American Medical Association Family Medical Guide - American Medical Association [355]
Treatment
The usual treatment for an aneurysm is surgery to repair or replace the affected portion of the artery with a tiny plastic tube. In people who do not have other health problems, most elective surgical procedures performed on aneurysms in either the thoracic (chest) or abdominal aortas are successful.
If an aneurysm in the thoracic aorta can be treated with surgery, chances of recovery are very good. If the aneurysm cannot be treated surgically, chances of survival are poor. In general, small aneurysms in the abdominal aorta are not life-threatening and usually do not require immediate treatment. Aneurysms in the abdominal aorta are removed surgically only if they are large or are expanding. Before recommending surgery, a doctor will usually monitor the aneurysm with ultrasound or CT scanning to determine how rapidly it is expanding. If a person is in generally good health, elective surgery on a large or rapidly expanding aneurysm carries far less risk than emergency surgery performed after the aneurysm has ruptured.
In a procedure called stent grafting, the doctor inserts a thin, flexible wire into an artery in the groin area and, observing the aorta on a video monitor, threads the wire to the aortic aneurysm. He or she then guides a tiny tube called a stent along the wire to the aneurysm. Once the stent is inside the aneurysm, the doctor expands it until it bridges the area of the aneurysm. By providing a sturdy new channel for blood flow, the stent relieves pressure on the weakened artery walls.
Arterial Embolism
An embolus is usually a fragment of clotted blood or a piece of a fatty deposit (plaque) that is carried along in the bloodstream. The embolus may be very small, but, because the arteries branch into smaller and smaller blood vessels as they deliver blood to the tissues, the embolus will eventually get stuck and create a blockage (called an embolism) that prevents blood from reaching the tissues beyond the blockage. An embolus may develop in the heart after a heart attack (see page 567) or from another heart disorder. It may be a fragment of bacterial growth resulting from bacterial endocarditis (see page 593). In rare cases, an embolus may be a tiny foreign object that entered an artery through a wound, or a gas bubble that formed in the tissues.
The severity of an arterial embolism depends on its size and location. Some organs, such as the brain, kidneys, and heart, are extremely sensitive to sudden decreases in blood supply. Other organs have multiple sources of blood and may not be affected significantly by an embolism. Although arterial embolisms most often affect the brain and legs, they can occur anywhere in the body.
Symptoms
A small embolism usually goes unnoticed unless it blocks the blood supply to a large area or to a very sensitive organ such as the heart or brain. An embolism in the intestine may cause loss of function in the affected part of the intestine and may produce symptoms of an intestinal obstruction (see page 759). To learn about the symptoms of a cerebral embolism, read the articles on stroke (see page 669) and transient ischemic attacks (see page 675). To learn about the symptoms of an embolism that affects the heart muscle, read the article on heart attack. In other parts of the body, especially the arms and legs, pain may be the earliest symptom, followed by a tingling or prickling sensation. The affected area eventually becomes numb, weak, and cold. If the embolism is in an arm or leg, the skin appears pale at first but later appears blue as sluggish blood flow depletes oxygen and leaves behind bluish, oxygen-poor hemoglobin. Both legs can be affected if a large embolus blocks the aorta (the main artery in the body) where it divides in two. This type of embolism (called a saddle embolism) can cause severe pain in the abdomen, back, and legs.
If a major artery is blocked, the tissues it supplies with oxygen and nutrients