MEDICAL TREATMENT

In some individuals, despite measures taken to reduce the risk of rupture of an abdominal aortic aneurysm, a heart or brain attack, these events may still occur. Some drugs can be used to treat these events, alleviate symptoms and contributing risk factors:

Antihypertensive drugs are used not only to control and stabilize high blood pressure but also to treat small chronic aneurysms by reducing the pressure on the weak area of the vessels.

Anticoagulant medicines, “blood thinners,” can prevent blood clots from forming and keep blood clots that are present from getting larger.

Antiplatelet medications, such as aspirin, are used to prevent platelets from forming clots.

Antilipid medications help to reduce plaque formation by lowering fat and cholesterol levels in your blood. However, dietary modification and exercise is the treatment of choice before this medication is prescribed.

SURGICAL AND ENDOVASCULAR TREATMENT
When there is a significant abdominal aortic aneurysm the person is at risk for rupture of the aneurysm. When there is a significant build up of plaque in the coronary or carotid arteries, a heart or brain attack can ensue. The following methods are available for treatment:

ABDOMINAL AORTIC ANEURYSM

Repair of an acute or large aneurysm requires surgical resection of the aneurysm with the involved segment of the aorta replaced with a bypass graft composed of a synthetic prosthesis.

An alternative to surgical repair of an abdominal aortic aneurysm is endovascular repair. Although still an investigational procedure, endovascular repairs have the potential of greatly reducing the complications of open aneurysm surgeries and provide benefits in both patient safety and costs. In this procedure, a small incision is performed over the groin area. An inverted Y-shaped graft is delivered inside the aneurysm. It is fixed to the aortic wall when deployed, re-channeling the blood and excluding the aneurysm.

CAROTID AND BRAIN ARTERIES - BRAIN ATTACK

Carotid endarterectomy is a surgical procedure used to prevent strokes that involves opening the artery and gently removing plaque that is restricting blood flow. The outer wall is left intact and closed, returning the blood flow in the carotid artery to normal. Most patients leave the hospital in 24-48 hours. When plaque buildup in the carotid artery is severe and the risk of a stroke is significant, carotid endarterectomy is the recommended treatment.

An alternative to carotid endarterectomy is carotid transluminal balloon angioplasty. Carotid angioplasty is an investigational procedure, presently being used at USC University Hospital, for individuals who are considered to be poor surgical candidates. In this procedure, a plastic tube, or catheter, with a balloon tip is advanced over a guidewire to the site of arterial narrowing. The balloon is inflated thereby pressing the plaque against the vessel wall to widen the flow channel. A metallic stent is then left in place afterwards to keep the artery open.

Thrombolytic therapy is a method, which can restore normal blood flow in a completely clogged brain artery. The blood clot is dissolved by advancing a tiny tube, or catheter, through the artery to the site of obstruction. Through this catheter, a “clot busting” medicine (thrombolytic agent) is directly applied to the clot to dissolve it. Once the blockage is relieved and normal blood flow is restored, the symptoms of a stroke may reverse and a brain attack can be avoided. However, in order for this form of therapy to be effective, it needs to be instituted within 6 hours of the onset of symptoms. Also, stroke victims can be helped by the intravenous infusion of tissue plasminogen activator (tPA), another “clot buster,” which must be administered within the first 3 hours of the onset of symptoms.

CORONARY ARTERIES - HEART ATTACK

Thrombolytic therapy, including the intravenous infusion of tissue plasminogen activator, is also available for the coronary arteries. Again, for these forms of treatment to be effective they must be instituted within the initial hours of the onset of symptoms.

Transluminal balloon angioplasty can also be performed on the coronary arteries to relieve coronary artery blockages. This procedure is common when 1 or 2 coronary arteries are obstructed.

When more severe or multiple coronary arteries are diseased, bypass grafts are used to create a detour around the diseased arteries to improve the blood flow to the heart muscle, thereby preventing a heart attack. Bypass grafts are usually constructed from a vein or artery in your body.

HYPERTENSION – RENAL ARTERY DISEASE

High blood pressure may be due to significant obstruction in the renal arteries from plaque formation. The surgical options are many and include most of those already described above, mainly:

• Endarterectomy,
• Transluminal balloon angioplasty with metallic stenting,
• Thrombolytic therapy, and
• Bypass graft placement

SET YOUR APPOINTMENT

To arrange for an appointment to evaluate your potential your risk of an abdominal aortic aneurysm, a heart and/or brain attack, please call 1-800-USC-CARE and ask for Vascular Screening Program at USC University Hospital