally invasive endovascular angioplasty and stent procedures, and carotid endarterectomy. Only when you see a vascular surgeon who offers all treatment modalities will you be assured of receiving the care that is most appropriate to your condition.

Treatment

Depending on the severity of your condition, treatment options may include lifestyle changes, medications, or a definitive procedure such as minimally invasive carotid stenting or open carotid endarterectomy.

Vascular surgeons are the only physicians treating vascular disease today who can perform all treatment options available, including medical management, minimally invasive endovascular procedures including balloon angioplasty, atherectomy, and stent procedures, and open surgical repair including bypass.

Only when you see a vascular surgeon who offers all treatment modalities will you be assured of receiving the care that is most appropriate to your condition.

For more information visit VascularWeb.org

Peripheral Arterial Disease

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What is peripheral arterial disease?

Your arteries deliver oxygen-rich blood from your heart to other parts of your body. Your peripheral arteries carry blood away from the heart to your arms and legs. The peripheral arteries in your legs are extensions of the largest artery in your body, the aorta. The aorta travels down through your abdominal region and branches off into the iliac arteries of each leg. The iliac arteries further divide into smaller arteries and deliver blood down your legs to your toes.

Healthy peripheral arteries are smooth and unobstructed, allowing blood to flow freely to the legs and provide oxygen, glucose, and other nutrients that your legs need. Typically with age, the peripheral arteries build up plaque, a sticky substance made up mostly of fat and cholesterol. Plaque narrows the passageway within the arteries and causes them to become stiff. Peripheral arterial disease results when the peripheral arteries become too narrow or obstructed and limit the blood flow to the legs. If left untreated, peripheral arterial disease can cause pain or aching in the legs, difficulty with walking, resting pain in the foot at night in bed, non-healing sores or infections in the toes or feet, and can lead to limb loss in its most severe form. In addition, it can be associated with other serious arterial conditions leading to heart attacks and stroke.

Causes and risk factors

• Age
• Gender — males are more prone to the condition than females
• History of atherosclerosis (hardening of the arteries)
• Hypertension (high blood pressure)
• Diabetes
• Smoking
• High cholesterol
• Obesity
• Lack of exercise
• Family history of vascular problems

Symptoms

There may be no symptoms in the early stages of peripheral arterial disease. Developing symptoms may include discomfort or pain in your legs when walking but no pain when you rest.

Diagnosis

The diagnosis of peripheral arterial disease can be established, and its severity confirmed, by a simple, noninvasive Doppler examination. If you experience symptoms of peripheral arterial disease in your legs, see a vascular surgeon. They are the only physicians treating peripheral vascular disease today who can perform all the treatment options available, including medical management, minimally invasive endovascular angioplasty and stent procedures, and open bypass surgery. Only when you see a vascular surgeon who offers all treatment modalities will you be assured of receiving the care that is most appropriate to your condition.

Treatment

Depending on the severity of your condition, treatment options may include lifestyle changes, medications, minimally invasive angioplasty/stenting, or open bypass surgery.

Vascular surgeons are the only physicians treating vascular disease today who can perform all treatment options available, including medical management, minimally invasive endovascular procedures including balloon angioplasty, atherectomy, and stent procedures, and open surgical repair including bypass.

Only when you see a vascular surgeon who offers all treatment modalities will you be assured of receiving the care that is most appropriate to your condition.

For more information visit VascularWeb.org

Dialysis Access

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What is chronic kidney disease?

Chronic kidney disease, also called chronic kidney failure, describes the gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine. When chronic kidney disease reaches an advanced stage, dangerous levels of fluid, electrolytes and wastes can build up in your body.

HIn the early stages of chronic kidney disease, you may have few signs or symptoms. Chronic kidney disease may not become apparent until your kidney function is significantly impaired.

Treatment for chronic kidney disease focuses on slowing the progression of the kidney damage, usually by controlling the underlying cause. Chronic kidney disease can progress to end-stage kidney failure, which is fatal without artificial filtering (dialysis) or a kidney transplant.

