Abdominal Aortic Aneurysm (AAA) Carotid Artery Blockage Peripheral Artery Disease (PAD) Understanding Risk Factors Certain factors increase your risk of having an artery problem. Some things can’t be controlled, such as older age or having a family history of artery problems. But you can control other risk factors, such as: • Smoking • High blood pressure • Diabetes • A high-fat diet • Lack of exercise • Hyperlipidemia (high levels of certain fats in the blood) • Heart disease • Too much stress • Obesity Common Artery Problems Artery problems can occur in almost all parts of the body. But some areas are more prone to disease than others. One of the most common artery problems is heart disease. This is blockage of the arteries in the heart. The focus of this booklet is artery problems outside the heart. These include: • Peripheral artery disease (PAD), which occurs when the body can’t send enough blood to the legs and feet. In rare cases, the arms are also affected. • Carotid artery blockages, which prevent the brain from receiving enough oxygen-rich blood. • Abdominal aortic aneurysm (AAA), a weakness in the main artery that carries blood to the lower body. Living with an Artery Problem Arteries are large blood vessels that carry oxygen-rich blood through the body. A problem with arteries can disrupt the flow of blood and cause serious health concerns. It can even threaten life. The good news: most artery problems can be treated. Read on to learn more about artery diseases and what can be done to treat them. Treating Artery Problems Your doctor will talk to you about your artery problem and treatment options. Then you and your doctor can decide on a treatment plan that’s right for you. This plan may include: • Exercise. Regular exercise can lower high blood pressure and improve circulation. It can help with weight loss and can improve your sense of well-being. • Medication. Medications, such as blood thinners, may be used to treat certain artery problems. Medications can also control risk factors, such as high blood pressure. • Surgical procedures. When an artery problem is a serious threat to your health, a surgical procedure may be needed. This can help restore healthy blood flow. Carotid arteries  carry oxygen-rich blood to the brain. The abdominal aorta carries blood to the lower body. Peripheral arteries carry blood to the extremities, such as the legs and feet. A Healthy Artery An artery is a muscular tube. It has 3 layers. • A smooth inner lining allows blood to flow freely through the artery. • Two strong outer layers help the artery maintain its shape and strength. When Artery Problems Occur With every heartbeat, oxygen-rich blood is pumped from the heart to the rest of the body. In healthy arteries, blood flows freely to tissues and organs. But when arteries are damaged by plaque (cholesterol and other deposits), blood flow can be slowed or blocked. Artery walls may also weaken (forming an aneurysm). Plaque Buildup A buildup of plaque narrows and roughens the smooth inner lining of an artery. This slows blood flow and can cause blood clots to form. Tiny blood clots or pieces of plaque (called emboli) can sometimes break off and cause damage in other parts of the body. Aneurysm The wall of an artery (such as the abdominal aorta, iliac arteries, femoral arteries or popliteal arteries) may weaken. It can then stretch outward, expanding like a balloon. As it expands, the artery wall gets thinner and weakens even more. Eventually, the artery wall may become so thin or weak that it ruptures (bursts or tears open). Plaque or a blood clot can block the flow of blood through an artery. A weakened artery wall may balloon outward to form an aneurysm. Types of Artery Damage Arteries can be damaged in different ways. One of the most common types of damage is a buildup of plaque. Another is the formation of an aneurysm. • Plaque buildup inside the artery wall can cause the artery to stiffen and narrow. This restricts the flow of blood. Plaque buildup is often tied to risk factors such as smoking, high levels of cholesterol, and a lack of exercise. • An aneurysm is the ballooning outward of an artery wall. This happens in part of an artery where the artery wall has become weak and thin. Aneurysms are often tied to risk factors such as high blood pressure, smoking, and having a family history of aneurysms. Imaging Tests To help diagnose an artery problem, your doctor may suggest one or more imaging tests. These allow your doctor to view blood flow through the arteries. In some cases, contrast