Arterial Diseases

Atherosclerosis is a common form of arterial disease in which lipid deposition forms a plaque in the blood vessel walls. Atherosclerosis is an incurable disease, for which there are clearly defined risk factors that often can be reduced through a change in lifestyle and behavior of the patient. It manifests itself as vessel stenosis and a source of thromboembolic disease. Its clinical manifestations depend on the specific vessels affected and include most notably coronary artery disease, carotid disease, and peripheral vascular disease. It is the most common primary disease of the arterial vascular system and is responsible for coronary heart disease, the leading cause of death worldwide.

Aortic dissection occurs due to shearing stress from pulsatile pressure causing a tear in the tunica intima of the aortic wall. This tear allows blood to flow into the media, creating a “false lumen.” Aortic dissection is most commonly caused by uncontrolled hypertension. Complications arise due to partial occlusion of vital branches off the aorta and reduced blood flow to the brain, visceral organs, and extremities. Patients often present with acute, tearing chest or back pain. Computed tomography is the diagnostic modality of choice. All type A dissections (ascending aorta) are a surgical emergency due to the risk of imminent rupture. Type B dissections (descending aorta) can be managed medically with impulse control using beta-blockers and calcium channel blockers. If there is evidence of malperfusion to visceral organs or extremities, aneurysm dilation to > 5 cm, retrograde extension into the ascending aorta, or intractable pain, the patient will need evaluation for endovascular or open repair.

Peripheral artery disease (PAD) is obstruction of the arterial lumen resulting in decreased blood flow to the distal limbs. The disease can be a result of atherosclerosis or thrombosis. Patients may be asymptomatic or have progressive claudication, skin discoloration, ischemic ulcers, or gangrene. Onset may be insidious (atherosclerosis) or abrupt (thrombosis). Diagnosis is made with the clinical history, exam, and measurement of the ankle-brachial index. Imaging studies can determine the location and extent of the arterial disease. Treatment varies depending on the severity but can include lifestyle modifications, antiplatelet therapy, risk factor modifications, phosphodiesterase inhibitors, and revascularization.

Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. The most common symptoms include tachycardia, tachypnea, hypotension, altered mentation, and oliguria. Treatment measures vary depending on the suspected cause of shock and may include mechanical ventilation, IV crystalloids, vasopressors, and blood transfusion.

An aortic aneurysm is the abnormal dilation of a segment of the aorta. Abdominal aortic aneurysm is the most common aortic aneurysm, occurring frequently in the infrarenal area. Degenerative aortic disorders are the prevalent etiology, affecting patients > 60 years of age. Most aneurysms are asymptomatic, but can cause compression of surrounding structures or rupture, which is a life-threatening emergency. Diagnosis is often made by ultrasound. As aneurysmal rupture carries a high mortality rate, surveillance is recommended for asymptomatic cases to monitor aortic diameter. Elective surgery (the majority via endovascular aortic repair) is an effective way to reduce complications and aneurysm-related death. This surgery is performed based on aortic size, underlying condition, and associated symptoms.

An aortic aneurysm is the abnormal widening of a part of the wall of the aortic artery leading to abnormal bulging out with or without a cause. An aortic aneurysm is a localized or diffused dilation of aortic artery usually more than 50% of its normal size. Aortic aneurysms can be classified into thoracic and abdominal aortic aneurysm with different clinical features, diagnostic criteria and management. If this bulging occurs continuously, it can result in the bursting of the artery and, eventually, haemorrhage, a condition termed as aortic dissection, which is considered a catastrophic fatal condition. Abdominal aortic aneurysms are generally caused due to infection, injury or atherosclerosis. Thoracic aortic aneurysms are caused due to injury, high blood pressure, and inherited tissue disorders.

Vascular diseases are any abnormal conditions that affect the circulatory system and are responsible for more mortality and morbidity than any other category of human disease. The spectrum of pathology encompasses congenital and acquired disorders that are arterial, venous, capillary or lymphatic in origin. Vascular disease can affect virtually any vessel in the body and present with different symptoms in different regions of the body. The most commonly involved areas include the heart, head, neck, and upper and lower extremities. Less commonly, vessels supplying the bowel may be involved leading to bowel infarction.

With a prevalence of approximately 50 %, arterial hypertension is a very common disease. Blood pressure is a risk factor of secondary diseases such as stroke, CHD and cardiac insufficiency. Social connections as well as a relationship between hypertension, body weight and age are apparent. Many individuals with hypertension are not treated at all or receive insufficient therapy and, in many cases, are not aware they have the disease.