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Undetected Aneurysms Threaten Life and Limb

Vice President Dick Cheney underwent surgery in October to repair aneurysms behind his knees. An aneurysm is a weakened blood vessel wall that balloons out from the pressure of blood pumping through it. The vice president has a long history of heart and circulation problems and receives very thorough health examinations. Unfortunately, aneurysms may go undetected in many older adults, leaving them at risk for serious complications.

Aneurysms can occur in any artery in the body. The most deadly type is an abdominal aortic aneurysm. The aorta carries blood away from the heart and through the body to the legs. An abdominal aneurysm becomes life threatening when it becomes large, since the risk of bursting is increased. Aneurysms that affect arteries other than the abdominal aorta – in the legs, arms or neck, for example – are called peripheral aneurysms. The most common type of peripheral aneurysm is the type Vice President Cheney had in the popliteal artery, which is located behind the knee. Popliteal aneurysms are not considered life threatening, but nonetheless are very important to treat, because they can threaten healthy limbs.

“Clot formation occurs in all aneurysms, and if popliteal aneurysms remain untreated, the clot can block off circulation to the leg, which in the worst case scenario may require amputation,” said Peter Kalman, MD, professor of surgery and radiology, and chief of vascular surgery at Loyola University Health System. “Also, people who have popliteal aneurysms are more likely to have an abdominal aortic aneurysm, or vice versa, so early detection of each type is important.”

In most cases, people with aneurysms feel no symptoms at all. Sensations that may indicate an abdominal aneurysm or a popliteal aneurysm include a pulsating lump in the abdomen or behind the knee. With a popliteal aneurysm, leg cramping with exercise, foot or toe pain during rest, or the development of painful sores at the tips of one or more toes, are potential symptoms.

“To detect an abdominal or popliteal aneurysm, the primary care physician should check for a prominent pulse in the abdomen or behind the knee,” said Dr. Kalman. An ultrasound test can confirm the diagnosis. It has been recommended that males over age 65 – particularly if they have a history of smoking –should undergo an ultrasound screening test even if a prominent pulse is not
detected by examination of the abdomen or legs.

Small aneurysms can be safely monitored with ultrasound measurements over time. When they reach a critical size or if symptoms develop, repair is indicated. “The gold standard for abdominal aortic and popliteal aneurysm repair is surgical,” said Dr. Kalman. For abdominal aneurysms, the ballooned segment is replaced with a synthetic graft. For popliteal aneurysms, the artery is tied off above and below the aneurysm and this segment is bypassed with a length of vein taken from the patient’s leg.

For some patients, such as those who are more frail, less mobile or at higher risk for surgery, Dr. Kalman may prefer a minimally invasive endovascular approach, in which he feeds a catheter into the patient’s artery and positions a stent graft (a little tube) within the aneurysm that can support the weakened artery walls from inside. All of the vascular surgeons at LUHS offer both types of treatments, and the selection is based on the individual patient’s needs.

Some aneurysms are caused by infection, injury or defect in the artery wall. Most often the cause is not known, but scientists believe that the risk factors for hardening of the arteries (atherosclerosis) may also be associated with aneurysms. Smoking, high blood pressure, high cholesterol, obesity, and family history of heart or vascular disease may all increase your risk of aneurysms. The risk also increases with age; most people diagnosed with aneurysms are over age 60.

To make an appointment with a peripheral vascular surgeon at Loyola, call (708) 216-8563.