Aneurysm (Aneurysmal Dilatation): Symptoms, Causes, Diagnosis & Treatment

An aneurysm occurs when an artery’s wall weakens and causes an abnormally large bulge. This bulge can rupture and cause internal bleeding. Although an aneurysm can occur in any part of the body, they most commonly occur in the brain, aorta, legs, and spleen.

Aneurysmal Dilatation usually doesn’t cause symptoms, so one might not realise the presence of an aneurysm even if it’s large. Aneurysms can develop in several parts of the body, and can be classified as:

  • Aortic Aneurysm –  When aneurysms develop in the aorta, which is the major blood vessel carrying blood from the heart to the vital organs.
  • Abdominal Aortic Aneurysm – When aneurysms develop in the section of the aorta that passes through the abdomen.
  • Thoracic Aortic Aneurysm – When aneurysms develop in the section of the aorta that passes through the chest.
  • Brain Aneurysm – When aneurysms develop in the blood vessels that supply blood to the brain.
  • Peripheral Aneurysm – When aneurysms develop in the blood vessels in other parts of the body, such as legs, groin or neck.

About 13,000 deaths occur each year in the United States from aortic aneurysms. Cranial aneurysms incidence rates are estimated between 0.4% and 3.6%. Those who don’t have risk factors have expected the prevalence of 2 to 3%. When compared to males, females are more likely to have aneurysms, especially those who are between 60 and 80 years of age. Aneurysmal Dilatation, though rare in children, has different incidences and features than adult aneurysms. More than 95% of aneurysms occur in adults. The mortality rate for a pediatric aneurysm is lower when compared to adults. Intracranial hemorrhages are twice more likely to be due to aneurysms than cerebral arteriovenous malformations in whites and are four times less in certain Asian populations.

Some small aneurysms have a low risk of rupture. The doctor will assess the size, location, and appearance of an aneurysm, and study the medical and family history, to clarify the risk of rupture. The doctor will then compare that risk to the risk of treatment and decide whether to manage or treat the Aneurysmal Dilatation.

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How Does Aneurysm Affect Your Body?

The aorta has a relatively low-resistance circuit for circulating blood and the lower extremities have higher arterial resistance. The repeated trauma of a reflected arterial wave on the distal aorta may injure an already weakened aortic wall and lead to aneurysmal degeneration. Systemic hypertension further increases the injury, accelerates the expansion of existing Aneurysmal Dilatation, and also contributes to their formation. The occurrence and expansion of an aneurysm depend on the local hemodynamic factors and factors intrinsic to the arterial segment itself.

What Are The Causes of Aneurysm?

An aneurysm can occur due to different reasons, such as:

  • Family history – People who have a family history of aneurysms are more likely to have an aneurysm than those who don’t.
  • Hardening of the arteries (atherosclerosis) – Atherosclerosis occurs when fat and other substances build up on the lining of a blood vessel. This condition may increase the risk of an aneurysm.
  • High blood pressure – The risk of subarachnoid hemorrhage is greater in people who have a history of high blood pressure.
  • Blood vessel diseases in the aorta – Abdominal aortic aneurysms can be caused by diseases that cause blood vessels to become inflamed.
  • Trauma –  Trauma such as being in a car accident, can cause abdominal aortic aneurysms.
  • Infection in the aorta –  Infections, such as a bacterial or fungal infection, may rarely cause abdominal aortic aneurysms.
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What Are The Risk Factors of Aneurysm?

  • Smoking – Smoking is the most significant risk factor for aneurysms, especially for abdominal aortic aneurysms. Smoking destroys the walls of the arteries and breaks down the lining. Over time, plaque and clots form in an effort to repair the wall, but they actually make the wall weaker.
  • Hypertension – Hypertension, or high blood pressure, is a disease in which the blood flows through the arteries at an elevated rate. Hypertension is the leading cause of subarachnoid hemorrhage, or bleeding between the brain and the surrounding membrane, which occurs when a brain aneurysm ruptures. The bleeding can also damage the brain and lead to a hemorrhagic stroke, which can cause weakness or paralysis of an arm or a leg, vision problems, seizures, and trouble speaking or understanding language.
  • Atherosclerosis – Atherosclerosis is a condition that develops due to the build-up of a waxy substance called plaque in the arteries. As plaque continues to build up, it hardens and narrows the arteries, and restricts the flow of oxygen to organs and other parts of the body.
  • Illicit Drug Use or Drug Abuse – Certain illicit drugs, like cocaine and methamphetamine, can spike a person’s blood pressure and inflame the blood vessels, which increase the risk for brain aneurysms.
  • Infection – Mycotic aneurysms are those caused by a bacterial infection that typically originates in the heart, and causes the artery wall to become infected and dilated. Some examples include endocarditis, vasculitis, and untreated syphilis.
  • Family History – People with a family history of aortic aneurysms have an elevated risk and may develop aneurysms before the age of 65.
  • Bicuspid Aortic Valve – The aortic valve allows blood to flow from the heart to the aorta, and prevents blood from flowing back from the aorta to the heart. Unlike a normal aortic valve, which has three leaflets to allow for this flow, a bicuspid aortic valve has only two. People with bicuspid aortic valve are believed to have a higher risk for a thoracic aneurysm due to weakness in the aorta.
  • Poor Diet – A diet high in saturated fat and cholesterol can increase the risk of atherosclerosis and hypertension
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What Are The Symptoms of Aneurysm?

