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Aneurysm

An aneurysm is an abnormal widening or ballooning of a portion of an artery due to weakness in the wall of the blood vessel. An aneurysm is an abnormal widening or ballooning of a portion of an artery, related to weakness in the wall of the blood vessel. Some common locations for aneurysms include:

  • Aorta (the major artery from the heart)
  • Brain (cerebral aneurysm)
  • Leg (Popliteal artery aneurysm)
  • Intestine (Mesenteric artery aneurysm)
  • Splenic artery aneurysm

Causes

It is not clear exactly what causes aneurysms. Some aneurysms are present at birth (congenital). Defects in some of the parts of the artery wall may be responsible.

Common locations for aneurysms include:
  • The major artery from the heart (the aorta)
  • The brain (cerebral aneurysm)
  • In the leg behind the knee popliteal artery aneurysm)
  • Intestine (mesenteric artery aneurysm)
  • An artery in the spleen (splenic artery aneurysm)

High blood pressure, high cholesterol, and cigarette smoking may raise your risk of certain types of aneurysms. High blood pressure is thought to play a role in abdominal aortic aneurysms. Atherosclerotic disease (cholesterol buildup in arteries) may also lead to the formation of some aneurysms.

Pregnancy is often linked to the formation and rupture of splenic artery aneurysms.

Symptoms

The symptoms depend on the location of the aneurysm. If the aneurysm occurs near the body's surface, pain and swelling with a throbbing mass is often seen.

Aneurysms within the body or brain often cause no symptoms.

If an aneurysm ruptures, pain, low blood pressure, a rapid heart rate, and lightheadedness may occur. The risk of death after a rupture is high.

Exams and Tests

Tests used to diagnose an aneurysm include:

  • CT scan
  • Ultrasound

Treatment

Surgery is generally recommended. The type of surgery and when you need it depends on your symptoms and the size and type of aneurysm

Some patients may have endovascular stent repair. A stent is a tiny tube used to prop open a vessel or reinforce its wall. This procedure can be done without a major cut, so you recover faster than you would with open surgery. Not all patients with aneurysms are candidates for stenting, however.

Some aneurysms, mainly small ones that are not causing pain, can be treated with watchful waiting. Others need to be treated to prevent growth and complications. The goals of treatment are to prevent the aneurysm from growing, prevent or reverse damage to other body structures, prevent or treat a rupture, and to allow the patient to continue to participate in normal daily activities.

Medicine and surgery are the two types of treatment for an aneurysm. Medicines may be prescribed before surgery or instead of surgery. They are used to reduce pressure, relax blood vessels, and reduce the risk of rupture. Beta blockers and calcium channel blockers are the medicines most commonly used.

Surgery may be recommended if an aneurysm is large and likely to rupture.

Aortic aneurysm

Some experts recommend that men who have ever smoked (at least 100 cigarettes in their lifetime) and are between the ages of 65 and 75 should have an ultrasound screening to check for abdominal aortic aneurysms.

Treatment recommendations for aortic aneurysms are based on the size of the aneurysm.

  • If the diameter of the aorta is small (less than 3 centimeters) and there are no symptoms, watchful waiting and a follow-up screening in 5 to 10 years may be all that is needed, as determined by the doctor.
  • If the aorta is between 3 and 4 centimeters (cm) in diameter, the patient is usually asked to return to the doctor every year for an ultrasound to see if the aneurysm has grown.
  • If the aorta is between 4 and 4.5 cm, testing should be repeated every 6 months.
  • If the aorta is larger than 5 cm (2 inches around, or about the size of a lemon) or growing more than 1 cm per year, surgery should be considered as soon as possible.

Two main types of surgery to repair aortic aneurysms are open abdominal or open chest repair and endovascular repair.

Open repair

The traditional and most common type of surgery for aortic aneurysms is open abdominal or open chest repair. It involves a major incision (cut) in the abdomen or chest. General anesthesia is needed with this procedure.

The aneurysm is removed and the section of aorta is replaced with an artificial graft made of material such as Dacron or Teflon. The surgery takes three to six hours, and the patient remains in the hospital for five to eight days. It often takes a month to recover from open abdominal or open chest surgery and return to full activity. Open abdominal and chest surgeries have been performed for 50 years. More than 90% of patients make a full recovery.

The illustration shows the placement of an endovascular stent graft in an aortic aneurysm. In figure A, a catheter is inserted into an artery in the groin (upper thigh). It is then threaded up to the abdominal aorta, and the stent-graft is released from the catheter. In figure B, the stent-graft allows blood to flow through the aneurysm.

In endovascular repair, the aneurysm is not removed, but a graft is inserted into the aorta to strengthen it. This type of surgery is performed through catheters (tubes) inserted into the arteries; it does not require surgically opening the chest or abdomen.

To perform endovascular repair, the doctor first inserts a catheter into an artery in the groin (upper thigh) and threads it up to the area of the aneurysm. Then, watching on live x-ray, the surgeon threads the graft (also called a stent graft) into the aorta to the aneurysm. The graft is then expanded inside the aorta and fastened in place to form a stable channel for blood flow. The graft reinforces the weakened section of the aorta to prevent the aneurysm from rupturing.

Compared to open repair, endovascular repair surgery reduces recovery time to a few days and greatly reduces time in the hospital. The procedure has been used since 1999. Not all aortic aneurysms can be repaired with this procedure, though, because the exact location or size of the aneurysm may prevent the stent graft from being safely or reliably positioned inside the aneurysm.

Cerebral aneurysm

Treatment for cerebral (brain) aneurysms depends on the size and location of the aneurysm, whether it is infected, and whether it has ruptured. A small cerebral aneurysm that hasn't burst may not need treatment. A large cerebral aneurysm may press against brain tissue, causing a severe headache or impaired vision, and is likely to burst. If the aneurysm ruptures, there will be bleeding into the brain, which will cause a stroke. If a cerebral aneurysm becomes infected, it requires immediate treatment. Treatment of many cerebral aneurysms, especially large or growing ones, involves surgery.

Peripheral aneurysm

Most peripheral aneurysms have no symptoms, especially if they are small. They seldom rupture.

Treatment of peripheral aneurysms depends on the presence of symptoms, the location of the aneurysm, and whether the blood flow through the artery is blocked. Blood clots can form in a peripheral aneurysm, break loose, and block the artery.

Aneurysms in the back of the knee that are larger than 1 inch in diameter, as well as aneurysms in the thigh, usually require surgery. An aneurysm in the thigh also is usually repaired with surgery.

Outlook (Prognosis)

With successful surgical repair, the outlook is often excellent.

Possible Complications

The main complications of aneurysm include:

  • Compression of nearby structures such as nerves, which may lead to weakness and numbness (most common with aneurysms that occur in the artery behind the knee)
  • Infection, can lead to body-wide illness and rupture
  • Rupture, which can cause massive bleeding that may lead to death

Massive bleeding is commonly seen with abdominal aortic aneurysms, mesenteric artery aneurysms, and splenic artery aneurysms.

Rupture of brain aneurysms can cause stroke, disability, and death.

When to Contact a Medical Professional

Call health care provider for if you develop a lump on your body, whether or not it is painful and throbbing.

Prevention

Control of high blood pressure may help prevent some aneurysms. Following a healthy diet, getting regular exercise, and keeping your cholesterol at a healthy level may also help prevent aneurysms or their complications.