An aneurysm is a permanent enlargement of an artery (artery) in a spindle or sac shape. It may be congenital or acquired. This arterial dilation can occur when there are changes in the wall of the blood vessel at certain locations.
What is an aneurysm?
Infographic showing the anatomy and location of an aneurysm in the brain and its surgical treatment. Click image to enlarge. The term aneurysm, which comes from the Greek, means “dilation.” This is a congenital or acquired, localized, permanent, spindle- or sac-shaped dilation of an artery due to a bulge or widening of the vessel wall. There is a risk that the dilated blood vessel will rupture and life-threatening internal bleeding will occur. Aneurysms are more common in older people. Risk factors for this are high blood pressure and hardening of the arteries (arteriosclerosis). If an aneurysm ruptures, only life-saving surgery can help. An extensive aneurysm near the heart or in the brain is life-threatening because it threatens to rupture as a result of the increased pressure on the vessel wall and can lead to internal bleeding. In this case, life-saving surgery is inevitable. Classification:
- True aneurysm – all three layers of the wall of the artery bulged out.
- Split aneurysm – due to bleeding into the walls of the vessel, the vessel walls are split and the middle layer of the vessel is injured
- Fake aneurysm – the bulge is caused by vessel wall injuries, for example, during catheter interventions for the diagnosis and treatment of heart disease.
Causes
An aneurysm can have several causes. The most common cause of a true aneurysm is arterial calcification. Much less commonly, infections are responsible. Syphilis, for example, can cause arterial dilation in the aorta, through which blood flows from the heart into the systemic circulation. Other infections tend to affect arteries farther from the heart. A heart attack or Chagas disease, which is caused by parasites, can cause an aneurysm to form in the heart wall. A spurious aneurysm is a possible result of catheter procedures. In a split aneurysm, the middle layer of the vessel, the media, of the artery is injured.
Symptoms, complaints, and signs
Many people are affected by an aneurysm and do not experience it throughout their lives. They have no symptoms, and the aneurysm does not lead to any illness or secondary disease. The number of unreported cases cannot be statistically determined. However, it is more likely that an aneurysm will cause symptoms sooner or later. This usually happens when it grows. This means that the bulge it forms expands and becomes larger. It then presses on other parts of the brain and causes discomfort and disturbances here. These depend on the location of the aneurysm. For example, the speech center can be affected – the patient then increasingly suffers from speech and also word-finding disorders. He forgets words and terms, and finds it difficult to formulate entire correct sentences. Frequently, the sentence is also broken off halfway through without the patient himself realizing this. If the aneurysm presses on the visual center, for example, impaired vision is to be expected. This can affect both visual acuity and the visual field itself. Eye flickering and loss of three-dimensional vision are common signs of aneurysm. If the sense of balance is impaired, the patient will have difficulty controlling his or her gait and body. Stumbling and falls are the result. All of these signs indicate neurological deficits and abnormalities.
Course
Disease symptoms of an aneurysm do not become apparent until extensive vasodilatation of a specific artery occurs. For example, an aneurysm of the aorta in the chest may cause difficulty swallowing, coughing, hoarseness, difficulty breathing, and circulatory problems in the arms or brain. Possible symptoms of an abdominal aortic aneurysm include back pain, pain radiating to the legs, urinary urgency and diarrhea or constipation alternately. Rarely, the aneurysm is also noticeable by a throbbing “bump” in the abdomen. If the wall of a split aneurysm of the aorta ruptures, an abrupt, crushing pain occurs. In this case, the emergency physician must act immediately.When arteries far from the heart dilate, there is a risk of blood clots forming, which can then travel to the heart or lungs and cause an embolism. An aneurysm in the brain can have serious consequences because it can press on cranial nerves and cause deficits.
Complications
An aneurysm can form in various places in the body and, depending on its location, can cause serious complications. If the blood clot is not detected and treated in time, blood flow to vital organs as well as limbs is no longer guaranteed. There is a risk of blood stasis, embolisms and strokes. If an afferent or branching area closes or the vessel wall of the aneurysm bursts, for example on the head or near the heart, the affected person’s life is in danger. The relief measures then immediately initiated cannot exclude permanent damage such as paralysis or irreparable functioning of the brain. The risk group for the formation of a blood clot is broad. Elderly and young people are equally affected, as are accident victims. Alternative methods cannot eliminate a blood clot. The doctor alone decides on the type of operation and therapy. In the case of surgical intervention, a greater loss of blood may occur. If the clot is removed from the head, it may be necessary to prevent cerebral hemorrhage by means of cerebral ventricular drainage. If the symptom is recognized and removed in time, other measures must be followed to prevent inflammation, cardiovascular problems, and bacterial invasion of the wound. In some cases, patients experience difficulty swallowing and shortness of breath, depending on the severity of the procedure. Patients can counteract complications by following subsequent medication and a healthy lifestyle.
When should you see a doctor?
