Atherosclerosis (Hardening of the Arteries)

Atherosclerosis

Atherosclerosis, sometimes referred to as hardening of the arteries, is a gradual process in which cholesterol and scar tissue accumulate to form a fatty deposit or plaque that clogs the blood vessels. Atherosclerosis results in diminished blood flow to an affected organ.

If you smoke or have diabetes, you have an especially high risk for atherosclerosis and developing peripheral arterial disease (PAD). Other risk factors include high blood pressure and elevated cholesterol. Atherosclerosis is a systemic problem that can affect multiple organs and manifest itself in a variety of ways.

Symptoms depend on which arteries are involved. For instance, if the arteries to the legs are involved, patients experience leg cramps and calf pain while walking (intermittent claudication). If the arteries in the neck develop blockages, patients are at risk of stroke. If the arteries to the kidneys are involved, patients can develop uncontrolled hypertension and kidney insufficiency. If the narrowing occurs in the arteries that feed the intestines, patients develop severe abdominal pain after eating.

Treatment for Atherosclerosis

Specific treatment for atherosclerosis will be determined by your doctor based on a number of factors. These include age, overall health and medical history, the extent and location of the problem area and your signs and symptoms. Treatment may include:

• Modification of risk factors: Risk factors that may be modified include smoking, elevated cholesterol levels, elevated blood glucose levels, lack of exercise, poor dietary habits and elevated blood pressure
• Medications, such as:
  • Antiplatelet drugs (which decrease the ability of platelets in the blood to stick together and cause clots)
  • Anticoagulants (often described as “blood thinners”)
  • Antihyperlipidemics that lower lipids (fats) in the blood, particularly low density lipid (LDL) cholesterol. This class of medication includes statins, bile acid sequestrants and nicotinic acid (niacin).
  • Antihypertensives, or medications used to lower blood pressure

• Coronary angioplasty: With this procedure, a balloon is used to create a bigger opening in the vessel to increase blood flow. Treatments in this category might include: balloon angioplasty, atherectomy, laser angioplasty, or coronary artery stent.
• Coronary artery bypass: Most commonly referred to as simply “bypass surgery,” this surgery is often performed in people who have angina (chest pain) due to coronary artery disease where plaque has built up in the arteries. Surgery is sometimes necessary either due to the location of the blockage or in cases where less invasive approaches either have not or would not be able to adequately addressed the problem. During the surgery, a bypass is created by grafting a piece of a vein above and below the blocked area of a coronary artery, enabling blood to flow around the obstruction. Veins are usually taken from the leg, but arteries from the chest or arm may also be used to create a bypass graft.

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Atherosclerosis (Arteriosclerosis) | UPMC

Atherosclerosis — commonly known as hardening of the arteries — is an accumulation of plaque deposits in the lining of the arteries — the blood vessels that carry oxygen-rich blood to your heart and other parts of your body. It affects nearly 4.6 million Americans.

As a recognized leader in cardiovascular care, the UPMC Heart and Vascular Institute offers innovative treatment techniques for atherosclerosis and other heart and blood vessel conditions.

Contact the UPMC Heart and Vascular Institute

To request an appointment, contact the UPMC Heart and Vascular Institute:

• Call: 1-855-876-2484
• Email: [email protected]

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  Overview
  
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  Symptoms & Diagnosis
  
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  Treatment
  
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  Education Material
  

What Is Atherosclerosis?

Atherosclerosis, also referred to as arteriosclerosis, causes a hardening of the arteries due to plaque build-up.

Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood.

As plaque builds up, it causes the arteries to narrow and harden, slowing — and even stopping — blood flow.

Arteriosclerosis is a serious condition that can lead to:

• Heart attack
• Stroke
• Death

Atherosclerosis risk factors

At the UPMC Heart and Vascular Institute, we can screen people for atherosclerosis risk factors and provide treatments to minimize the risks.

Common risk factors for atherosclerosis include:

• A family history of cardiovascular disease
• High blood pressure
• Diabetes
• Obesity
• Smoking

Why choose the UPMC Heart and Vascular Institute for atherosclerosis care?

