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A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

ANEURYSM: An aneurysm is an abnormal widening or ballooning of a portion of an artery, related to weakness in the wall of the blood vessel.

COMMON ANEURYSM LOCATIONS:

• Aorta (the major artery from the heart / thoracic aortic aneurysm)
• Abdominal Aorta (the major artery from the heart in the abdomen)
• Brain (cerebral aneurysm)
• Intestine (mesenteric artery aneurysm)
• Leg (popliteal artery aneurysm a.k.a. behind the knee aneurysm)
• Splenic artery aneurysm (intra-abdominal aneurysm)

CAUSES AND RISK FACTORS:

Aneurysms are either congenital (present before birth) or acquired. It is not clear exactly what causes aneurysms. Defects in some of the components of the artery wall may be responsible. In certain cases (abdominal aortic aneurysms), high blood pressure is thought to be a contributing factor.

Atherosclerotic disease (cholesterol buildup in arteries) may contribute to the formation of certain types of aneurysms. Pregnancy is often associated with the formation and rupture of aneurysms of the splenic artery (an artery leading to the spleen).

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SYMPTOMS:

The symptoms vary depending on the location of the aneurysm. Swelling with a throbbing mass at the site of an aneurysm is often seen if it occurs near the body surface. Aneurysms within the body or brain often have no symptoms

In the case of rupture, low blood pressure, high heart rate, and lightheadedness may occur. The risk of death after a rupture is high.

TYPES OF AORTIC ANEURYSYMS:

Aortic aneurysms are classified by shape, location along the aorta and the process that leads to their formation.

The wall of the aorta is made up of three layers: a thin inner layer of smooth cells called the endothelium, a muscular middle layer which has elastic fibers, and a tough outer layer. When the walls of the aneurysm have all three layers, they are called true aneurysms. If the wall of the aneurysm has only the outer layer remaining, it is called a pseudoaneurysm. Pseudoaneurysms may occur as a result of trauma when the inner layers are torn apart.

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SHAPE OF THE ANEURYSM:

Fusiform Aneurysms:

Most fusiform aneurysms are true aneurysms. The weakness is often along an extended section of the aorta and involves the entire circumference of the aorta. The weakened portion appears as a generally symmetrical bulge.

Saccular Aneurysms:

Saccular aneurysms appear like a small blister or bleb on the side of the aorta and are asymmetrical. Typically they are pseudoaneurysms caused either by trauma such as a car accident or as the result of a penetrating aortic ulcer.

Mycotic or Infectious Aneurysms:

The "mycotic" (or "infectious") aneurysm, very rare, is a saccular aneurysm that arises from an artery that has had a certain part of the wall affected by a source of infection usually originating from somewhere else in the body (e.g., the heart) and spreading to the brain blood vessel by the blood stream (i.e., "hematogenous spread").

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WHAT CAUSES AN ANEURYSM:

Degenerative aneurysms:

Degenerative aneurysms are the most common. They occur as the result of breakdown of the connective tissue and muscular layer. The cause could be cigarette smoking, high blood pressure and/or genetic conditions.

Dissecting aneurysms:

Dissecting aneurysms occur when a tear begins within the wall of the aorta causing the three layers to separate similar to what happens to plywood that is left out in the weather. The dissection (separation of the layers) causes the wall of the aorta to weaken, and the aorta enlarges.

Dissections may occur any place along the aorta and treatment depends upon the location. Frequently, dissections involving the ascending aorta are treated with emergency surgery while those involving the descending thoracic aorta are treated with medication.

Although dissections are uncommon, they are the most common of the acute aortic syndromes. They are lethal if not treated. They should be treated only by surgeons who have special expertise.

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WHAT IS THE LOCATION OF AN ANEURYSM:

Thoracic aortic aneurysms:

The aorta is shaped like an old-fashioned walking cane with the short stem of the curved handle coming out of the heart and curling through the aortic arch, which gives off branches to the head and arms. Then the aorta descends through the chest cavity into the abdomen and separates to provide blood to the abdominal organs and both legs. Thoracic aneurysms can occur anywhere along the aorta above the diaphragm, including the ascending aorta, the aortic arch, and the descending thoracic aorta.

Up to 25 percent of aortic aneurysms are thoracic. They can result from various connective tissue disorders (such as Marfan's syndrome), atherosclerosis, previous dissection of the aorta, prolonged high blood pressure (hypertension), and trauma (usually falls or motor vehicle accidents).

Abdominal aortic aneurysms:

Abdominal aortic aneurysms are located along the portion of the aorta that passes through the abdomen. Continuing from the thoracic aorta, the abdominal aorta carries blood down through the abdomen until it eventually splits off into two smaller arteries that provide blood to the pelvis and legs.

Abdominal aortic aneurysms are far more common than thoracic aortic aneurysms, comprising up to 75 percent of aortic aneurysms. They can affect anyone, but are most often seen in men ages 40 to 70. Most abdominal aortic aneurysms are caused by atherosclerosis.

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SIGNS AND TESTS:

Physical exam, ultrasound examination, and CT scan are used to evaluate aneurysms.

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TREATMENT:

Surgery is generally recommended. The timing and indications for surgery differ depending on the type of aneurysm.

Some people are candidates for stent placement. This procedure involves the use of a tube placed inside the vessel and can be performed without an incision, with specialized catheters that are introduced through arteries at the groin. This is called an endovascular repair, a new technique, which should only be performed by experienced physicians. Not all patients with aneurysms are candidates for stenting, however.

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EXPECTATIONS AND PROGNOSIS:

With successful surgical repair, the outlook is often excellent.

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COMPLICATIONS:

The main complications of aneurysm include rupture, infection, and compression of local structures. Rupture of some types of aneurysms can cause massive bleeding, which is often fatal. This is commonly seen with abdominal aortic aneurysms, mesenteric artery aneurysms, and splenic artery aneurysms.

Rupture of aneurysms in the brain can cause stroke, disability, and death. Brain surgery for aneurysms can also result in these complications, if the aneurysm ruptures during surgery and bleeding cannot be controlled.

Infection of the aneurysm, which sometimes follows infection at other sites of the body, can lead to systemic illness and rupture. Clotting of the aneurysm occurs when blood stops moving inside the aneurysm, blocking further blood flow past the site of the aneurysm and depriving the tissues beyond of blood.

In certain cases, aneurysms can compress neighboring structures such as nerves, leading to neurologic problems, such as weakness and numbness. This can occur with popliteal (behind the knee) artery aneurysms.

CALL YOUR DOCTOR:

Call your physician for if you develop any new mass on your body, whether or not it is throbbing.

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Prevention Control of high blood pressure may help prevent some aneurysms. Control of all risk factors associated with atherosclerotic disease (diet, exercise, cholesterol control) may help prevent aneurysms or their complications.