Brief overview
- Symptoms: Often asymptomatic, but depending on location may include pain, indigestion, cough, shortness of breath, headache, visual disturbances or facial paralysis. In case of rupture extreme pain, circulatory collapse, coma.
- Examination and diagnosis: Usually incidental finding on abdominal ultrasound, brain scan, or chest x-rays
- Treatment: Closure of the aneurysm, usually minimally invasive, by vascular prosthesis, stent, bypass, coiling, clipping, wrapping or trapping. Smaller aneurysms are often only observed.
- Disease progression and prognosis: If detected in time, the prognosis is good. If an aneurysm ruptures, more than 50 percent of patients die.
- Prevention: No general prevention of congenital aneurysms; all measures that reduce the risk factor of high blood pressure, healthy lifestyle.
- Causes and risk factors: Congenital malformations, familial predisposition, atherosclerosis, hypertension, rarely bacterial infections
What is an aneurysm?
According to the definition, an aneurysm is a pathological widening of a blood vessel. The vessel wall is usually dilated like a sac, berry or spindle. In most cases, aneurysms form in arteries. They have a higher blood pressure than veins.
Aneurysm in the abdomen most common
More information about the vessel outpouching in the head can be found in the text Aneurysm in the brain.
Frequency
An estimated three to nine percent of men 65 and older have an aneurysm of the abdominal aorta. Men are about six times more likely to be affected than women. Sometimes aneurysms occur more frequently within a family.
Often symptom-free for a long time
Aneurysms often do not cause any symptoms. Doctors therefore often discover them by chance during an ultrasound or brain scan examination – or, in the worst case, only when they rupture. Then there is an acute danger to life as a result of the blood loss. If an aneurysm in the head ruptures, the blood also exerts pressure on the brain. This is also potentially life-threatening.
However, many people live with such a vascular change for decades without ever learning about it.
What forms of aneurysms are there?
Depending on the type of vessel wall change, doctors distinguish between the following forms of aneurysms:
- “True” aneurysm (aneurysm verum): In the so-called “true aneurysm”, the various layers in the blood vessel wall are all preserved in a continuous manner, but the vessel wall is dilated in a saccular manner.
- Split aneurysm (aneurysm dissecans): A layer in the wall of the blood vessel is torn and blood collects between the layers of the vessel wall.
What are the symptoms of an aneurysm?
If an aneurysm is not yet too large, it is usually not noticeable. What symptoms larger ones cause depends on their location.
Abdominal aortic aneurysm: symptoms
If an abdominal aortic aneurysm becomes so large that it presses on surrounding structures, the following symptoms sometimes occur:
- Pain, especially in the lower abdomen, usually sharp and persistent, regardless of body position
- @ Back pain radiating to the legs
- Rarely, digestive complaints
- Palpable, pulsating structure under the abdominal wall
Burst aortic aneurysm in the abdomen
The larger the aneurysm, the greater the risk of rupture. This is especially true for aortic aneurysms larger than six centimeters in diameter.
If such an aortic aneurysm ruptures, the patient suddenly experiences unbearable abdominal pain that radiates to the back. This is accompanied by nausea and vomiting.
The massive blood loss causes the blood pressure to drop rapidly. The patient suffers circulatory shock.
Such a hemorrhage is an absolute emergency! About half of those affected do not survive a ruptured aortic aneurysm.
Chest aortic aneurysm: symptoms
If the aneurysm is located on the aorta at the level of the chest (thoracic aortic aneurysm), the following symptoms sometimes occur:
- Chest pain
- Cough
- Hoarseness
- Dysphagia
- Shortness of breath (dyspnea)
If the airways are severely constricted in a thoracic aortic aneurysm, pneumonia recurs in many cases.
Burst thoracic aortic aneurysm
Thoracic aneurysms over five and a half centimeters in diameter are particularly dangerous. If they rupture, severe chest pain usually occurs. The symptoms are similar to those of a heart attack. Rupture is fatal in three out of four cases.
Symptoms of an aneurysm in the brain
Some aneurysms in the brain (intracranial or cerebral aneurysm) press on individual cranial nerves. The eyes are particularly frequently affected, and facial paralysis also occurs. Of the vascular bulges in the head, the ACOM aneurysm is the most common. It affects the anterior communicating artery.
Ruptured cerebral aneurysm
If the vessel wall ruptures in a brain aneurysm, massive symptoms occur. The most common is a so-called subarachnoid hemorrhage, or SAB. This involves bleeding into the space between the brain and the meninges, or more precisely the arachnoid membrane.
Due to the solid skullcap, the blood does not escape and quickly exerts increased pressure on the brain. The symptoms of an aneurysm in the brain occur due to the increased intracranial pressure:
- Sudden onset of severe headache
- Nausea
- Vomiting
- Neck stiffness
- Drowsiness
- Drowsiness
If the patient survives, stroke-typical sequelae such as hemiplegia are possible.
Aneurysm symptoms in the popliteal artery
An aneurysm in the leg, more precisely in the popliteal artery, also usually goes unnoticed. However, if the popliteal aneurysm has a diameter of more than three centimeters, a blood clot (thrombosis) may form.
