Overview Symptoms Causes Diagnosis Treatment

Peripheral artery aneurysm

What are peripheral aneurysms?

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.

Swelling in Wrist
Picture 1 – aneurysm at the wrist

 

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

 

Calf Pain
Picture 2 – calf pain on walking
arterial ulcer
Picture -3 foot ulcer

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.

 

aneurysm
Picture 4 – ultrasound showing aneurysm
angiography - Ultrasound
Picture 5 – angiography

What are the problems of leaving it alone?

These include:

  • Rupture
  • Embolisation (Blue toes) (Picture 6)
  • Nerve compression (numbness)
  • Vein compression (distal swelling)
blue toes
Picture 6 – blue toes

Who are the people more prone to peripheral artery aneurysms?

      • Hypertensives
      • 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
  • Bypass surgery
  • 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
peripheral aneurysms
Picture 7 – endovascular options for peripheral aneurysms

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.