An Aneurysm is a bulging or ballooning of the wall of an artery. This disease can happen in any part of the body but is most common in the aorta, the main artery that travels from the heart through the chest and abdomen. Aneurysms also happen in the brain which is referred to as a cerebral aneurysm. If this disease is in the brain bursts, it can cause stoke. If an aneurysm goes undetected in can become larger and burst and cause serious internal bleeding and even be fatal. Sometimes a blood clot in an aneurysm will break lose and flow to a smaller artery blocking the flow of blood. The most common cause of aortic aneurysms is atherosclerosis which is the formation of substances on arterial walls. High blood pressure and smoking increase risks for getting this disease. Aneurysms can also be caused by some diseases. Often people with this have no symptoms so regular doctor visits are important. In obese people sometimes even large aneurysms go undetected.
Types of aneurysm include aortic aneurysms, cerebral aneurysms, and peripheral aneurysms.
Aortic Aneurysm: Most aneurysms occur in the aorta. The aorta is the main artery that carries blood from the heart to the rest of the body. The aorta comes out from the left ventricle of the heart and travels through the chest and abdomen. The two types of aortic aneurysm are thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA).
Thoracic Aortic Aneurysm: An aortic aneurysm that occurs in the part of the aorta running through the thorax (chest) is a thoracic aortic aneurysm. One in four aortic aneurysms is a TAA. Most TAAs do not produce symptoms, even when they are large. Only half of all people with TAAs notice any symptoms. TAAs are identified more often now than in the past because of chest computed tomography (CT) scans performed for other medical problems. In a common type of TAA, the walls of the aorta become weak and a section nearest to the heart enlarges. Then the valve between the heart and the aorta cannot close properly and blood leaks backward into the heart. Less commonly, a TAA can develop in the upper back away from the heart. A TAA in this location can result from and injury to the chest such as from an auto crash.
Abdominal Aortic Aneurysm: An aortic aneurysm that occurs in the part of the aorta running through the abdomen is an abdominal aortic aneurysm. An AAA can grow very large without producing symptoms.
Cerebral Aneurysm: Aneurysms that occur in an artery in the brain are called cerebral aneurysms. They are sometimes called berry aneurysms because they are often the size of a small berry. Most this disease produce no symptoms until they become large, begin to leak blood, or rupture.
A ruptured cerebral aneurysm causes a stroke. Signs and symptoms can include a sudden, extremely severe headache, nausea, vomiting, stiff neck, sudden weakness in an area of the body, sudden difficulty speaking, and even loss of consciousness, coma, or death. The danger of a this disease depends on its size and location in the brain, whether it leaks or ruptures, and the person's age and overall health.
Peripheral Aneurysm: Aneurysms that occur in arteries other than the aorta (and not in the brain) are called peripheral aneurysms. Common locations for this disease include the artery that runs down the back of the thigh behind the knee (popliteal artery), the main artery in the groin (femoral artery), and the main artery in the neck (carotid artery). Peripheral aneurysms are not as likely to rupture as aortic aneurysms, but blood clots can form in this. If a blood clot breaks away from the aneurysm, it can block blood flow through the artery. If a peripheral aneurysm is large, it can press on a nearby nerve or vein and cause pain, numbness, or swelling.
The signs and symptoms of an aneurysm depend on its type, location, and whether it has ruptured or is interfering with other structures in the body. This disease can develop and grow for years without causing any signs or symptoms. It is often not until an aneurysm ruptures or grows large enough to press on nearby parts of the body or block blood flow that it produces any signs or symptoms.
Abdominal Aortic Aneurysm: Most abdominal aortic aneurysms (AAAs) develop slowly over years and have no signs or symptoms until (or if) they rupture. Sometimes, a doctor can feel a pulsating mass while examining a patient's abdomen. When symptoms are present, they can include: Deep penetrating pain in your back or the side of your abdomen, steady gnawing pain in your abdomen that lasts for hours or days at a time, coldness, numbness, or tingling in your feet due to blocked blood flow in your legs. If an AAA ruptures, symptoms can include sudden, severe pain in your lower abdomen and back; nausea and vomiting; clammy, sweaty skin; lightheadedness; and a rapid heart rate when standing up. Internal bleeding from a ruptured AAA can send you into stroke. Stroke is a life-threatening condition in which the organs of the body do not get enough blood flow.
Thoracic Aortic Aneurysm: A thoracic (chest) aortic aneurysm may have no symptoms until the aneurysm begins to leak or grow. Signs or symptoms may include: Pain in your jaw, neck, upper back (or other part of your back), or chest, coughing, hoarseness, or trouble breathing.
Cerebral Aneurysm: If a cerebral (brain) aneurysm presses on nerves in your brain, it can cause signs and symptoms. These can include: A droopy eyelid, double vision or other changes in vision, pain above or behind the eye, a dilated pupil, numbness or weakness on one side of the face or body.
If a cerebral aneurysm ruptures, symptoms can include a sudden, severe headache, nausea and vomiting, stiff neck, loss of consciousness, and signs of a stroke. Signs of a stroke are similar to those listed above for cerebral aneurysm, but they usually come on suddenly and are more severe. Any of these symptoms require immediate medical attention.