As a result, the lower leg is no longer supplied with sufficient blood. The calf in particular hurts, and sensory disturbances such as tingling, numbness and cold sensations appear.
If the blood clot is carried along by the blood flow, there is a risk that it will block a vessel at a narrower point, for example in the lung (pulmonary embolism).
How do you recognize an aneurysm?
Doctors often discover an aneurysm by chance during a routine examination, such as an abdominal ultrasound, X-ray of the lungs or brain scan. An aneurysm can be detected on these.
When listening with a stethoscope, the doctor sometimes also detects suspicious flow sounds above the vessel outpouching. In slim people, an abdominal aortic aneurysm with a diameter of more than five centimeters can usually be felt as a pulsating swelling through the abdominal wall.
Imaging techniques
How can an aneurysm be treated?
Treatment is not always necessary for an aneurysm. Whether treatment is an option and which treatment method is suitable depends on various factors:
- Size of the aneurysm
- Location
- Probability of rupture
- Surgical risk
- Condition of the patient
- Desire of the patient
Aneurysm – operate or wait?
Smaller, asymptomatic aneurysms are often not treated immediately. Instead, the physician checks them once a year, and slightly larger ones twice a year using ultrasound. It is important that the blood pressure remains in the lower normal range (120/80 mmHg). For this, the doctor may prescribe an antihypertensive medication.
If an aortic aneurysm reaches a diameter of six centimeters in the abdominal aorta or five and a half centimeters in the chest cavity, the risk of the vessel wall rupturing increases. In this case, an aortic aneurysm must be treated. However, there is also a risk of the vessel rupturing during the procedure.
In the case of an aneurysm in the brain, the situation is often even more delicate. Depending on the location and condition of the vessel, the risk of causing a brain injury during surgery varies, potentially leading to serious permanent damage. Surgery or not – this decision must be weighed by the physician and patient on an individual basis.
Surgical treatment for aortic aneurysm
Stent (endovascular procedure)
An aortic aneurysm can often be stabilized with the help of a stent. Through a small incision in the inguinal artery, the physician advances a small tube to the wall bulge. The stent bridges the weak spot in the blood vessel.
Vascular prosthesis
During surgery for an aortic aneurysm, the surgeon removes the dilated portion of the artery wall through an incision and replaces it with a tube- or Y-shaped vascular prosthesis.
If there is dilatation near the heart, the aortic valve must often also be replaced (artificial valve).
Treatment of cerebral aneurysm
For the treatment of an aneurysm in the brain, there are mainly two procedures that complement each other: clipping or coiling. It depends in particular on the shape of the aneurysm which method is individually more promising.
Coiling
In coiling, the physician usually stabilizes the vessel with the aid of a wire mesh (stent) and closes the aneurysm in the brain from the inside with a special platinum coil. To do this, he first pushes a microcatheter through the groin to the cerebral artery in question.
These microcoils only partially fill the brain aneurysm. However, blood platelets accumulate and clump together, thus closing the aneurysm.
Clipping
If coiling is not possible or if the aneurysm has already ruptured, the physician will usually perform clipping. In this procedure, the surgeon closes the aneurysm in the brain using a miniclip. To do this, he first opens the skull. He creates a gentle access to the vessel bulge between the natural coils of the brain.
The aneurysm is then closed with the aid of a high-resolution surgical microscope.
With this method, the aneurysm can usually be reliably closed. Follow-up examinations are then no longer necessary. However, the procedure is less gentle than coiling.
Wrapping
Another neurosurgical option is wrapping. It is used in complicated cases when clipping is not possible. In this case, the surgeon stabilizes the unstable vessel section from the outside by wrapping the vessel. This is done, for example, with the help of the patient’s own tissue or with gauze or plastic. A connective tissue capsule is then formed around the outside.
Trapping
Another method is known as trapping. This relieves the pressure on the aneurysm in the brain by placing clips or balloons in front of and behind it. However, the procedure is only possible if the affected cerebral artery is not the only supply route for certain areas of hearing.
Treatment of an aneurysm of the popliteal artery
Life after an aneurysm
The prognosis for an aneurysm depends on several factors. Whether it is an aneurysm in the head in the abdomen, chest or heart, life expectancy and prognosis depend critically on location, size and treatability. The diameter of the vessel outpouching and the rate at which it enlarges also affect prognosis.
High risk of death in case of rupture
The most serious complication is rupture of the aneurysm – the bleeding is potentially life-threatening. In such a case, mortality depends on where the aneurysm is located.
For example, the mortality rate for a ruptured abdominal aortic aneurysm is over 50 percent; if the aorta ruptures in the chest, it is as high as 75 percent. If an aneurysm of a blood vessel in the head ruptures, about half of the patients die within the first 28 days. Survivors sometimes suffer damage similar to that which sometimes occurs after a stroke.
If an aneurysm is discovered and treated in time, the chances of recovery are sometimes good, depending on the location and size of the aneurysm. If the aneurysm surgery is successful, the chances of survival increase. However, surgery, especially in the brain, carries its own risks.