Medical advice should be sought immediately if an aneurysm is suspected. A quick visit to the doctor is recommended if there is chest pain, coughing, or abnormal breathing sounds that occur quite suddenly and are not due to any other cause. Sudden hoarseness, difficulty swallowing or shortness of breath are also warning signs that should be clarified as soon as possible. If there is also severe abdominal pain or bleeding, the aneurysm may have already ruptured – at the latest, emergency medical services must be called. In the event of a sudden drop in blood pressure or circulatory shock, first aid measures must be taken until the emergency physician arrives. A visit to the doctor is therefore almost always necessary in the case of an aneurysm. If the vasodilatation has already been diagnosed by a doctor, attention must be paid to the typical warning signs. If there is a suspicion that the aneurysm has ruptured, the only option is to go to the emergency room. In general, if there are unexplained feelings of numbness and coldness in the limbs, as well as other symptoms that cannot be attributed to any specific cause, a doctor should be consulted. Prompt treatment can usually prevent further complications.
Treatment and therapy
For an aortic aneurysm: If the aneurysm is not that large or the risk of surgery is too high, the doctor may treat risk factors such as high blood pressure with medications (beta blockers) and urge the patient to avoid physical exertion and ensure regular digestion. In the case of a larger aneurysm or uncontrollable high blood pressure, surgery cannot be avoided. In this case, the dilated part of the vessel is replaced by a plastic prosthesis. Newer procedures also allow for a smaller (minimally invasive) procedure in which the surgeon inserts a stabilizing stent prosthesis, a kind of umbrella, into an artery via a catheter], which can then be unfolded in the vessel. For a brain aneurysm: Neurosurgeons take care of an aneurysm in the brain. In the past, they would clip the aneurysm during open surgery or reinforce the vessel wall with tissue or Teflon. Today, they can also intervene in the vessels in the brain through the inguinal artery and stabilize the vessels so that the risk of rupture is eliminated.
Outlook and prognosis
As a rule, an aneurysm has a very negative effect on the patient’s quality of life and, in the worst case, can even lead to the death of the affected person in the process. In the case of an aneurysm, diarrhea or constipation occurs primarily and further also a strong urge to urinate.In most cases, these symptoms do not disappear on their own, so there is no self-healing. Not infrequently, the aneurysm also leads to coughing and shortness of breath, due to which loss of consciousness may occur. Difficulty swallowing can also occur, making it much less easy or difficult to take liquids and food. Whether the aneurysm is treated usually depends on the severity of the condition. In some cases, the risk of surgery is too high, so treatment is exclusively with the help of medication. This can limit the symptoms. However, it cannot be ruled out that the life expectancy of the patient is reduced by the disease. Furthermore, in severe cases, surgical intervention cannot be avoided. It cannot be universally predicted whether complications will occur. In some cases, the affected person is dependent on a catheter after surgery.
Prevention
Preventing an aneurysm is possible only to a limited extent. It is important to avoid or treat risk factors such as high blood pressure, smoking, alcohol, obesity, and high blood lipid levels as much as possible. Living a healthy life, eating a sensible diet, and getting enough exercise is definitely a reasonable approach to preventing the development of an aneurysm.
Follow-up
After treatment of an aneurysm, regular follow-up with a neurosurgeon or neurologist is required during the first few months. At follow-up appointments, a procedure called echocardiography is often performed to check the function of the aortic valve. At the beginning, these examinations usually take place once a week, then only once a year. Many patients also have to take medication after the operation, such as rhythm-stabilizing agents or painkillers. After the hospital stay, which usually lasts seven to nine days, rehabilitation often follows. In addition, those affected should eliminate risk factors as far as possible. For example, nicotine should be completely avoided, as this can cause vasoconstriction and make the clip unstable. Furthermore, blood pressure should also be very well adjusted. Here, too, regular checks and, if necessary, treatment of the blood pressure with medication are necessary. If patients suffer from diabetes mellitus, the attending physician must also adjust this well, since diabetes that is not optimally adjusted could have negative effects on the blood vessels. In general, a healthy lifestyle should be maintained, which means that those affected should exercise regularly, avoid nicotine, as well as pay attention to a healthy diet.
Here’s what you can do yourself
Patients with an aneurysm attend regular check-ups with a specialist to monitor the condition of the malformation and respond to critical new developments in a timely manner. Outside of medical care, patients also pay sensitive attention to their physical condition and register potential changes in the aneurysm. Since an emergency is possible at any time in patients with aneurysms, the person’s environment must be informed about the condition and possible first aid measures. In the case of an aneurysm, a medical emergency usually manifests itself in a collapse of the circulation, with a simultaneous rapid drop in blood pressure. Many patients with aneurysms receive medical agents for therapy and prevention of complications, which are to be taken according to the doctor’s prescription. In addition, a healthy lifestyle tailored to the disease helps to potentially prevent or minimize complications as well as exacerbations of the disease. For example, a significant risk factor in an existing aneurysm is high blood pressure. To help themselves, patients reduce their excess weight and also adjust their diet to the symptom. In addition, it is beneficial to refrain from smoking in the case of an existing aneurysm. Alcohol consumption should also be greatly reduced and, if possible, completely discontinued.