Definition

A peripheral vascular aneurysm is an abnormal dilation (aneurysm) of blood vessels occurring in vessels other than the aorta. Aneurysms most commonly occur in the aorta, the largest and main blood vessel that carries blood from the heart to the rest of the body. However, aneurysms can also develop in other arteries, such as those in the thigh, behind the knee, the coronary arteries of the heart, the carotid arteries in the neck, and brain arteries.

Peripheral vascular aneurysms are very rare, found in only about 0.07% of the population. They are most often seen in men. The most commonly affected artery is the popliteal artery located behind the knee.

Causes

This abnormal dilation is caused by the weakening of the arterial wall. The pressure of blood flowing through blood vessels with thin walls can cause them to widen. The weakening of the artery wall can be caused by:

1. Genetic predisposition (congenital)
Some people are genetically predisposed to aneurysms.

2. Atherosclerosis
Atherosclerosis is the buildup of fatty plaques in the artery walls, triggered by prolonged high cholesterol levels or damage caused by smoking, alcohol, or high blood sugar. This buildup can weaken the artery wall and cause inflammation. Prolonged inflammation affects the strength of the arterial wall.

3. Vascular Injury
Injuries to blood vessels, such as from accidents, puncture wounds, or gunshot wounds, can lead to aneurysm development.

4. Infection of the Vessel Wall
Bacterial or fungal infections of the blood vessel wall can cause aneurysms. Such infections may result from severe sepsis or the use of intravenous drugs like heroin. The infection usually begins in other organs, such as the heart valves, and spreads to other parts of the body.

Risk Factor

Most cases of peripheral vascular aneurysms are caused by genetic disorders that run in families. A family history of aneurysms increases the likelihood of other family members developing the condition.

In addition to genetic factors, other risks include:

• Smoking
• Uncontrolled high blood pressure
• High cholesterol
• Obesity
• Age 60-70
• Male gender

People with peripheral vascular aneurysms are at higher risk of developing aneurysms in other vessels and should undergo further evaluation.

Symptoms

Peripheral vascular aneurysms don’t always produce symptoms. Only one in three patients with these aneurysms is aware of specific symptoms. They are often discovered incidentally during medical checkups or while being evaluated for other conditions.

When symptoms do occur, they depend on the location of the affected artery. Common signs include a pulsating lump in areas like the neck, limbs, arms, or groin. Other symptoms may include weakness, numbness, pain, or organ dysfunction related to the affected blood vessels. For example, an aneurysm in the carotid artery, which supplies blood to the brain and face, can lead to vision disturbances, speech difficulties, facial weakness, or balance problems.

Diagnosis

To diagnose a peripheral vascular aneurysm, your doctor will begin with a physical examination and ask about your symptoms, when they started, other accompanying symptoms, your general health, and family history of aneurysms. If you report a pulsating lump, your doctor will check if it's an aneurysm.

Diagnostic tests may include:

• CT Scan: A radiological examination to see detailed and 3-dimensional images of body organs. This examination can help doctors find the location and size of the aneurysm to estimate the risk of rupture of the aneurysm.
• Angiogram: A radiological exam using contrast dye to view blood vessels in detail.
• Ultrasound: A non-invasive test using sound waves to visualize the structure of blood vessels. This procedure is safe and requires no preparation.

Management

Once an aneurysm forms, it won’t go away or shrink with medication. Lifestyle changes and controlling risk factors can help prevent the aneurysm from worsening, but they won’t reverse the dilation.

Treatment depends on the aneurysm's location and size, the surrounding tissues, symptoms, and overall health. Generally, only aneurysms larger than 2 cm, located in the upper limbs, and causing symptoms require treatment. Consult your doctor for further guidance.

Treatment options include:

• For small aneurysms, your doctor will recommend regular follow-ups to monitor the aneurysm's condition as well as lifestyle changes like quitting smoking and controlling blood pressure.
• Your doctor might suggest the following treatments for larger aneurysms that are symptomatic or at risk of rupturing:
• Open surgical repair involves removing the enlarged blood vessel and using a graft to replace it.
• Endovascular repair involves inserting a stent—a device—into the blood vessel using a catheter. The stent's function is to preserve your blood vessel's structure so that blood flow is unhindered.

Complications

Although all aneurysms carry a risk of rupture, peripheral vascular aneurysms are less likely to rupture. Only about < 5% of cases in the legs (popliteal artery) and 1-14% of aneurysms in the hips and thighs experience rupture. However, surgery may cause complications, such as blood clots that could block blood flow.

Prevention

Aneurysms can’t always be prevented, but you can lower your risk with the following steps:

• Don't smoke, or stop smoking immediately. Quitting smoking can reduce your risk of having an aneurysm. Talk with your doctor about quitting smoking.
• Manage your blood pressure. Uncontrolled high blood pressure can cause an aneurysm. If you have high blood pressure, your doctor will prescribe medications to help you control it. Even if you are not experiencing any other symptoms, you must take these medications on a daily basis.
• Eat a healthy, balanced diet, limit salt intake, and consume fruits and vegetables.
• Limit your alcohol and caffeine intake.
• Maintain the ideal body weight. If you are overweight, losing even a small amount of weight can have a significant impact on your overall health.
• Regular screening if you have a family history of Marfan syndrome or other genetic conditions.

When to See a Doctor?

If you have any of the above symptoms or a family history of aneurysms, you should see a doctor for regular check-ups to monitor your health.

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