Internal Medicine

Calcifications in the abdominal artery

introduction

Calcifications in the abdominal artery are the deposits of blood lipids and waste materials in the abdominal artery.

These deposits calcified as a result of reaction processes in the vessel wall. Usually the calcification of the abdominal artery is accompanied by the calcification of other vessels. Such calcifications lead to circulatory disorders and can thus cause life-threatening complications.

What causes calcification of the abdominal artery?

The causes of calcification of the abdominal artery are manifold, most of which are part of our lifestyle today.

The main risk factors for these vascular calcifications are high blood lipid levels. High blood pressure, chronic diseases such as diabetes (blood sugar disorder) and the consumption of alcohol and nicotine also increase the risk of calcification of the abdominal artery. The lifestyle contributes to these risk factors, which is characterized by a lack of exercise, too many foods, especially unhealthy foods, and the availability of unhealthy luxury foods. All of these factors can damage the vessels and thus contribute to the calcification of the abdominal artery.

For example, diabetes leads to high blood sugar levels. The sugar is then deposited on the vessel walls, and then there are the fat droplets, which also swim around in the blood due to the high blood lipid levels. The vessel wall tries to remove these deposits, but this leads to reactions and calcification of the vessel walls. This effect is intensified by high blood pressure. The blood pressure puts the vessel walls under stress and thus reduces their defenses.

This is how calcification of the abdominal artery is diagnosed

When diagnosing calcification of the abdominal aorta, the risk factors and blood tests first play a role.

If high blood fat levels, high blood sugar levels and high blood pressure are found, the blood vessels are usually examined. You can first try to perform an ultrasound examination of the abdominal aorta. If the suspicion is confirmed, an angiography, i.e. a visualization of the vessels using a computer tomography, is often performed. This allows conclusions to be drawn about the severity of the disease and the narrowing of the blood vessel by the calcifications. Thereafter, therapy decisions can be made.

What do you see in the ultrasound?

In the ultrasound you can see the calcification of the abdominal aorta, especially when the vascular walls are brightened.

The calcification is echogenic, so it reflects many of the ultrasonic waves and sends them back to the source, i.e. the transducer. The calcification therefore appears white on the ultrasound image. Behind it is a so-called acoustic shadow, i.e. a darkening of the image.

Usually a Doppler sonography is also performed. This examination measures the speed at which the blood flows in the vessel. Normally, a blue or red coloration of the vessel should appear on the screen. However, the calcification leads to turbulence, which appears as yellowish to white color codes. These flow velocities can be used to estimate the limitation caused by calcification.

These symptoms show that the abdominal artery is calcified

Calcification of the abdominal artery is often symptom-free for a very long time.

The abdominal artery has a very large diameter, which is why small calcium deposits reduce the blood flow only very slightly and there are no symptoms. Symptoms of insufficient blood flow can only occur with heavy deposits and a significant restriction in blood flow. These can affect the legs, for example, and the first symptoms usually arise when running because the muscles are not adequately supplied with oxygen.

Organs such as the kidneys can also suffer from insufficient blood flow, leading to blood pressure derailments and malfunctions in the excretion of urine. Usually calcifications of the abdominal artery are accompanied by calcifications of other vessels. This can affect the heart, for example, so that a heart attack or pressure on the chest during physical exertion can be indicative of calcifications in the abdominal artery.

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Symptoms of atherosclerosis

Pain in the abdominal artery

Abdominal artery pain is usually not caused by calcifications. Rather, pain is triggered in other parts of the body due to the insufficient blood flow. For example, the legs hurt during physical exertion.

Pain in the abdominal artery or in the abdomen suggests the development of an aortic aneurysm, i.e. a bulging of the abdominal artery. This can be a complication of calcification of the vessel walls. In the worst case, the wall of the abdominal artery can tear. However, this only happens at an extremely advanced stage of the disease. There is severe pain in the abdominal artery, which can project onto the abdomen or back. If the defect in the vessel wall is large, the affected person can bleed to death within a few minutes.

This is how the calcification of the abdominal artery is treated

Conservative treatment

The calcification of the abdominal artery is usually treated conservatively, i.e. non-surgically.

At first you even try therapy without medication. However, this requires an extensive change in lifestyle. It is necessary to completely avoid harmful substances such as alcohol and nicotine. Movement must also be integrated into everyday life. At least 150 minutes of physical activity per week is a guideline that should be achieved. The diet also has to be changed. So a lot of fruits and vegetables should be consumed. You should avoid particularly fatty foods, especially those that contain “bad” fats (LDL). On the other hand, one should consume more "good" fats (HDL), which are contained in nuts and fish, for example. Even sweet foods with a lot of sugar are harmful.

