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Aneurysms

An aneurysm occurs when part of an artery wall weakens, allowing it to balloon out or widen abnormally. Aneurysms are classified by their location in the body. The arteries of the brain and heart are the two most common locations of a serious aneurysm.

Aneurysms can develop slowly over many years and often have no symptoms. An aneurysm occurring near the skin's surface may be painful and include swelling with a visible throbbing mass.

If an aneurysm is left untreated, the aorta's wall may continue to weaken. The artery wall will weaken and become vulnerable to a rupture. The risk of rupture increases as the diameter of the aorta grows.

What happens once you have an aortic aneurysm?

Aneurysms often have no symptoms at first; many are first discovered by accident during an examination for another condition. If the aneurysm is pressing against nearby tissues, you may notice a deep, steady pain in your back, abdomen, or groin.

If it ruptures, it causes a severe, tearing pain in the chest, back, abdomen or brain. A ruptured aortic aneurysm can cause life-threatening internal bleeding and/or a stroke. Symptoms from a ruptured aneurysm may develop suddenly and include:

  • Pain.

  • Shock.

  • Dizziness.

  • Clammy skin.

  • Rapid heart rate.

  • Nausea and vomiting.

  • Low blood pressure.

What causes aneurysms?

Sometimes the cause of an aneurysm is unknown. But these are some factors that make aneurysms more likely:

  • Age.

  • Injury.

  • Smoking.

  • Family history.

  • Disease of the aorta (main artery).

  • High blood pressure (hypertension).

  • A congenital defect, meaning a defect you are born with.

The majority of aortic aneurysms are caused by the hardening of the arteries (atherosclerosis). The hardening develops when cholesterol and fat build up inside the arteries.

Atherosclerosis accelerates the breakdown of collagen and elastin, two proteins that make the walls of the aorta strong and elastic. Over time, the walls of the aorta weaken and become damaged. Elevated blood pressure can then cause the aortic wall to expand and bulge.

Other less common disorders can also cause an aneurysm:

  • Inflammatory diseases, such as Takayasu's arteritis, may block the flow of blood through the aorta and weaken the aortic wall.

  • Genetic disorders, such as Marfan Syndrome or Ehler-Danlos syndrome, can cause the aortic wall to weaken.

  • Aortic aneurysms can also be caused by physical trauma to the chest or abdomen.

What types of tests are used to diagnosis aneurysms?

If your doctor thinks you have an aneurysm in your aorta, you may get an ultrasound test. This test is painless and can locate and measure an aneurysm.

If your doctor is concerned that you have one in your brain, you may get a CT scan, or an invasive test called a CT angiogram. A dye is injected into an artery in an arm or leg and travels to your brain. The dye makes it easier for your doctor to see any problems. A picture of your brain is taken.

Other tests include:

  • Cerebrospinal fluid test: If you've had a subarachnoid hemorrhage, there will most likely be red blood cells in the fluid surrounding your brain and spine (cerebrospinal fluid). Your doctor will order a spinal tap (lumbar puncture) of the cerebrospinal fluid if you have symptoms of a ruptured aneurysm, but a CT scan hasn't shown evidence of bleeding.

  • Magnetic resonance imaging (MRI): An MRI uses a magnetic field and radio waves to create detailed images of the brain, either 2-D slices or 3-D images. A type of MRI that assesses the arteries in detail (MRI angiography) may detect an aneurysm's presence.

What types of treatments and procedures are used to treat aneurysms?

A broken (ruptured) aneurysm needs emergency surgery. Otherwise, there is a low chance of survival.

An unruptured aortic aneurysm may just need to be watched if you don't have any symptoms. Your doctor may recommend medications and preventive measures instead. The decision to operate depends on several factors:

  • Age, general health, other conditions you may have, and your personal choice.

  • Size of the aneurysm relative to its location in the thorax or abdomen and how fast it’s growing.

  • Presence of chronic abdominal pain or risk of thromboembolism.

A large or rapidly growing aneurysm is more likely to need surgery. There are two options for surgery:

  • Open surgery to fit a stent-graft.

  • Endovascular stent-graft surgery.

In a brain aneurysm case, the surgeon will only operate if there is a high risk of rupture. The potential risk of brain damage is too great.

Instead of brain surgery, patients receive guidance on monitoring and managing the risk of a ruptured brain aneurysm. For example, they may be asked to check their blood pressure regularly. If a brain aneurysm ruptures, surgery is likely. This is a medical emergency.

What can I do to support my health when I have an aneurysm?

Preventing an aneurysm is not always possible. Some are congenital, meaning they are present from birth.

However, some lifestyle choices can reduce the risk:

  • Smoking increases your risk. Quit smoking to lower the risk of an aneurysm.

  • Managing blood pressure can minimize the risk of an aneurysm. Normal blood pressure can be achieved through a healthy diet with less salt, regular exercise, and medications.

  • A healthy diet can also reduce cholesterol and decrease the risk of atherosclerosis. Obesity can put extra pressure on the heart, so a better diet is important for reducing stress on the artery walls.

Why choose Presbyterian for aneurysm treatment?

Presbyterian Heart and Vascular Care has a skilled vascular care team who can provide a wide range of services from diagnosis to treatment. Their surgeons are trained in many different techniques and procedures, many of which can provide you with a shorter recovery period and less hospital time.