Following are the potential signs of an Aneurysmal Dilatation by its type:

  • Cerebral Aneurysm – Double vision, vision loss, dilated pupils, sudden onset headache, pain above and behind the eye, eyelid drooping, nausea, vomiting, weakness, numbness, difficulty in speaking, pulsing sound in one ear, etc.
  • Abdominal Aortic Aneurysms – Sudden onset abdominal pain, blood in the urine or stool, abdominal bloating, fainting, etc.
  • Thoracic Aortic Aneurysms – Sudden onset, severe, “ripping” chest pain, shortness of breath, hoarseness, difficulty in swallowing, etc.
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How is Aneurysm Diagnosed?

Diagnosis of an aneurysm can be done by:

  • Computed Tomography (CT) scan – A CT scan can help identify bleeding in the brain. Sometimes a lumbar puncture may be used if the doctor suspects a ruptured cerebral aneurysm with a subarachnoid hemorrhage.
  • Computed Tomography Angiogram (CTA) scan – CTA is a more precise method of evaluating blood vessels than a standard CT scan. CTA uses a combination of CT scanning, special computer techniques, and contrast material (dye) injected into the blood to produce images of blood vessels.
  • Magnetic Resonance Angiography (MRA) – Similar to a CTA, an MRA uses a magnetic field and pulses of radio wave energy to provide pictures of blood vessels inside the body. As with CTA and cerebral angiography, a dye is often used during MRA to make blood vessels show up more clearly.
  • Cerebral angiogram – During this X-ray test, a catheter is inserted through a blood vessel in the groin or arm and moved up through the vessel into the brain. A dye is then injected into the cerebral artery. As with the above tests, the dye allows any problems in the artery, including aneurysms, to be seen on the X-ray. Although this test is more invasive and carries more risk than the above tests, it is the best way to locate small (less than 5 mm) brain aneurysms.
  • Abdominal ultrasound – This test is most commonly used to diagnose abdominal aortic aneurysms. During this painless exam, a small amount of warm gel is applied to the abdomen as the patient lies on the back. The gel helps to eliminate the formation of air pockets between the body and the instrument that the technician uses to see the aorta i.e. a transducer. The technician presses the transducer against the skin over the abdomen and moves it from one area to another. The transducer sends images to a computer screen that the technician monitors to check for a potential aneurysm.
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How To Prevent & Control An Aneurysm?

Quit smoking – Smoking is a greater risk factor for an aneurysm than it is for atherosclerosis i.e. the cardiovascular disease where fatty deposits accumulate on the arterial wall and further weakens them.

Healthy diet – A healthy diet includes a variety of fruits, vegetables, and whole grains. It also includes lean meats, poultry, fish, beans, and fat-free or low-fat milk or milk products. A healthy diet is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar.

Treatment of An Aneurysm

The treatment of an aneurysm depends on its size, location, and whether it has ruptured or is at risk for rupture. The doctor may decide on a wait-and-watch approach, medication, surgery, or a combination of treatments.