Causes and risk factors

Chronic kidney disease occurs when a disease or condition impairs kidney function, causing kidney damage to worsen over several months or years. Diseases and conditions that cause chronic kidney disease include:

• Type 1 or type 2 diabetes
• High blood pressure
• Glomerulonephritis (gloe-mer-u-low-nuh-FRY-tis), an inflammation of the kidney's filtering units (glomeruli)
• Interstitial nephritis (in-tur-STISH-ul nuh-FRY-tis), an inflammation of the kidney's tubules and surrounding structures
• Polycystic kidney disease
• Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some cancers
• Vesicoureteral (ves-ih-koe-yoo-REE-tur-ul) reflux, a condition that causes urine to back up into your kidneys
• Recurrent kidney infection, also called pyelonephritis (pie-uh-low-nuh-FRY-tis)

Risk factors

Factors that may increase your risk of chronic kidney disease include:

• Diabetes
• High blood pressure
• Heart and blood vessel (cardiovascular) disease
• Smoking
• Obesity
• Being African-American, Native American or Asian-American
• Family history of kidney disease
• Abnormal kidney structure
• Older age

Symptoms

Signs and symptoms of chronic kidney disease develop over time if kidney damage progresses slowly. Signs and symptoms of kidney disease may include:

• Nausea
• Vomiting
• Loss of appetite
• Fatigue and weakness
• Sleep problems
• Changes in how much you urinate
• Decreased mental sharpness
• Muscle twitches and cramps
• Swelling of feet and ankles
• Persistent itching
• Chest pain, if fluid builds up around the lining of the heart
• Shortness of breath, if fluid builds up in the lungs
• High blood pressure (hypertension) that's difficult to control

Signs and symptoms of kidney disease are often nonspecific, meaning they can also be caused by other illnesses. Because your kidneys are highly adaptable and able to compensate for lost function, signs and symptoms may not appear until irreversible damage has occurred.

Diagnosis and Treatment

Chronic kidney disease occurs when a disease or condition impairs kidney function, causing kidney damage to worsen over several months or years.

Diseases and conditions that cause chronic kidney disease include:

• Type 1 or type 2 diabetes
• High blood pressure
• Glomerulonephritis (gloe-mer-u-low-nuh-FRY-tis), an inflammation of the kidney's filtering units (glomeruli)
• Interstitial nephritis (in-tur-STISH-ul nuh-FRY-tis), an inflammation of the kidney's tubules and surrounding structures
• Polycystic kidney disease
• Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some cancers
• Vesicoureteral (ves-ih-koe-yoo-REE-tur-ul) reflux, a condition that causes urine to back up into your kidneys
• Recurrent kidney infection, also called pyelonephritis (pie-uh-low-nuh-FRY-tis)

Depending on the underlying cause, some types of kidney disease can be treated. Often, though, chronic kidney disease has no cure.

Treatment usually consists of measures to help control signs and symptoms, reduce complications, and slow progression of the disease. If your kidneys become severely damaged, you may need treatment for end-stage kidney disease.

Treating the cause

Your doctor will work to slow or control the cause of your kidney disease. Treatment options vary, depending on the cause. But kidney damage can continue to worsen even when an underlying condition, such as high blood pressure, has been controlled.

Treating complications

Kidney disease complications can be controlled to make you more comfortable. Treatments may include:

