Newswise — Vice President Dick Cheney will have surgery this weekend to repair a bulging blood vessel behind one of his knees. It may sound like a minor operation, but it brings to the nation's attention an often-overlooked and sometimes life-threatening issue: the link between blood vessel problems and heart disease.
Cheney's heart problems, including a history of heart attacks and heart rhythm disturbances, are well known. But a University of Michigan blood vessel specialist says many Americans don't make the connection between their heart's health and the health of their arteries and veins.
And a lack of early diagnosis and treatment for problems with major blood vessels could cost them their limbs — or their lives.
"The same things that harm the heart, such as smoking, high cholesterol, obesity, high blood pressure, stress and genetic factors, harm the blood vessels throughout your body," says Peter Henke, M.D., a vascular surgeon and medical director of the Noninvasive Diagnostic Vascular Laboratory at the U-M Cardiovascular Center.
"Vice President Cheney is like millions of Americans who have lived with all of these risk factors for many years, and like many Americans, especially men, his blood vessels are showing signs of wear and tear. Fortunately, he was diagnosed and is being treated before something more serious happens," Henke adds.
Cheney's operation is for a condition called a popliteal aneurysm (POP-li-teel ANN-yur-ism), which is a bulging, weakened spot in the main artery that travels up the back of the leg. They're often diagnosed when a physical exam reveals a bulge in the leg or a patient complains of leg pain and tiredness. Cheney's spokespeople have said he has one of these aneurysms behind each knee; the operation this weekend will fix one of them.
Popliteal aneurysms can encourage the formation of blood clots that can block blood flow to the legs and can lead to amputation of a limb. Once a person begins having symptoms from their popliteal aneurysm, they have a 1 in 5 chance of losing a leg, and a 1 in 20 chance of dying, unless the problem is treated.
But even more seriously, the presence of popliteal aneurysms can mean that a person has a high risk of having other aneurysms elsewhere in their body, says Henke, an Associate Professor of Vascular Surgery who specializes in diagnosing and repairing aneurysms and other blood vessel problems in the legs, neck and trunk.
And those kinds of aneurysms carry even higher risks of death and disability. The biggest threat, Henke explains, are aneurysms in the aorta, the giant artery that brings blood out of the heart and branches off to feed the body.
Like popliteal aneurysms, aortic aneurysms are much more common among people who have smoked, and who have had high cholesterol and high blood pressure for years. Men, and people with a family history of aneurysms, have a much higher risk. Risk also rises with a person's age.
With every beat of the heart, the high pressure of blood rushing through the aorta presses on the blood vessel's muscular walls. "Hardened" artery walls, made stiff by cholesterol deposits and the effects of smoking and high blood pressure, can become weak in spots. At any of those spots, the force of the blood can cause an aneurysm to bulge out, and to grow over time. Or, it can cause the layers of the aorta wall to come apart, a condition called aortic dissection that killed actor John Ritter.
If an aneurysm anywhere in the aorta ruptures, death can come within minutes or hours as the body is starved of blood. Only about 20 percent of patients who have a rupture of an aortic aneurysm in their abdomen survive, making it the 13th leading cause of death in the United States.
Like leg aneurysms, aortic aneurysms often go undetected, and are usually picked up only in a thorough physical exam that includes a chest X-ray, says Henke. An estimated 10 percent of all men over the age of 70, and a smaller percentage of younger men and women, may have an aneurysm somewhere in their aorta that could grow and rupture. But most don't know it.
In many cases, aortic aneurysms can be treated before they rupture, with surgery that takes the strain off the bulging area by bypassing it with transplanted blood vessel tissue or lining it with a device called a stent graft. The U-M Section of Vascular Surgery has years of experience in both open-surgical and minimally invasive surgery to repair aortic aneurysms, and is currently offering patients the chance to take part in clinical trials of new options. U-M vascular surgeons also study the reasons why aneurysms form, and the factors that affect diagnosis, treatment and recovery.
But artery and vein problems throughout the body can include much more than aneurysms, Henke emphasizes. Just like the blood vessels around the heart can become clogged with cholesterol plaques and inflamed tissue, the blood vessels in the legs and the neck can become partially or totally blocked. And that can keep blood from getting to the limbs and brain.
When this occurs in the legs, Henke says, it's called PAD, for peripheral artery disease. It can make a person's legs hurt, cramp up or feel tired when they walk or even while they rest, because their leg muscles don't get enough oxygen due to the lack of blood flow.
Often, people think the symptoms of PAD are just a sign of "getting old" — but in fact they can be a danger sign for much more serious clogs in the blood vessels of the heart. People with PAD are three times more likely to die of heart attacks or strokes than people who don't have it.
When arteries in the neck, called the carotid arteries, become clogged, the danger is even greater, Henke says. Carotid occlusion, the technical name for this condition, can lead to dizziness, feeling faint, partial blindness, or numb feelings. If a carotid artery becomes fully blocked, or if a blood clot breaks off from the plaque and travels into the head, blood flow to part of the brain stops. And that causes a stroke that can kill or leave someone permanently disabled.
For more information: Popliteal aneurysms and other peripheral aneurysms (Society for Vascular Surgery) Visit http://www.vascularweb.org, search for "peripheral aneurysm"
U-M Cardiovascular Center heart and blood vessel information: http://www.med.umich.edu/cvc/learn
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