Peripheral artery aneurysm is a weak area in the wall of the artery which expands the artery to more than 50% of its original diameter. It is an irreversible dilatation. The commonest site is the Aorta but they may present in the peripheral arteries.
How do they present?
One third of the cases go totally unnoticed as they are asymptomatic.
Symptoms depend on the size and the location:
Pulsatile lump that you can feel
There may be pain in the limb with cramps on exercise – claudication (picture 2)
The pain persists during rest and there may be blueness of toes.
There may be painful sores or ulcers involving the toes or fingers. (picture 3)
Radiating pain or numbness in arm caused by nerve compression
Gangrene due to blockage of the vessel needing urgent attention.
In carotids aneurysms TIA or stroke can take place
In case of bowel arteries involvement abdominal pain occurs
Most symptoms are due to blockage of the aneurysm
What are the types of aneurysms?
They could be true or false. The former is due to weakness of the arterial wall while the latter is due to injury.
What causes peripheral aneurysms?
Mostly the cause is not known
Infection or injury
Smoking weakens the wall of the arteries
High blood pressure increases the risk
Family history of heart disease
Increasing age (60 – 70 years)
How is it diagnosed?
A good history and examination is mostly diagnostic
Colour Doppler study confirms the diagnosis (Picture 4)
CT Angiogram tells us about the circulation of the lower leg. (Picture 5)
Conventional Angiography is needed in centres where CT is not available.
MR Angiogram is needed where the patient is in renal failure and cannot be given contrast.
What are the problems of leaving it alone?
Embolisation (Blue toes) (Picture 6)
Nerve compression (numbness)
Vein compression (distal swelling)
Who are the people more prone to peripheral artery aneurysms?
Chronic obstructive airway disease
Coronary artery disease
Aortic Abdominal aneurysms
How are they treated?
This depends upon the following factors:
Location of the aneurysm
Size of the aneurysm
Symptoms they are causing
Blockage of the artery due to blood clots.
What are the various treatment options?
A. Open surgery
Primary aneurysm repair
Ligation of the aneurysm
B. Endovascular surgery – (picture 7)
Stenting across the aneurysm
Coils within the aneurysm
Blockage of the inflow and outflow with coils
What are false aneurys and how are they treated?
These occur due to injury to the artery. The commonest cause is puncturing of the artery (femoral or radial) during angiograms and angioplasty. They have the same presentation as that of a true aneurysm given above. They are treated by ultrasound guided compression or endovascular stenting or open surgery where primary repair is done but sometimes a bypass may be needed.