dye is used during the tests to make the arteries easier to see. • Doppler/Duplex ultrasound uses sound waves to detect blood flow and make images of an artery. • Arteriography is used to make arteries more visible on x-rays. • A CT scan (also called a CAT scan) uses a series of x-rays to make computer images of the arteries. • Magnetic resonance imaging (MRI) uses a strong magnet to form images of the body without x-rays. History and Physical Your doctor will ask you questions about your symptoms and any history of artery problems. Be sure to mention other health problems you may have. Also mention whether you’re taking any medications, including over-thecounter drugs such as aspirin. You will also have a physical exam. This helps your doctor learn more about your health and your arteries. Your Evaluation An evaluation helps your doctor diagnose an artery problem. This includes a medical history, physical exam, and imaging tests. You may also have other tests, such as blood tests. Based on the evaluation, your doctor will talk with you about your artery problem. You’ll then discuss the options you have for treatment. Diagnosis: Peripheral Artery Disease (PAD) With PAD, an artery in the lower body becomes narrowed. This can cause blood flow to the legs and feet to be reduced or even blocked. Without a supply of oxygen-rich blood, body tissues below the blockage can become damaged. In rare cases, tissues can even die (gangrene). Warning Signs Peripheral artery disease may not cause any symptoms at first. But as it gets worse, the arteries have a harder time carrying blood to muscles in the legs. A peripheral artery blockage can make walking painful. Walking even short distances may then become painful. The pain, called claudication, usually stops with rest. But pain in your legs shouldn’t be ignored. Pain caused by walking is often the first warning sign of PAD. Treatment for PAD Treatment for PAD depends on how narrowed the artery is. Treatment may include: • Lifestyle changes, especially quitting smoking, to improve your condition. • Exercise, which encourages blood to flow through other vessels (collaterals) around a blockage. This helps improve circulation and reduce pain. • Medication, such as aspirin, which can help reduce blood clotting. • A surgical procedure if blood flow is severely blocked. This can improve circulation in your legs and feet. Diagnosis: Carotid Artery Blockage A buildup of plaque in the carotid arteries can restrict blood flow to the brain. This buildup can also cause blood clots to form. Small pieces of blood clot or plaque (emboli) may break off and travel in the blood to the brain. Once in the brain, these emboli can block blood flow in smaller vessels. This may cause symptoms or even a stroke (death of brain cells). Treatment Options Treatment for a carotid artery problem depends on your symptoms and how narrow the artery has become. Treatment may include: • Lifestyle changes, especially quitting smoking, to improve your condition. • Medication, such as aspirin, which can help reduce blood clotting. • A surgical procedure, such as an endarterectomy, if you are at a high risk of a stroke. This will help remove plaque that is blocking the artery. Warning Signs When blood flow to part of the brain is reduced or blocked, a stroke can occur. In some cases, a “ministroke” (called a TIA or transient ischemic attack) can be a warning sign. A TIA can last from a few moments to a full day. TIAs often cause weakness in an arm or leg. They can also cause temporary blindness or slurring of speech. TIAs are very serious. If you have any symptoms of a TIA, don’t ignore them. Seek medical help right away. When to Seek Emergency Care Symptoms of a TIA and a stroke are the same. Get medical help right away if you have any of the following: • Weakness or numbness in an arm or leg • Sudden changes of vision or loss of vision in one eye • Slurring your words or difficulty speaking • Facial droop Diagnosis: Abdominal Aortic Aneurysm (AAA) The abdominal aorta is a large artery. It carries blood through your abdomen (stomach area) to the lower body. When part of this artery is weakened, it can stretch and balloon outward to form an aneurysm. If the artery wall is stretched too thin, the aorta may expand rapidly or even rupture. This can be life-threatening Treatment Options Treatment for AAA usually depends on the size of the aneurysm. Treatment may include: • Monitoring of a smaller aneurysm by your doctor. • Lifestyle changes, especially quitting smoking, to improve your