The carotid arteries are located in the neck on each side of the windpipe. They provide important blood flow to the head including the brain. Normally, these arteries have a smooth lining but in diseased vessels, owing to the formation of cholesterol plaque a narrowing develops. This results in deranged blood flow and dislodgement of plaque and other debris, a process called embolisation, that can travel to the brain causing a stroke or transient ischaemic attack (TIA).
A stroke occurs when blood flow to a part of the brain is restricted causing brain cells to die. This may be owing to pressure from bleeding (cerebral haemorrhage) or blockage of an artery in the brain (cerebral infarction). The latter can be caused by carotid artery disease from embolisation or severe restriction of blood flow to the brain.
Aortic aneurysms are dilatations (or swellings) of the aorta, which is the main artery from the heart supplying blood to the body. They most commonly occur in the abdomen although they can occur in the chest. . They do not cause symptoms usually until they rupture, which is often fatal. They are diagnosed by performing an abdominal ultrasound or CT scan. If there is an aortic aneurysm, then there is a possibility that other arteries can also have an aneurysm, most commonly involving the leg artery behind the knee.
The risk of rupture is directly related to the maximum diameter, and treatment is advised when the aneurysm reaches 5.5cm, as this is the size where the risk of rupture overtakes the risk of treatment. The natural history of aortic aneurysms is to slowly enlarge (about 3-5mm per year) although they can remain static for years. Once an aneurysm is diagnosed, then 6-monthly or annual scans should be performed to monitor expansion rate. This can be done in our vascular ultrasound lab.
This involves blockage of the arteries of the lower leg which may present in 2 different ways. Firstly the patient may experience pain in their calf muscle on walking. This condition is called intermittent claudication. The pain is typically relieved with rest. The walking distance is less when walking up a hill or an incline. The problem is a reduction in blood flow to the muscles due to a build up of plaque in the arteries of the leg, which could be causing a narrowing or a blockage. This condition is seldom related to critical blood flow problems and treatment is only required in a minority of circumstances such as significantly reduced exercise tolerance such that the patient’s lifestyle is severely threatened. It is unusual for the blockage to progress to the extent that the limb is threatened. Treatment always involves control of risk factors, which include stopping smoking, control of blood pressure and cholesterol, and regular exercise. Definitive treatment may involve either a balloon angioplasty or a bypass.
Less commonly the reduction in blood flow may be so severe that there is not enough blood getting to the leg. This may present with pain in the feet at night (rest pain), ulceration in legs or even gangrene. When this occurs, intervention to improve the blood supply is required and usually will involve a bypass but an angioplasty or stent can be performed.
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