  • Wait and Watch – All types of aneurysms that are small and asymptomatic may only require close and careful monitoring, with imaging studies (X-rays, ultrasound, CT, or MRI) performed periodically. The size and how fast it grows, however, will determine how frequently it should be checked.
  • Medications – Blood pressure medicines such as calcium channel blockers and beta blockers may be prescribed to control blood pressure because hypertension can further weaken an aneurysm and increase the risk of leaking or rupture. Statins such as (atorvastatin) may also be used to prevent vasospasm, which is a condition in which the arteries in the brain narrow after a brain aneurysm rupture. Brain aneurysms that have burst will require emergency surgery for the Aneurysmal Dilatation itself and evacuate blood from the skull, or drain excess fluid from the brain.
  • Endovascular Embolization – This is a treatment in which coils are inserted into an aneurysm to stabilize it and prevent blood flow. The wire causes a blood clot and destroys the Aneurysmal Dilatation.
  • Microvascular Clipping – This is a treatment in which a small titanium clip is placed across the neck of an aneurysm to prevent blood flow.
  • Flow Diversion – For large or wide aneurysms where the doctor doesn’t advise a watch-and-wait approach, flow diversion treatment is used. The treatment uses a device made of fine metal wires that guide blood flow through the artery and past the aneurysm, resulting in a closure of the Aneurysmal Dilatation.
  • Open Repair – During the open repair, the surgeon removes the Aneurysmal Dilatation and a portion of the aorta. The section of the aorta is then replaced with a graft made from a material such as Dacron or Teflon.
  • Endovascular Stenting – For this treatment, the surgeon threads a catheter into the aneurysm, uses an X-ray to visualize the artery, and inserts collapsed stent/graft into the Aneurysmal Dilatation. The stent/graft allows blood flow through the aorta instead of an aneurysm and reinforces the weakened section to the aorta to prevent a rupture.

Aneurysm – Lifestyle Tips

  • Quit smoking – Any kind of tobacco use can increase the likelihood of an aneurysm.
  • Monitoring the diet – The amount of sodium and cholesterol in the diet must be reduced. One must eat lean meats, lots of fruits and vegetables, and whole grains.
  • Avoiding strenuous activities – Things like shoveling snow, chopping wood, and lifting heavy weights can actually put a strain on an existing aneurysm. However, moderate exercise is good for the body.
  • Eliminating stress – High-stress and emotional situations that could cause the blood pressure to rise and increase the likelihood of an aneurysm to rupture must be avoided.

What Are Recommended Exercises For Person With Aneurysm?

  • Start slowly and emphasize duration over intensity. Gradually progress to exercising 15 to 20 minutes, three or more days per week.
  • All exercise training, whether aerobic or resistance, should be performed at the moderate-to-low intensity.
  • In case of gait or balance problems, consider adding balance-training exercises to the program.
  • Some yoga activities may be useful for helping to control blood pressure.

Aneurysm And Pregnancy – Things to Know

Aneurysms are rarely detected in pregnant women. However, ruptured aneurysms during pregnancy and delivery is an unpredictable complication with a substantial risk of death for both the mother and infant.

Common Complications Related To An Aneurysm

  • Thromboembolism – Depending on where the clot has traveled to, thromboembolism can cause pain in the extremities or the abdomen. If a clot travels to the brain, it can cause a stroke.
  • Dissection of the aorta – People who have an aortic dissection, often describe a tearing or ripping pain in the chest that is abrupt and excruciating, and the pain can travel as the dissection progresses along the aorta. The pain can radiate toward the back.
  • Severe chest and/or back pain – If a silent or diagnosed aortic aneurysm in the chest ruptures, severe chest or back pain may arise. Such symptoms may help hospital medical staff diagnose an aneurysm.
  • Angina – Certain types of an aneurysm can lead to angina, another type of chest pain; the pain is related to narrowed arteries supplying the heart itself (causing myocardial ischemia and possibly a heart attack).
  • Sudden extreme headache – If a brain aneurysm leads to subarachnoid hemorrhage (a kind of stroke), the main symptom is a sudden extreme headache. Often, this is so severe that it is unlike any previous experience of head pain.

Other FAQs About An Aneurysm

Q. Are there any warning signs of a brain aneurysm?

A. Aneurysms are unpredictable and may not show any symptoms until they rupture. The symptoms and warning signs of an aneurysm vary based on whether it’s ruptured or not. Symptoms of an unruptured aneurysm include a headache or pain behind or above the eye, which can be mild or severe.

Q. Can an aneurysm be cured?

A. Aortic aneurysms are treated with medicines and surgery. Small aneurysms that are found early and aren’t causing symptoms may not need treatment. Other Aneurysmal Dilatations need to be treated.

Q. Can you get an aneurysm from stress?

A. Although the exact cause of an aneurysm is unclear, certain factors contribute to the condition. For example, damaged tissue in the arteries can play a role. The arteries can be harmed by blockages, such as fatty deposits. This stress can damage the arteries because of the increased pressure.

Q. Do you die instantly from a brain aneurysm?

A. There is a brain aneurysm rupturing every 18 minutes. Ruptured brain aneurysms are fatal in about 40% of cases. Of those who survive, about 66% suffer some permanent neurological deficit. Approximately 15% of patients with aneurysmal subarachnoid hemorrhage (SAH) die before reaching the hospital.

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