Causes, Symptoms and Treatment of Aneurysm
An aneurysm is a medical condition which is due to an inflated sac inside an artery. Normally arteries are sturdy as they have to withstand average blood pressure. However, artery walls can be affected by some medical problems, genetic conditions or trauma. An aneurysm can result from the pressure of blood pushing against weakened or damaged walls of an artery resulting in a rupture or a dissection. An aneurysm can rupture allowing blood to flow out into the body. A dissection is a split in an artery wall causing bleeding along the layers with the same effect only slower. Both of these conditions are fatal but not all aneurysms must necessarily lead to death.
Fast Facts about Aneurysm
- An aneurysm is an inflated sac inside an artery.
- Arteries are normally sturdy enough to withstand blood pressure. However, artery walls can become affected by some medical or genetic conditions and trauma.
- Most common aneurysms occur in the aorta and are called thoracic aortic aneurysms. An aneurysm which develops in the abdominal portion of the aorta is known as an abdominal aortic aneurysm. In the US approximately 13,000 people die annually from aortic aneurysms. Most of the deaths are due to rupture or dissection. Aneurysms can develop and increase in size before causing a single symptom. However, early diagnosis and treatment can help prevent rupture and dissection. Individuals who are considered high risk do benefit from early, routine screening.
Types of Aneurysm
Abdominal aortic aneurysm and thoracic aortic aneurysm are the two main kinds of aortic aneurysms. Some people have both types. Other common types include brain and peripheral aneurysms.
Abdominal Aortic Aneurysm (AAA)
Most abdominal aortic aneurysms (or AAAs) are more prominent today because of the use of computed tomograph scans, or CT scans, done for other medical problems. While AAAs are generally small and rarely rupture, they can grow large without causing symptoms. Routine check-ups can help prevent growth and rupture.
Thoracic Aortic Aneurysm (TAA)
A thoracic aortic aneurysm (or TAA) occurs in the chest portion of the aorta and does not always cause symptoms, even when they are large. Fifty percent of all people who have TAAs do not notice any symptoms. CT scans of the chest diagnose more TAA’s now than ever before.
The most common form of thoracic aortic aneurysm occurs when the walls of the aorta depress and a section enlarges. This results in the valve between the heart and the aorta not closing properly, allowing blood to spill back into the heart. Another type usually develops from an injury to the chest and is found in the upper back, away from the heart.
Cerebral aneurysms or brain aneurysms (aka berry aneurysms) occur in the arteries of the brain. Most may not show symptoms until they increase in size, begin to leak or rupture. Brain aneurysms that burst can cause a stroke.
Peripheral Aneurysms are those that occur in arteries other than the aorta and the brain. They are commonly found in the popliteal (arteries that run down the back of the thighs, behind the knees), femoral (main arteries in the groin) and carotid arteries (two main arteries on each side of your neck).
Blood clots can form in peripheral aneurysms but they are not as likely to rupture or dissect as aortic aneurysms. If the blood clot breaks off, it can block blood flow. If the peripheral aneurysm is substantial, it can cause pressure on a nerve or vein causing pain, numbness, or swelling.
Common Causes of Aneurysm
Family history and damage to arterial walls from medical problems, genetic conditions, and/or the effects of trauma are the most common causes of aneurysms. Many conditions and factors can cause this type of damage causing aortic aneurysms. Some of them are smoking, normal aging process, high blood pressure and atherosclerosis, which is the hardening and narrowing of the arteries due to the build-up of plaque.
In addition to the causes above, certain genetic conditions can weaken the body’s connective tissues and damage the aorta causing TAAs. Some of these specific conditions include Marfan syndrome, Loeys-Dietz syndrome, Turner syndrome and Ehlers-Danlos syndrome (the vascular type). People diagnosed with these conditions tend to develop aneurysms at a young age and show a higher risk for rupture and dissection. Researchers are looking into genetic mutations that may contribute to aneurysms.
Rarely, infections (such as untreated syphilis) and diseases such as vasculitis can cause aortic aneurysms.
Risk Factors for Aneurysm
- Men have a higher risk for developing aortic aneurysms than women and the risk for both sexes increases as people get older.
- Smokers are at high risk because of the damage smoking does to your arterial walls.
- Risks are higher for people with family members afflicted with this condition.
- If you have certain conditions such as high blood pressure or atherosclerosis.
- People with a bicuspid aortic valve because of the reduced leaflet count.
If you have any of these risk factors, you should talk to you physician about any concerns you may have.
Symptoms of Aneurysm
Different symptoms appear, depending on the type and location of the aneurysm. They can grow for years without any signs or symptoms. If the aneurysm has burst, it may affect other parts of the body.
Abdominal Aortic Aneurysms develop slowly, often over years. The most prevalent sign is a throbbing area in your abdomen but you may also feel a deep pain in your back or side. Many patients complain of a steady pain in their abdomen that does not go away for hours or even days. A rupture will give you a sudden intense pain in your abdomen or back followed by nausea, vomiting, bowel problems, dizziness and an accelerated heartbeat. A rupture can also send you into shock, which is life threatening.
Thoracic Aortic Aneurysms rarely show symptoms until they dissect (a split in the arterial wall) or grow large enough to cause problems. Symptoms include pain in your chest, neck, back or jaw, coughing with sore throat and trouble breathing or swallowing. A rupture will make you feel a sudden intense pain beginning in your upper back and moving down through your abdomen. Pain in your chest or arms can also occur and shock can happen quickly.
Many doctors find that patients with aneurysm often have very few symptoms but complain of stomach pain. In order to diagnose an aneurysm, one or more of the following tests is recommended.
Ultrasound and Echocardiography are simple, pain-free tests that use sound waves to create pictures of the insides of your body.
Computed Tomography Scan (CT Scan) is a pain-free test that uses x rays to take detailed images of your organs. This is done by injecting dye into your veins. The dye makes your arteries visible on the CT scan images.
Magnetic Resonance Imaging (MRI) uses radio waves and magnets to create images of your organs.
Angiography uses dye and special x-rays to show the insides of your arteries. Aortic angiography shows the inside of your aorta specifically.
Treatment Options for Aneurysm
Small aneurysms found early that are not causing symptoms may not need any treatment. Larger aneurysms need to be treated by medications or surgery because of their size. Your doctor may recommend continued testing on any aneurysm that is less than 5 centimeters (about 2 inches) across. The duration of your testing depends on their growth rate and current size.
Medication is prescribed before surgery to lower blood pressure, thus lowering the risk of the aneurysm rupturing. Beta blockers and channel blockers are common medicinal treatments.
Surgery is ordered when an aneurysm is growing at a fast rate and/or the risk for rupture is high. The main types of surgery to repair aortic aneurysms are open abdominal or open chest repair, involving a major incision in the abdomen or chest and this is the most common surgery for aortic aneurysms, and endovascular repair. General anesthesia is used while the aneurysm is being removed. A section of the aorta is grafted, using materials such as Dacron or Teflon. The surgery takes 3 to 6 hours and you will be released from the hospital in 5 to 8 days. However, it will take close to a month to recover.
Prevention of Aneurysm
The best prevention for an aortic aneurysm is to avoid putting yourself at higher risk for developing this condition. You cannot control all risk factors but lifestyle changes (like those discussed above) can help you lower some risks.
Coping with Aneurysm
Following your treatment plan and having ongoing medical care are the most important things for you, followed by avoiding heavy lifting and emotional stress. Depending on the size of your aneurysm, you may not need any treatment. Otherwise, your doctor may prescribe medications.