An aneurysm is an outward bulge in the wall of a blood vessel. Although it may occur anywhere in the body, the most worrisome site is the aorta, the major artery that carries blood from the heart. Aortic aneurysms most commonly occur either in the chest or abdomen. Aneurysms disturb local blood flow and increase the risk of blood clot formation, leading to a heart attack or stroke. Aneurysms may also occur inside the heart. If an aneurysm ruptures, blood escapes from the artery, cutting off the supply to tissues beyond the site. A major aortic rupture can cause circulatory collapse and death if not treated immediately.
ARE THERE DIFFERENT TYPES OF ANEURYSM?
Yes. Fusiform aneurysms, the most common type, are characterized by a widening in the circumference of the aorta. Saccular aneurysms are localized out-pocketing of the aortic wall. More important is whether or not the aneurysm is dissecting; a condition where the inner and outer layers of the artery split apart and blood gets between the layers. This is the type of aneurysm most likely to rupture.
WHAT ARE THE SYMPTOMS?
In the chest a thoracic aortic aneurysm, may cause chest pain, hoarseness, cough, difficulty swallowing, or shortness of breath. Dissecting aneurysms in the chest also can cause pain similar to a heart attack or a tearing sensation. Abdominal Aortic Aneurysms are located in the abdomen and do not often cause symptoms since the aneurysm can grow and not be restricted by the soft tissue and organs in that area. While abdominal aneurysms may cause a loss of appetite or weight, it is often diagnosed when the patient is tested for other abdominal conditions. In thin people, it may be seen just under the skin, a small throbbing lump that is tender to touch. Ventricular aneurysms in the heart can cause heart failure or arrhythmias.
WHAT CAUSES ANEURYSMS?
The most common cause of an aortic aneurysm is atherosclerosis. The plaque deposits weaken arterial walls. Aneurysms are also more common in people with hypertension. Left ventricular aneurysms usually develop as a result of a heart attack, but also may be caused by arterial injury; an inflammatory disease, such as infectious endocarditis; or syphilis. The tendency to develop an aneurysm may be inherited.
HOW ARE THEY DIAGNOSED?
An aneurysm may be difficult to diagnose, and may cause no symptoms until it ruptures. If you have any symptoms suggestive of an aneurysm, your doctor will probably order chest X-rays, an echocardiogram, and perhaps a CAT scan or MRI.
WHAT ARE NON-AORTIC ANEURYSMS?
The most serious non-aortic aneurysms occur in the brain. Ruptured cerebral aneurysms are quite serious and may lead to swelling in the brain, narrowing of blood vessels, or stroke. About 60% of its victims die. Ideally, cerebral aneurysms, which may cause headache, weakness, numbness, vision change, or pain behind the eye, should be repaired before a crisis occurs.
Less common non-aortic aneurysms may occur: behind the knee (popliteal), in the lower section of the small intestine (iliac), the thigh (femoral) and, even less frequently, in the upper arm or spleen.
HOW ARE ANEURYSMS TREATED?
Depending upon the size of the aneurysm, your doctor may either treat you medically or recommend a surgical treatment. Medical therapy includes medications to lower your blood pressure and reduce the force of the heart’s contractions. X-rays, CT scans or MRI’s are frequently performed to measure the size and possible growth of the aneurysm.
When surgery is advised, the surgeon now has two options. Traditional surgery involves the replacement of the diseased aorta with a Dacron graft. When the patient has a thoracic ascending aortic aneurysm or a left ventricular aneurysm, surgical intervention is the only option. If the individual is diagnosed with congestive heart failure along with the aneurysm, surgical repair is also advised.
The second less invasive option is stenting. A stent-graft (scaffolding device covered by fabric) may be implanted in the weakened inner wall of the aneurysm to support the aorta and prevent rupture. This procedure may be performed in either the operating room or a catheterization lab. It may involve a small incision in the groin to access the leg arteries and anesthesia maybe required. Patients are usually sent home in half the time after the stenting procedure.