The UPMC Heart and Vascular Institute offers standard and minimally invasive approaches to treat:

• Atherosclerosis
• Coronary artery disease
• Heart failure
• Other heart diseases and defects 

Learn More at UPMC Health Beat

Follow the beat for a healthier life. Check out this post from UPMC Health Beat:

• What Is Atherosclerosis, or Hardening of the Arteries?

Learn More About Atherosclerosis Risks

From our Health Library at UPMC.com

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Atherosclerosis Symptoms and Diagnosis

Atherosclerosis is a cardiovascular (heart) disease with no visible symptoms, and it often remains undetected until the arteries leading to a vital organ are blocked.

Atherosclerosis symptoms

When a blockage occurs, symptoms vary — depending on the location of affected arteries — and may include:

• Chest pain (angina)
• Heart attack
• Stroke symptoms, such as weakness or dizziness
• Leg, arm, or pelvic pain (peripheral arterial disease)

Diagnosing atherosclerosis

If you have atherosclerosis symptoms, your doctor at the UPMC Heart and Vascular Institute will ask you questions during your physical exam to help determine what arteries might be affected.

Following your exam, you may need to have additional tests to help confirm a diagnosis of atherosclerosis, such as:

• Blood tests
• CT scans
• An electrocardiogram
• An echocardiogram
• Angiography
• Ultrasound

Testing results

Your doctor or nurse will tell you when to expect your test results and will call you when they’re available.

Learn More About Atherosclerosis Symptoms and Testing

From our Health Library at UPMC.com

• Aortic Aneurysm

Atherosclerosis Treatment

Medications, lifestyle changes, and surgery may be helpful in treating atherosclerosis.

The UPMC Heart and Vascular Institute’s multidisciplinary team of cardiologists, radiologists, surgeons, rehabilitation specialists, physical therapists, and nutritionists provides a full range of advanced atherosclerosis treatments.

Treatments focus on:

• Reducing strain on the heart
• Increasing blood flow to affected organs

Atherosclerosis treatment options

Medicines

• Prevent blood clots (aspirin or clopidogrel)
• Control blood pressure
• Lower cholesterol
• Improve blood through narrowed arteries (cliostazol, pentoxifyline)

Lifestyle changes

• Quitting smoking
• Reducing fat and cholesterol intake
• Exercise
• Losing weight
• Eating a healthy diet

Catheter-based procedures

• A balloon angioplasty to widen narrowed arteries to increase blood flow
• Stenting — repair of a damaged artery by inserting a wire mesh tube to keep it open and support the arterial walls
• Coronary artery bypass graft to create an alternate route for blood 

Learn More About Atherosclerosis Treatment

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• Aortic Aneurysm

Atherosclerosis Educational Materials

The UPMC Heart and Vascular Institute offers educational information and videos about atherosclerosis and other heart and vascular diseases and treatments.

Many people find these resources helpful in answering their questions about their condition and preparing them for their procedure or diagnostic test.

The links below will open a new browser window.

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Retroperitoneal tumors – symptoms and signs.

Have you been diagnosed with a retroperitoneal tumor?

Surely you are wondering: what to do now?

Such a diagnosis always divides life into “before” and “after”. All the emotional resources of the patient and his family are thrown into experiences and fear. But it is at this moment that it is necessary to change the vector “for what” to the vector “what can be done”. Very often, patients feel infinitely lonely at the beginning of the journey. But you must understand that you are not alone. We will help you cope with the disease and will go hand in hand with you through all stages of your treatment.

Here is a brief but very detailed overview of a retroperitoneal tumor. It was prepared by highly qualified specialists of the Abdominal Department of the P.A. Herzen – a branch of the Federal State Budgetary Institution “NMITs Radiology” of the Ministry of Health of Russia.

General information about tumors of the retroperitoneal space (in the small pelvis)

Most oncological tumors of the small pelvis have a local form of occurrence and development, that is, they appear in certain organs located in the small pelvis. These organs include the rectum, uterus in women, bladder, prostate in men.

