Aneurysm
About aneurysms
An aneurysm is a bulging out of part of the wall of a blood vessel. Aneurysms occur in several different forms. Saccular aneurysms protrude from the wall of the artery, like a berry. They may occur singly or in groups. Risk factors for saccular aneurysms include high blood pressure (hypertension), cigarette smoking and various diseases of the connective tissue. Fusiform aneurysms are characterized by the enlargement of the entire artery. They are often a complication of atherosclerosis, or a buildup of plaque in the artery.
Unfortunately, aneurysms do not typically produce symptoms. In many cases, the first symptoms of an aneurysm occur after the aneurysm bursts. However, various imaging tests can detect aneurysms, enabling their treatment before a medical emergency occurs.
Left untreated, aneurysms may tear or burst (a ruptured aneurysm). Ruptures are very painful events that cause massive internal bleeding and may result in permanent disability or death, depending on where the aneurysm is located. Ideally, aneurysms are diagnosed before rupture, allowing physicians the opportunity to treat it and hopefully prevent a rupture. Aneurysms can be treated with surgery to remove the weakened portion of the arterial wall, or with specialized stent-grafts that are permanently implanted in the artery to route blood around the aneurysm. Other devices to treat aneurysms include tiny coils that are delivered via catheter and cause a blood clot in the aneurysm, thus sealing it off. In some cases, aneurysms will be closely monitored instead of aggressively treated, to see if the aneurysm is stable as opposed to expanding in size.
If the aneurysm ruptures, the outcome depends on its location. If an aneurysm bursts in the brain, it could cause a hemorrhagic stroke. If an aneurysm bursts in the aorta, the body’s main artery that runs from the
heart down through the chest and abdomen, there is an immediate medical emergency. More than half of people with aortic aneurysms do not survive the event. Therefore, early diagnosis and treatment before the aneurysm bursts are critical. Because aortic aneurysms often produce either no symptoms or mild symptoms (e.g., back pain), routine physical examinations are strongly encouraged so that a physician can regularly test for warning signs.
Patients with a family history of aneurysms may be screened for aneurysm.
There are a number of different types of aneurysms, which include:
Aortic aneurysm
A very dangerous condition characterized by the distention, or ballooning out, of part of the wall of the aorta. Aortic aneurysms may occur in the chest (thoracic aortic aneurysm) or abdomen (abdominal aortic aneurysm). An aneurysm is usually diagnosed when the enlarged portion of the aorta is 1.5 times its normal size. If accompanied by an aortic dissection, it is classified as a dissecting aortic aneurysm.
Cerebral aneurysm
A cerebral aneurysm is a bulge in the wall of a blood vessel in the brain (one of the cerebral arteries). A cerebral aneurysm is typically found where the arteries branch at the base of the brain. There are various kinds of cerebral aneurysms, including berry aneurysms. As the name implies, these aneurysms are shaped like hanging berries. The cause is unknown, but smoking increases a person’s risk of developing this condition.
Ventricular aneurysm
A bulging or ballooning out of part of the wall of one of the heart’s lower chambers (ventricles), usually the left. If the aneurysm is present in the wall between the ventricles (the ventricular septum), it is also known as a ventricular septal aneurysm, an interventricular aneurysm or simply a septal aneurysm. It may be present since birth (congenital) or may be a complication of a heart attack or other trauma.
Atrial aneurysm
A bulging or ballooning out of part of the wall of one of the heart’s upper chambers (atria). If the aneurysm is present in the wall between the atria (the atrial septum), it is also known as an atrial septal aneurysm (ASA), an aneurysm of septum primum or an aneurysm of the septum secundum. An ASA has been associated with an increased risk of stroke and is often accompanied by the presence of a patent foramen ovale (PFO), an opening between the upper chambers (atria) of the heart. Normally, this opening is present in the developing fetus and closes shortly after birth. It is often present since birth (congenital).
Cirsoid aneurysm
The enlargement of a network of blood vessels that commonly occurs on the scalp and may result in the formation of a tumor.
Aneurysm signs and symptoms
Symptoms vary according to which artery is affected:
- Thoracic (chest) aneurysm produces pain in the chest, neck, back and abdomen. The pain may be sudden and sharp.
- Abdominal aneurysm produces back pain (sometimes severe), appetite and weight loss, and a pulsating mass in the abdomen.
- Aneurysm in a leg artery causes poor circulation in the leg, with weakness and pallor or swelling and bluish color. A pulsating mass may appear in the groin or behind the knee.
- Aneurysm in a brain artery produces headache (often throbbing), weakness, paralysis or numbness, pain behind the eye, vision change or partial blindness, and unequal pupils.
- Aneurysm in a heart muscle causes heartbeat irregularities and symptoms of congestive heart failure.
Causes
- Most common cause is high blood pressure that weakens an artery.
- Atherosclerosis (hardening of the arteries).
- Congenitally weak artery (especially with aneurysms in blood vessels to the brain).
- Infection in the aorta caused by syphilis (rare).
- Injury.
Risk increases with
- Adults over 60.
- Previous heart attack.
- High blood pressure.
- Smoking.
- Obesity.
- Family history of atherosclerosis.
- Polyarteritis nodosa (inflammation of the small and medium arteries).
- Bacterial endocarditis (infection of the heart lining).
Preventive measures
- Don't smoke.
- Get regular exercise.
- Maintain adequate nutrition and a low-fat diet.
- Obtain early treatment for syphilis.
- Follow your treatment program to control high blood pressure.
- Reduce stress.
Expected outcomes
Often curable with surgery to replace the diseased vessel with grafts (artificial vessels). Surgery on a heart aneurysm can stabilize the heartbeat and prolong life. Aneurysms sometimes recur.
Possible complications
- Stroke.
- Rupture of the aneurysm. Symptoms include severe headache, severe knife-like chest, abdominal or leg pain, and loss of consciousness. If not treated, it can be fatal.
Aneurysm treatment
- Early detection and treatment before rupture are essential.
- Medical tests include laboratory blood studies of clotting, ECG, X-rays of blood vessels (angiography), other X-rays, CT scan or ultrasound.
- Surgery to replace the diseased vessel or close off the aneurysm.
- An aneurysm to the brain requires emergency surgery. Surgery for other types of aneurysms may be scheduled at a convenient time.
- Following surgery, learn to monitor and control your blood pressure.
Questions for your doctor about Aneurysm
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to aneurysms:
- Do you suspect there is an aneurysm anywhere in my body?
- How serious is my condition?
- Are there any tests I can take to give you a better idea of my condition?
- Are there any underlying conditions causing the aneurysm?
- What type of treatment do you recommend for my condition?
- Will my condition require any type of surgery?
- Are there any minimally invasive alternatives to surgery?
- How urgently do I need to begin treatment for this condition?
- Are there any lifestyle changes I can make to improve my condition?
- Can an aneurysm affect my pregnancy in any way?
Additional Information
Medications
- Following surgery, anticoagulants to prevent bloodclot formation and pain relievers.
- Antibiotics to prevent infection may be prescribed.
Activity
Avoid heavy exertion or straining prior to surgery. After surgery, resume normal activities gradually.
Diet
Before surgery, eat a high-fiber diet so you can avoid straining during bowel movements. After surgery, no special diet is necessary.
Notify your physician if
- You or a family member has symptoms of an aneurysm, especially a pulsating mass in your abdomen or leg, or chest or abdominal pain. This is an emergency! Call for help, and rest in bed until help arrives.
- You have had a heart attack and develop heartbeat irregularity or symptoms of congestive heart failure.
- After surgery, any symptoms return.