condition. • Medications to control risk factors such as high blood pressure. • A surgical procedure for a larger aneurysm. This repairs the artery wall and prevents it from rupturing. Detecting an Aneurysm AAA usually doesn’t cause any symptoms. It’s often found when tests are done for an unrelated problem. Your doctor may also feel it in your abdomen during a routine exam. Once you are diagnosed with AAA, your doctor will perform tests to measure the size and growth of the aneurysm. A CT scan may be used to measure an aneurysm. The risk that a small aneurysm will burst is low. And some aneurysms may not grow, or may only grow slowly. When to Seek Emergency Care If you know you have an AAA, get medical help right away if you have these symptoms: • Pulsating or throbbing sensation in the abdomen • Intense pain in your back, stomach, or groin area • Pale skin • Rapid heartbeat and dry mouth • Dizziness or a feeling of being lightheaded Surgical Procedures If surgery is needed, the type of procedure you have will depend on your artery problem. In some cases, blood flow is rerouted around a blockage. In others, the artery is widened or repaired to improve circulation. Your doctor will talk to you about the procedure that’s right for you and its possible risks. Surgical Risks and Complications Possible risks of surgery may include: • Bleeding or blood clots • Infection • Heart attack or stroke • Need for a second surgery • Nerve damage and numbness Reaching the Artery There are two basic techniques for reaching the damaged area of an artery: • Open surgery involves one or more incisions through the skin. This exposes the artery so it can be operated on. Afterward, the artery and overlying tissues are closed so the incision can heal. • Minimally invasive surgery is a name for procedures that use only very small incisions. A catheter (long, flexible tube) is inserted through the skin into a blood vessel. It is then moved to the problem area so surgical instruments can be guided through the catheter. For artery problems, a minimally invasive technique called endovascular surgery is used. Angioplasty/Stents Angioplasty is a minimally invasive technique. A catheter with a tiny balloon on the tip is first guided to the artery blockage. The balloon is then inflated to widen the artery. In some cases, a stent (a wire mesh supportive tube) is used along with the balloon. After the balloon is removed, the stent is left in place to keep the artery open. Endarterectomy Endarterectomy is usually done using open surgery. This procedure clears plaque from a blocked artery, such as the carotid. After making an incision in the artery, the surgeon removes the plaque from the artery wall. During the procedure, blood flow is sometimes temporarily rerouted around the blockage using a shunt (small tube). The shunt is removed after the procedure is over. AAA Grafts A manmade graft is used to replace the weakened wall of the aorta. In open surgery, an incision is made to allow the doctor to place the graft. Then the aortic wall is wrapped back around the graft. In endovascular surgery, a catheter helps guide the graft to the weakened part of the artery. The graft is then secured in place. Bypass Surgery This procedure is done using open surgery. A bypass reroutes blood around a blockage using a graft (tube). The graft can be a blood vessel from your own body. Or it can be manmade. Once in place, the graft creates a new passage for blood flow. The blocked section of artery is usually not removed. Treating the Problem Several different procedures can be used. Talk with your doctor to learn more about your treatment. Before Surgery Follow the guidelines you are given to prepare for surgery. These include: • Telling your doctor about any medications you take, especially aspirin, blood thinners, or diabetes medications. Also mention if you take any supplements or herbal remedies. • Stopping smoking right away. Ask your doctor for help quitting. • Not eating or drinking anything after midnight the night before surgery. If your doctor tells you to take medication the morning of surgery, swallow it with only a few sips of water. Preventing Pain During Surgery You will be given an IV (intravenous line). You’ll then be given medication (anesthesia) to prevent discomfort. Types of anesthesia include: • Local to numb the surgical area. • Regional to numb certain areas of your body. • General to let you “sleep” during surgery. If you’re awake during surgery, tell the doctor if you’re uncomfortable or cold. Your Surgical