Retroperitoneal tumor occurs in people of any age, but usually occurs in people aged 40 to 60 years. At the same time, retroperitoneal tumors are diagnosed less frequently in men than in women.

Tumors that affect multiple organs are the most difficult to treat. However, these diseases are extremely rare. The pelvic space contains a large number of embryogenetically diverse tissues. This is what contributes to the development of various forms of malignant tumors.

Malignant tumors that are not associated with organs are much less common. As a rule, such formations are classified as different types of sarcomas. This type of neoplasm is diagnosed at the stage when the tumor begins to affect the organs: the rectum, urogenital organs, bones and blood vessels.

Classification of retroperitoneal tumors (in the small pelvis)

Retroperitoneal space is the space between the posterior peritoneum, diaphragm, back muscles, spine and muscles lining the pelvic floor. In this anatomical zone, the pancreas, kidneys, adrenal glands, ureters, part of the duodenum and part of the large intestine are localized. The space between the organs is filled with fiber, in which the nerve plexuses, lymph nodes, lymphatic and blood vessels are located. Retroperitoneal tissue is divided by fasciae into several sections.

Tumors of the retroperitoneum are any nodes located in this space, with the exception of neoplasms originating from the organs listed above, as well as metastatic lesions of the lymph nodes and tumors that grow into the retroperitoneal space from other anatomical zones (for example, from the abdominal cavity). The most popular classification of retroperitoneal tumors, created by Ackermann in 1954, is based on the histogenetic features of neoplasia. According to this classification, three large subgroups of such neoplasms are distinguished: mesodermal, neurogenic, and those originating from elements of embryonic tissues.

Mesodermal retroperitoneal tumors:

Adipose-derived: lipomas (benign) and liposarcomas (malignant).

Originating from smooth muscle tissue: leiomyomas (benign) and leiomyosarcomas (malignant).

Originating from striated muscle tissue: rhabdomyomas (benign) and rhabdomyosarcomas (malignant).

Connective tissue-derived: fibromas (benign) and fibrosarcomas (malignant).

Originating from blood vessels: hemangiomas (benign) and angiosarcomas (malignant), hemangiopericytomas (benign and malignant).

Lymphatic origin: lymphangiomas (benign) and lymphangiosarcomas (malignant).

Originating from remnants of the primary mesenchyme: myxomas (benign) and myxosarcomas (malignant).

Unclear histogenesis: xanthogranulomas (benign).

Neurogenic retroperitoneal tumors

Derived from nerve sheaths: neurofibromas (benign), neurolemomas (benign and malignant).

Derived from sympathetic nerve ganglia : ganglioneuromas (benign) and ganglioneuroblastomas (malignant).

Derived from chromaffin and non-chromaffin paraganglia cells and extra-organically located areas of adrenal tissue: paragangliomas (benign, malignant), pheochromocytoma, cancer from adrenal cells.

Retroperitoneal tumors from embryonic remains : teratomas, chordomas.

Symptoms of tumors of the retroperitoneal space (in the small pelvis)

Various symptoms occur with the appearance and development of cancer of the caecum and its location in the rectosigmoid part. The manifestation of symptoms depends on the size of the formation, the presence of complications such as bleeding, intestinal obstruction, perforation. The most characteristic symptom is anemia caused by bleeding from the tumor. In addition, a person with caecum cancer may feel frequent dizziness, general weakness. There is pallor and tachycardia. In more complex situations, aching incessant pains are noted in the lower right abdomen.

Early symptoms of colorectal cancer: lack of appetite, weight loss, digestive upset. With a significant weight loss, we can talk about the progressive development of malignant formation.

Retroperitoneal tumor of the sigmoid colon is characterized by the appearance of intestinal obstruction. In most patients, there is a change in the consistency of feces, blood clots and mucus may be observed in it.

If a malignant formation has arisen in the rectum, then the symptoms are very imperceptible to a person. Among the early manifestations of the disease, one can answer the feeling of incomplete exit of feces from the intestines. There is bleeding. Patients may indicate pulling and grasping pains in the lower abdomen. As a rule, such pains are not severe.

