Peripheral aneurysms

PERIPHERAL ARTERY ANEURYSMS

Peripheral aneurysms

Peripheral aneurysms develop in arteries other than the aorta (the largest artery in your body). Peripheral aneurysms most commonly develop in the popliteal artery, which runs down the lower part of your thigh and knee. Though not as common, peripheral aneurysms can also develop in the:

  • Femoral artery (located in the groin)
  • Carotid artery (located in the neck)
  • Arteries in the arms
  • Arteries supplying blood to the kidneys or bowel (a visceral aneurysm)

Symptoms and Signs

The patient may be aware of a pulsatile mass when the aneu­rysm is in the groin, but popliteal aneurysms are often unde­tected by the patient and clinician. Rarely, peripheral aneurysms may produce symptoms by compressing the local vein or nerve. T

The first symptom may be due to ischemia of acute arterial occlusion. The symptoms range from sudden onset pain and paralysis to short-distance claudication that slowly lessens as collateral circulation develops. Symptoms from recurrent embolization to the leg are often transient, if they occur at all.

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Sudden ischemia may appear in a toe or part of the foot, followed by slow resolution, and the true diagnosis may be elusive. The onset of recurrent episodes of pain in the foot, particularly if accompanied by cyanosis, suggests embolization and requires investigation of the heart and proximal arterial tree.

Because popliteal pulses are somewhat difficult to pal­pate even in normal individuals, a particularly prominent or easily felt pulse is suggestive of aneurysm and should be investigated by ultrasound. Since popliteal aneurysms are bilateral in 60% of cases, the diagnosis of thrombosis of a popliteal aneurysm is often aided by the palpation of a pulsatile aneurysm in the contralateral popliteal space. Approximately 50% of patients with popliteal aneurysms have an aneurysmal abdominal aorta.

Diagnosis

Duplex color ultrasound is the most efficient investigation to confirm the diagnosis of peripheral aneurysm, measure its size and configuration, and demonstrate mural throm­bus. MRA or CTA are required to define the aneurysm and local arterial anatomy for reconstruction. Arteriography is not recommended because mural thrombus reduces the apparent diameter of the lumen on angiography. Patients with popliteal aneurysms should undergo abdominal ultra­sonography to determine whether an abdominal aortic aneurysm is also present.

Treatment

To prevent limb loss from thrombosis or embolization, surgery is indicated when an aneurysm is associated with any peripheral embolization, is larger than 2 cm, or a mural thrombus is present. Immediate or urgent surgery is indi­cated when acute embolization or thrombosis has caused acute ischemia. Bypass is generally performed. Endovascu­lar exclusion of the aneurysm can be done but is reserved for high-risk patients. Intra-arterial thrombolysis may be done in the setting of acute ischemia, if examination (light touch) remains intact, suggesting that immediate surgery is not imperative. Acute pseudoaneurysms of the femoral artery due to arterial punctures can be successfully treated using ultrasound-guided compression. Open surgery with prosthetic interposition grafting is preferred for primary aneurysms of the femoral artery.

Peripheral aneurysm complications

While the risk of a rupture (when the aneurysm bursts) is low with peripheral aneurysms, they can lead to blood clots. Blood clots block blood flow or shower downstream.

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If a clot blocks blood flow for an extended time, this can lead to tissue or organ loss.

Peripheral aneurysms may also put pressure on surrounding nerves or veins. This can cause pain, numbness, or swelling.

Reference

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