Experience You’ll be told how to prepare for your procedure. Be sure to ask any questions you have. For most surgeries, you’ll spend at least one night in the hospital. Some procedures require a longer stay. After the surgery, follow your doctor’ s instructions for recovery. When to Call Your Doctor Call your doctor if you have any of the following: • Sudden bleeding at the incision • Increasing pain or swelling • An incision that is very red • Numbness or weakness in any part of your body • A fever over 100°F (37.7°C) • Chest pain or shortness of breath • Dizziness or lightheadedness • Symptoms of your artery problem that suddenly reappear After Surgery For the first few hours after surgery you’ll be in a recovery area or the intensive care unit. Your blood pressure, breathing, and other vital signs will be checked. You may also be given medication for any discomfort. Depending on the procedure, you may be moved to a regular room once you’re stable. Your doctor will talk with you about when you can go home. At Home Once you’re home, follow your doctor’s instructions for recovery. These may include: • Taking prescribed medications (take them exactly as directed). • Avoiding strenuous exercise. • Not showering until your doctor says it’s okay. • Following instructions about what kinds of food to eat. • Making follow-up appointments. Living a Healthier Lifestyle Whether or not you have surgery, you can make healthy lifestyle choices. Healthy choices help prevent artery problems from getting worse. They can also help you feel better and have more energy. Stop Smoking If you smoke, there’s no better choice you can make than to quit. Quitting smoking lowers high blood pressure and can help improve the health of your arteries. Here are some tips for quitting: • Make a list of reasons to quit. Read it every day. • Ask for advice from family members or friends who have quit smoking. • Talk with your doctor about quitting aids, such as medications, nicotine patches, or gum. • Join a quit-smoking support group. Exercise Daily Regular exercise is great for your arteries. It lowers high blood pressure and improves circulation. It can also help you lose weight. Talk with your doctor about an exercise program. You can also try the following: • Go for a swim or take aquatic aerobics classes. • Take a walk. • Ride a bike around your neighborhood. • Join a mall-walking club. Manage Health Problems Managing health problems is an important part of keeping your arteries healthy. Talk with your doctor about the best ways to manage conditions you may have, including: • High blood pressure • Diabetes • Heart disease • High cholesterol • Obesity Tips for Making Lifestyle Changes Making lifestyle changes may be easier than you think. The key is to think small. Make just one or two changes at a time. Then move on to the next. With time, making healthier lifestyle choices can become second nature. Eat Healthy Foods A low-fat, high-fiber diet can help keep plaque from building up in your arteries. Eating less sodium (salt) may help lower high blood pressure. Talk with your doctor about the best diet for you. The following tips may help: • Cook with herbs instead of salt.  You can also try salt substitutes. • Eat at least five servings of fresh fruit  and vegetables each day. • Choose foods that are baked, broiled, or steamed—not fried. • Eat whole-grain products, such as whole-wheat bread and brown rice. 11382 0501 Consultant: John R. Crew, MD, Vascular Surgery With contributions by: Mitzi A. Ekers, MS, ARNP, CVN David J. Friedman, MD, FACS, Vascular & General Surgery Cheryl Hubner, RN, MS, CCRN John Thomas Mehigan, MD, Vascular Surgery Rasesh M. Shah, MD, FACS, Vascular Surgery Harold J. Welch, MD, Vascular Surgery Resources To learn more about artery problems, talk with your doctor. Also try contacting the following groups for information: • American Heart Association 800-242-8721 www.americanheart.org • American Association for Vascular Surgery and the Society for Vascular Surgery www.vascularweb.org/publiceducation/patientinfo.cfm Looking Ahead An artery problem doesn’t have to keep you from enjoying the things you love. By working with your doctor and making some lifestyle changes, you can look ahead to a positive, healthy future. This booklet is not intended as a substitute for professional medical care. Only your doctor can diagnose and treat a medical problem. ©2003 The StayWell Company, 1100 Grundy Lane, San Bruno, CA 94066-3030. www.krames.com 800-333-3032. All rights reserved. Lithographed in Canada.