Causes of tumors of the retroperitoneal space (in the small pelvis)

Types of tumors may vary depending on the age of a man or woman. In girls, in the first weeks of life, the influence of placental estrogens from the mother is observed. In this condition, they can cause ovarian cysts. At the age of puberty, a tumor of the small pelvis in women may occur due to stagnation of blood during the menstrual period, if there is an overgrowth of the hymen. Because of this, malignant tumors can form in the uterus and ovaries.

From the age of 18, women may experience uterine enlargement during pregnancy and in the presence of fibroids. A pelvic tumor in women can occur in the ovarian region if there is a pathological pregnancy. In addition, cancer can occur in the fallopian tubes due to frequent inflammatory processes.

Pelvic tumor in women occurs most often during the completion of reproductive function.

Pelvic tumor in men can occur as a disease of the prostate gland. Prostate cancer is considered the most common malignant neoplasm in males.

Diagnosis of tumors of the retroperitoneal space (in the small pelvis)

In women and men, a retroperitoneal tumor manifests itself with the same symptoms. As a rule, these are pains in the lower abdomen, constipation, blood in the stool. Some patients have anemia associated with intra-abdominal bleeding.

A tumor of the small pelvis in women that occurs in the uterus manifests itself in the form of bleeding from the internal genital organs, pain in the pelvic organs, the occurrence of ectopic pregnancy and trophoblastic disease is less common.

Endometriosis causes pain during menstruation. In young girls with an early onset of the menstrual cycle, a hormone-producing ovarian tumor may be diagnosed. Girls with a late onset of the menstrual cycle may develop masculinizing ovarian neoplasms. During the end of menstruation, females with menometrorrhagia may develop a malignant tumor of the pelvis in women.

Diagnosis of tumors of the retroperitoneal space (in the pelvis)

If a pelvic tumor in women is not detected during a clinical examination, then special methods of examination are prescribed. The same examination is prescribed if a pelvic tumor in men is not detected during a general examination. Examinations are ordered if symptoms are present.

Ultrasound is prescribed as the initial method of examination. If the ultrasound examination did not give a complete picture of the situation, then MRI and CT can be used to detect malignant neoplasms. When performing an MRI, a retroperitoneal tumor, even a small one, will be detected.

If a retroperitoneal tumor of a dense composition, non-standard shape with inclusions is detected, it is very important to do a tissue study for cancer cells. A tumor of the small pelvis in women, namely malignant tumors in the ovaries, is diagnosed by tumor markers.

Treatment of tumors of the retroperitoneal space (in the small pelvis)

A retroperitoneal tumor that has arisen in the tissues of the small pelvis can only be cured with the help of surgery. If a pelvic tumor in men has involved several organs, then surgery is extremely difficult. Unfortunately, it is beyond the power of many doctors to carry out an intervention of such complexity, and even experienced doctors refuse to perform operations. Such an intervention may entail partial or complete cutting off of the bladder, rectum and reproductive organs in women. If a pelvic tumor in men and women has affected the bones and large vessels, then the disease is considered incurable.

A tumor of the pelvis in men and women that affects the large intestine is treated by cutting off the diseased part of the intestine. The method of cutting depends on the location of the initial formation and the presence of metastases. Before the appointment of the operation, the abdominal organs are carefully examined. The size of the excised part of the intestine depends on the size of the tumor. If the retroperitoneal tumor comes from the caecum or sigmoid colon, then the diseased part of the intestine must be removed, leaving and connecting the healthy parts.

Tumor of the small pelvis in men in the sigmoid colon requires cutting off the sigmoid colon itself, the lower part of the colon, vessels.

Conclusion

Any retroperitoneal tumor requires a certain number of chemotherapy drips. Even after the retroperitoneal tumor has been removed, chemotherapy treatment continues for the required amount of time.

Everyone should remember that in the event of early symptoms, it is recommended to seek immediate medical attention. With early diagnosis of the disease, a retroperitoneal tumor can be completely cured without major surgical intervention.

Do not forget that although a retroperitoneal tumor is a serious disease, it can be treated, so you should not delay visiting an oncologist. At the same time, a retroperitoneal tumor is quite simply diagnosed using ultrasound, MRI and CT.