If this lifestyle change does not succeed, drug therapy can also be used. This consists of adjusting the blood pressure, and cholesterol-lowering drugs must also be taken if the blood lipid levels are high. If the affected person also has diabetes, this must be controlled as well as possible using antidiabetic drugs.

Operational options

Usually, a minimally invasive procedure is used for the operations. A so-called stent, i.e. a wire mesh, is pushed over the inguinal artery to the abdominal artery on a long wire. There the calcification is removed as far as possible and the stent is inserted into the affected part of the abdominal artery.

If the calcification is too large or if the vessels branching off the abdominal artery such as the renal arteries are also affected, major surgery must be considered. The original vessel is replaced by a prosthesis. This operation can also be performed using the inlay technique, in which the abdominal artery is cut open, the prosthesis is inserted and the artery is then sutured again over the prosthesis.

Treatment of atherosclerosis
Aortic prosthesis

When do you need an operation?

In the case of calcification of the abdominal artery, an operation is often not initially possible. The disease can usually be treated for years or even decades with lifestyle adjustments and medication.

However, if the calcification is so pronounced that serious circulatory disorders occur, an operation should be performed. Part of the calcifications can be removed in a minimally invasive manner, i.e. without large incisions in the abdomen. A stent, a type of wire mesh, is then usually used to stabilize the abdominal artery. Larger operations, in which the affected part of the abdominal artery has to be replaced with a prosthesis, are only necessary at a very advanced stage. They are used when stent implantation is not sufficiently promising.

Proper nutrition in case of calcification of the abdominal artery

The diet for vascular calcifications is largely based on the types of fat that someone consumes.

The good cholesterol has a protective effect on the blood vessels, while the bad cholesterol favors the development of arteriosclerosis. You should therefore consume as little saturated fatty acids as possible. These are mainly found in animal fats, i.e. in meat. But deep-frying fat also largely consists of these saturated fatty acids.

Vegetable fat, on the other hand, is particularly valuable. In addition to vegetable margarine and olive oil, nuts and fish are also important sources of good fat. It is therefore not important to completely ban fat from the menu when eating, rather attention should be paid to the source of the fat. In addition, fruits and vegetables with their fiber and vitamins have a very positive effect on the vascular system. As a rule, around 5 servings (50g each) of fruit per day and 250g of vegetables are sufficient for an adult to meet the vitamin requirement.

Course of disease

The calcification of the abdominal artery is usually associated with the calcification of other vessels. This calcification begins naturally in every person from the age of 20 and can remain inconspicuous for a whole life in ideal health.

However, if the calcification is increased by other factors, initially only calcium deposits appear on the vessel walls. This first affects the blood pressure. Thereafter, circulatory disorders occur in various affected organs. Often times, the heart is one of the first organs to be affected. The blood supply to fingers and toes is also getting worse. Later, especially with calcification of the abdominal artery, there is also insufficient blood flow to the digestive organs and kidneys. If the vascular walls of the abdominal artery are completely damaged, the abdominal artery may tear, which is life-threatening.

Consequences of calcifications in the abdominal artery

In the case of calcification of the abdominal artery, the consequences only occur with very severe calcifications.

First of all, due to the reduced blood flow, there is insufficient blood flow to the digestive organs and the kidneys. The kidneys in particular react very sensitively to the circulatory disturbance and trigger high blood pressure peaks as a result. The organs can be so severely damaged by the insufficient blood flow that serious functional restrictions occur.

The legs are also not well supplied with blood if the abdominal artery is calcified. Initially, this is only noticeable in the case of physical resilience through pain in the legs. In the advanced stages, the leg vessels also clog or blood clots form that clog the vessels. The tissue that is no longer supplied with blood can die if this clot is not removed.

If the calcification of the abdominal artery has progressed so far that the vascular wall is weakened, the abdominal artery bulges (aneurysm). This can happen suddenly and possibly tear the abdominal artery with life-threatening bleeding. But a chronic aneurysm can also develop.

What happens if the carotid arteries are also calcified?

The carotid artery is largely responsible for the blood flow to the head and the brain. Therefore, a calcified carotid artery can have life-threatening consequences.

The consequences are based on three mechanisms: there may be insufficient blood supply to the brain because not enough blood is flowing through the carotid artery. Or part of the calcification loosens, jams in another vessel and blocks it. The third possibility is the formation of blood clots on the calcification, which can also clog the vessels. The result is circulatory disorders in the brain, which, depending on the location, can lead to very different and even life-threatening brain function failures. Above all, sudden closures or insufficient supplies trigger strokes.