Nebraska Heart Institute

Vascular Disease

After the blood leaves the heart, it travels through arteries to transport oxygen-rich blood to the body. If the arteries become diseased, they may not be able to carry enough blood flow. Symptoms of vascular disease are dependent upon which artery is diseased.

Carotid artery disease
The carotid arteries (left and right) carry oxygen rich blood to the brain. When one or both carotid arteries becomes narrowed by a fatty substance called "plaque," the blood flow to the brain is decreased. Blood clots may also form on the diseased artery wall. If tiny blood clots or bits of plaque break off (emboli), they travel to the brain. This can cause a stroke or "mini-stroke" (TIA or transient ischemic attack).

If the emboli is small, it may only briefly interrupt blood flow to a part of the brain.

Symptoms of a stroke or "mini-stroke" (TIA)
Seek medical help immediately if any of these symptoms occur, even if they last for only a moment:

numbness or weakness in arms or legs
sudden changes in vision of loss of vision in one eye
slurring of words
a facial droop

Surgical treatment of carotid artery disease
After a diagnosis confirms the presence of carotid artery disease, the surgeon will determine the best course of treatment. If treatment is needed, a stent may be placed in the carotid artery to increase its lumen, or surgery may be done to remove the plaque and smooth out the inside of the carotid artery. For both of these procedures, the patient remains awake, unless other circumstances arise which would require a general anesthesia.

Recovery and lifestyle changes
After surgery, there is some discomfort at the incision site. There may also be bruising and slight swelling. Ice and medication help ease the discomfort. Before dismissal, instructions are given regarding medications, wound care, and lifestyle changes (smoking cessation, healthy diet, exercise, and controlling blood pressure).

Abdominal aortic aneurysm (AAA)
The aorta is the large artery that carries blood from the heart. The area of the aorta that travels through the abdomen is called the abdominal aorta. Branches of the abdominal aorta supply blood to the abdominal organs (kidney, intestines, etc) and to the legs.

When the wall of the abdominal aorta is weakened or damaged, it may stretch outward. As it expands, its walls become thinner. High blood pressure may cause further strain on the artery wall. This bulging in the abdominal aorta is called an aneurysm. As it grows in size, it is more apt to leak or rupture. This is life threatening if not treated immediately.

Symptoms of abdominal aortic aneurysm (AAA)
An AAA is often a "silent problem" because it may produce no symptoms at all. It is often found during a routine exam or during tests for an unrelated problem. Risk factors for developing an AAA include:

having a close relative who has had an AAA
smoking
high blood pressure
being over age 55 for men, and over 65 for women

Symptoms of AAA rupture include: (call 911)

severe back pain
abdominal tenderness
lightheadedness, dizziness

Treatment
If the aneurysm is small, the physician may monitor it yearly to track its growth. During this time, factors which could reduce the risk of AAA rupture should be controlled. Smoking cessation and blood pressure control are important.

If the aneurysm is large, or growing quickly, surgical repair is advised. Two methods of repair are available. Which type is best depends on many factors.

Endovascular repair: Small incisions are made in the groin area. The artificial graft, which is placed inside the damaged aorta, is guided in to place using x-rays. The hospital stay is overnight.
Open AAA repair: An incision is made in the abdomen. The graft is sewn to the aorta above and below the aneurysm. Open surgery involves a longer and more involved recovery period.

Recovery and lifestyle changes
After surgery, there is some discomfort at the incision site. Medications help ease the discomfort. Getting up and walking will speed recovery. Before dismissal, instructions are given regarding medications, wound care, and lifestyle changes (smoking cessation, healthy diet, exercise, and controlling blood pressure).

Peripheral artery disease (PAD)
The peripheral arteries carry oxygen-rich blood to the legs, feet, and toes. Over time, the walls of these arteries may thicken with a fat-like substance called plaque. As plaque builds up, the arteries become narrow. The diseased artery can become totally blocked by the plaque or by a blood clot which can lodge in the narrowed area.

Factors which contribute to PAD:

smoking
high blood pressure
high cholesterol
diabetes
heredity

Symptoms of PAD
Symptoms usually occur in one leg first, but often disease is present in both legs.

muscle cramping, fatigue, or discomfort after a short walk. This pain, called claudication, goes away with rest. Pain which occurs even during rest is called "rest pain."

Treatment of PAD
After a diagnosis is made, surgical treatment may be necessary to relieve symptoms and restore health. The surgical treatment involves the use of a bypass graft to detour blood around a blockage. There are two types of grafts:

Vein Graft
The vein graft is usually taken from the same leg where the bypass will be done. This graft is removed and prepared, then sewn to the diseased artery above and below the blocked area.
Synthetic Graft
This is a manmade graft which is sewn to the diseased artery above and below the blocked area. This type of graft works best on arteries at or above the knee.

Recovery and lifestyle changes
After surgery, there is some discomfort at the incision sites. Medications help ease the discomfort. The affected leg may swell. Getting up and walking will speed recovery. Before dismissal, instructions are given regarding medications, wound care, and lifestyle changes (smoking cessation, healthy diet, exercise, and controlling blood pressure).

If you have any question about Coronary Artery Bypass Surgery, contact the Nebraska Heart Hospital at (800) NHI DOCS or send us an info@neheart.com.