Cysts and tumors of the retroperitoneum

Retroperitoneal tumors .

Retroperitoneal extraorgan tumors are a rare pathology and account for 0.2% of all human tumors. Retroperitoneal tumors are more common in women. The greatest number of patients of young and middle age (21 — 50 years).

Classification of retroperitoneal tumors.

The most widely used classification is Assegmann (1954), who calls the division of tumors of a given localization conditional and is based on the histogenetic principle:

Tumors of mesodermal origin

A. Tumors from adipose tissue: 1) benign – lipomas, 2) malignant – liposarcomas.

B. Tumors from smooth muscles: 1) benign – leiomyoma, 2) malignant – leiomyosarcoma.

C. Connective tissue tumors: 1) benign – fibroma, 2) malignant – fibrosarcoma.

D. Tumors from the transverse striated muscles: 1) benign – rhabdomyoma, 2) malignant – rhabdomyosarcoma.

E. Tumors from blood vessels: 1) hemangioma and angiosarcoma, 2) hemangiopericytoma – benign and malignant.

F. Tumors from the lymphatic vessels: 1) benign – lymphangioma, 2) malignant – lymphangiosarcoma.

G. Tumors from the primary mesenchyme: 1) benign – myxoma, 2) malignant – myxosarcoma.

H. Undifferentiated tumors of unknown origin – xanthogranulomas.

II. Tumors of neurogenic origin

A. Tumors from the anlages of the nerve sheaths: 1) neurofibroma, without capsule, 2) encapsulated neurolemma, 3) malignant neurolemmoma (malignant schwannoma).

B. Tumors from tissues of the sympathetic nervous system: 1) ganglioneuroma, 2) sympathoblastoma, 3) neuroblastoma.

C. Tumors from heterotopic tissues of the adrenal cortex and chromaffin tissues: 1) cancer from adrenal cells, 2) malignant neuromuffin paragangioma, 3) paragangioma, 4) active pheochromocytoma.

III. Tumors from embryonic remains of the kidney

A. Malignant and benign teratomas.

B. Chordomas.

IV. Malignant tumors of a metastatic nature

Clinical course extraorganic retroperitoneal tumors .

Anatomical features of the retroperitoneal space with the presence of fatty tissue cause a long asymptomatic period. Developing in the free tissue of the retroperitoneal space, these neoplasms can gradually reach a significant size without any clinical manifestations, squeezing adjacent organs. In some cases, urination disorders develop, in others – intestinal obstruction, nerve damage in the form of persistent pain in the abdominal cavity, lumbar region, and lower extremities.

Sometimes the first signs of the disease are lymphovenous stasis in one or both lower extremities, secondary varicocele.

The general condition of patients, even in the presence of large tumors, remains satisfactory for a long time. Fatigue, weakness, weight loss, fever, intoxication phenomena indicate a long process.

Abdominal pain is one of the early symptoms, most characteristic of small tumors located paravertebral in the pelvic cavity. Pain occurs when the tumor compresses the nerves that come from the lumbar or sacral plexus, and also when the parietal peritoneum is stretched.

Identification of the tumor during palpation of the abdomen is a very valuable clinical symptom, which is more often detected in the case of malignant tumors.

Violations of venous and lymphatic outflow are clinically manifested by an increase in the volume of the lower limb on the side of the lesion, pain, dilatation of the saphenous veins of the anterior abdominal wall. Compression and deformation of the veins often lead to neurogenic tumors. Retroperitoneal tumors do not compress the arterial trunks, but displace them.

Disorder of the function of the digestive tract is manifested by nausea, heaviness in the abdomen, constipation; disorder of the urinary system – dysuria, pain in the lumbar region (in case of compression and shift of the ureters, kidneys), difficulty during urination. Oliguria can sometimes be observed (if both ureters are compressed).

Tumors that are localized in the right half of the retroperitoneal space, give an earlier clinical picture of venous congestion.