• High blood pressure medications. People with kidney disease may experience worsening high blood pressure. Your doctor may recommend medications to lower your blood pressure — commonly angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers — and to preserve kidney function. High blood pressure medications can initially decrease kidney function and change electrolyte levels, so you may need frequent blood tests to monitor your condition. Your doctor will likely also recommend a water pill (diuretic) and a low-salt diet.
• Medications to lower cholesterol levels. Your doctor may recommend medications called statins to lower your cholesterol. People with chronic kidney disease often experience high levels of bad cholesterol, which can increase the risk of heart disease.
• Medications to treat anemia. In certain situations, your doctor may recommend supplements of the hormone erythropoietin (uh-rith-roe-POI-uh-tin), sometimes with added iron. Erythropoietin supplements aid in production of more red blood cells, which may relieve fatigue and weakness associated with anemia.
• Medications to relieve swelling. People with chronic kidney disease may retain fluids. This can lead to swelling in the legs, as well as high blood pressure. Medications called diuretics can help maintain the balance of fluids in your body.
• Medications to protect your bones. Your doctor may prescribe calcium and vitamin D supplements to prevent weak bones and lower your risk of fracture. You may also take medication known as a phosphate binder to lower the amount of phosphate in your blood, and protect your blood vessels from damage by calcium deposits (calcification).
• A lower protein diet to minimize waste products in your blood. As your body processes protein from foods, it creates waste products that your kidneys must filter from your blood. To reduce the amount of work your kidneys must do, your doctor may recommend eating less protein. Your doctor may also ask you to meet with a dietitian who can suggest ways to lower your protein intake while still eating a healthy diet.

Your doctor may recommend follow-up testing at regular intervals to see whether your kidney disease remains stable or progresses.

Treatment for end-stage kidney disease

If your kidneys can't keep up with waste and fluid clearance on their own and you develop complete or near-complete kidney failure, you have end-stage kidney disease. There are 2 main types of kidney (renal) failure: acute (sudden) and chronic (over time). At that point, you need dialysis or a kidney transplant.

Dialysis

Dialysis artificially removes waste products and extra fluid from your blood when your kidneys can no longer do this. In hemodialysis, a machine filters waste and excess fluids from your blood. In peritoneal dialysis, a thin tube (catheter) inserted into your abdomen fills your abdominal cavity with a dialysis solution that absorbs waste and excess fluids. After a period of time, the dialysis solution drains from your body, carrying the waste with it.

• To treat ARF, you have to treat the cause (such as blood pressure that is too high or too low, a kidney stone or high blood sugar). Sometimes you need dialysis for a short time.
• With CRF, treating the cause (such as high blood pressure and/or high blood sugar) can slow the disease. CRF can lead to end stage kidney disease.
• When kidney function falls below 10% of normal, dialysis or a kidney transplant is most often needed, especially if you have signs of uremia (a buildup of waste in the blood), like nausea and itching.

Dialysis

Dialysis is a way to pump your blood through a machine that filters out the waste and returns the blood to your body. The 2 types of dialysis are hemodialysis and peritoneal dialysis.

Hemodialysis: For hemodialysis, a tube (catheter) is stuck into one of the veins in your neck, or an arm or leg. Hemodialysis is most often done 3 times a week for 3 to 4 hours at a time.

Peritoneal dialysis: Peritoneal dialysis is done through a tube permanently set in your belly.

Most adults have dialysis done in an outpatient hemodialysis center. Most children have peritoneal dialysis done at home.

Kidney transplant

A kidney transplant involves surgically placing a healthy kidney from a donor into your body. Transplanted kidneys can come from deceased or living donors. You'll need to take medications for the rest of your life to keep your body from rejecting the new organ. You don't need to be on dialysis to have a kidney transplant.

For some who choose not to have dialysis or a kidney transplant, a third option is to treat kidney failure with conservative measures. However, once you have complete kidney failure, your life expectancy generally would be only a few months.

Potential future treatments

Regenerative medicine holds the potential to fully heal damaged tissues and organs, offering solutions and hope for people who have conditions that today are beyond repair.

Regenerative medicine approaches include:

• Boosting the body's natural ability to heal itself
• Using healthy cells, tissues or organs from a living or deceased donor to replace damaged ones
• Delivering specific types of cells or cell products to diseased tissues or organs to restore tissue and organ function

For people with chronic kidney disease, regenerative medicine approaches may be developed in the future to help slow progression of the disease.

For more information visit VascularWeb.org