Peripheral Aneurysm: Signs and symptoms of peripheral aneurysm may include: A pulsating lump that can be felt in your neck, arm, or leg, leg or arm pain, or cramping with exercise, painful sores on toes or fingers, gangrene (tissue death) from severely blocked blood flow in your limbs, this disease in the popliteal artery (behind the knee) can compress nerves and cause pain, weakness, and numbness in your knee and leg. Blood clots can form in peripheral aneurysms. If a clot breaks loose and travels through the bloodstream, it can lodge in your arm, leg, or brain and block the artery. This disease in your neck can block the artery to the brain and cause a stroke.
Medicine and surgery are the two types of treatment for this disease. Medicines may be prescribed before surgery or instead of surgery. Medicines 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: Treatment recommendations for aortic aneurysms are based on the size of this disease. If the diameter of the aorta is small-less than 3 centimeters (cm)-and there are no symptoms, "watchful waiting" and a follow up screening in 5 to 10 years may be all that is needed.
If the aorta is between 3 and 4 cm in diameter, the patient should 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.
The traditional and most common type of surgery for aortic aneurysms is open abdominal or open chest repair. It involves a major incision 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 3 to 6 hours, and the patient remains in the hospital for 5 to 8 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 percent of patients make a full recovery.
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 this disease. Then, watching on 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.
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. 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 this ruptures, there will be bleeding into the brain which will cause a stroke. If a cerebral aneurysm becomes infected, it requires immediate medical treatment. Treatment of many this, especially large or growing ones, involves surgery, which can be risky depending on the location of the aneurysm.
Peripheral Aneurysm: Most peripheral aneurysms have no symptoms, especially if they are small. They seldom rupture. Treatment of this 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. This disease in the back of the knee that is larger than 1 inch in diameter usually requires surgery. An aneurysm in the thigh also is usually repaired with surgery.
Causes and Risk factors:
Most aneurysms occur in older patients with a history of hypertension and atherosclerosis. However the causes of this are poorly understood.
Thoracic aortic dissections or aneurysms can occur in young people. The dissecting tear can begin as the result of trauma such as a car accident. Patients with Marfan's syndrome (a problem with collagen which makes the vessels weak) or with an abnormal aortic valve, which increases stress on the artery, can cause it to dilate. Several basketball players have undergone surgery to correct this type of aneurysm. The actor John Ritter reportedly had an abnormal valve which led to an aortic dissection
The causes of abdominal aortic aneurysms are less well-understood. The wall may become weak because atherosclerosis (cholesterol deposits) make the artery less healthy and cause it to weaken. Some studies have suggested low-grade inflammation in the arterial wall slowly digests the wall making it weak. There are some families that have multiple aneurysms suggesting that at least some cases are related to a genetic disorder.
An aneurysm may be found by chance during a routine physical exam. More often, an aneurysm is found by chance during an X-ray, ultrasound, or computed tomography (CT) scan performed for another reason, such as chest or abdominal pain.
If you have an abdominal aortic aneurysm (AAA), the doctor may feel a pulsating mass in your abdomen. A rapidly growing aneurysm about to rupture can be tender and very painful when pressed. If you are overweight or obese, it may be difficult for your doctor to feel even a large abdominal aneurysm. If you have an AAA, your doctor may hear rushing blood flow instead of the normal whooshing sound when listening to your abdomen with a stethoscope. You may be referred to a cardiothoracic surgeon, vascular surgeon, or neurosurgeon for diagnosis and treatment of an aneurysm.
Diagnostic Tests and Procedures: To diagnose and evaluate an aneurysm, one or more of the following tests or procedures may be performed:
Chest x ray: A chest x ray provides a picture of the organs and structures inside the chest, including the heart, lungs, and blood vessels.
Ultrasound: This simple and painless test uses sound waves to create a picture of the inside of the body. It shows the size of an aneurysm, if one is detected. The ultrasound scan may be repeated every few months to see how quickly this is growing.
CT scan: A CT scan provides computer-generated, x-ray images of the internal organs. A CT scan may be performed if the doctor suspects a TAA or AAA. A liquid dye that can be seen on an x ray is injected into an arm vein to outline the aorta or artery on the CT scan. The CT scan images can be used to determine the size and shape of an abdominal aneurysm more accurately than an ultrasound.
MRI: MRI uses magnets and radio waves to create images of the inside of the body. It is very accurate in detecting aneurysms and determining their size and exact location.
Angiography: Angiography also uses a special dye injected into the blood stream to make the insides of arteries show up on x-ray pictures. An angiogram shows the amount of damage and blockage in blood vessels.
Aortogram: An aortogram is an angiogram of the aorta. It may show the location and size of this disease, and the arteries of the aorta that are involved.
Medicine and medication:
Medicines used to treat high blood pressure, such as beta-blockers, may be used to slow the growth rate of an aortic aneurysm. If you have high cholesterol, your doctor might recommend that you take medicines, such as statins, to lower it. Having high cholesterol increases your risk of atherosclerosis, which can cause this disease and other conditions, such as coronary artery disease and stroke.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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