In the case of localization of the tumor in the epigastric region (right or left), patients often complain of a feeling of heaviness and pain, not associated with eating. Symptoms of intestinal obstruction, predetermined by extraorganic compression, appear earlier against the background of neoplasms, which are located in the lower parts of the left half of the retroperitoneal space. In the case of tumors of this localization, pain is observed that radiates to the lumbar region, rectum, inguinal region and lower limbs.

Tumors of pelvic localization are characterized by a long and often asymptomatic onset of the disease, and therefore early diagnosis has significant difficulties. Non-organ retroperitoneal tumors of the small pelvis do not have specific diagnostic features that distinguish them from tumors or non-tumor diseases of the same localization.

One of the earliest symptoms of primary non-organ tumors of the small pelvis is pain in the lower abdomen, which occurs in approximately 50% of cases and is more often permanent. Early clinical symptoms are also defecation and urination disorders. Edema and dilation of the saphenous veins of the lower extremities are usually observed against the background of malignant tumors.

Irradiation of pain in one or both lower extremities is predetermined by the pressure of the tumor on the roots of the lumbosacral plexus, which must be taken into account during the differential diagnosis of non-organ tumors of the small pelvis and sciatica.

A symptom that is observed in almost all patients with primary non-organ tumors of the small pelvis is the definition of a tumor during palpation through the rectum or vagina. Retroperitoneal tumors of pelvic localization can contribute to the occurrence of perineal hernias

Tumor diagnostics

Complaints and anamnesis of the disease, as well as examination with percussion and palpation are important in order to suspect the presence of a retroperitoneal tumor.

The diagnosis of the disease is specified after an X-ray study, therefore it is necessary to start with a survey X-ray of the chest and abdominal cavities, which can confirm the presence of a tumor, but does not make it possible to clarify the localization and relationship to the organs. In this regard, X-ray contrast examination of the digestive tract and urinary system is considered mandatory. Displacement of the stomach, large or small intestine, kidney, ureter indicates the retroperitoneal localization of the tumor and helps to determine the functional disorders of these organs. A special place in the diagnosis of retroperitoneal neoplasms is occupied by ultrasonography, as well as aortography, angiography, cavography, intravenous excretory urography, irrigoscopy, computed tomography, nuclear magnetic resonance imaging, chest x-ray to exclude metastases in the lungs.

On the basis of direct and indirect signs, the noted X-ray methods of research allow us to clarify the biological nature of the disease and the location of the tumor, to determine its relationship with neighboring organs and great vessels, which is necessary to resolve the issue regarding the treatment plan and the nature of the surgical intervention.

Ultrasound echography helps to determine the size and depth of the tumor, to find out its connection with the vessels; computed tomography allows you to determine tumors with a diameter starting from 1.5-2.0 cm, their exact distribution, topography, and detect enlarged lymph nodes.

Less common methods include angioscanning of retroperitoneal tumors. However, none of the listed research methods allows to determine the histological structure of the neoplasm, which is necessary for choosing a treatment method, especially radiation and chemotherapy.

In the case of retroperitoneal non-organ tumors, a biopsy is mandatory for cytological and histological examination. Percutaneous aspiration puncture biopsy is performed in the case of a retroperitoneal tumor located on the side walls of the pelvis. In the case of a pelvic location of the tumor, a puncture biopsy is used through the posterior wall of the vagina or by puncturing the ischiorectal area. Echography and computed tomography help to conduct targeted biopsy.

Needle biopsy allows you to clarify the nature of the process and determine the morphological structure of the neoplasm. More often, a puncture biopsy is the final stage in the examination of the patient after clarifying the location, size and relationship of the tumor with neighboring organs.

Treatment of retroperitoneal tumors

The main method of treatment is surgery. Operability for non-organ retroperitoneal tumors remains low. Operations can be performed only in 20 – 30% of patients. Relapses occur frequently – in 35 – 50% of those operated.

Radiotherapy . The radiation method of treatment is used in non-operated patients in the late stages of the disease, the results of treatment are not very comforting. For the use of radiation and combination therapy, confidence in the malignant nature of the tumor is necessary.

Currently, the indications for radiation therapy of retroperitoneal tumors have been significantly expanded.