Aneurysm

Definition:
An aneurysm (AN-u-rism) is a balloon-like bulge in an artery. Arteries are blood vessels that carry oxygen-rich blood from your heart to your body.

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Arteries have thick walls to withstand normal blood pressure. However, certain medical problems, genetic conditions, and trauma can damage or injure artery walls. The force of blood pushing against the weakened or injured walls can cause an aneurysm.

An aneurysm can grow large and burst (rupture) or cause a dissection. Rupture causes dangerous bleeding inside the body. A dissection is a split in one or more layers of the artery wall. The split causes bleeding into and along the layers of the artery wall.

Aneurysms most commonly occur in arteries at the base of the brain (the circle of Willis) and in the aorta (the main artery coming out of the heart, a so-called aortic aneurysm). As the size of an aneurysm increases, there is an increased risk of rupture, which can result in severe hemorrhage, other complications or even death.

Most aneurysms occur in the aorta—the main artery that carries blood from the heart to the rest of the body. The aorta goes through the chest and abdomen.

An aneurysm that occurs in the part of the aorta that’s in the chest is called a thoracic (tho-RAS-ik) aortic aneurysm. An aneurysm that occurs in the part of the aorta that’s in the abdomen is called an abdominal aortic aneurysm.Aneurysms also can occur in other arteries, but these types of aneurysm are less common.

About 14,000 Americans die each year from aortic aneurysms. Most of the deaths result from rupture or dissection.

Early diagnosis and medical treatment can help prevent many cases of rupture and dissection. However, aneurysms can develop and become large before causing any symptoms. Thus, people who are at high risk for aneurysms can benefit from early, routine screening.

Types:
Aortic Aneurysms:

The two types of aortic aneurysm are abdominal aortic aneurysm (AAA) and thoracic aortic aneurysm (TAA).

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Abdominal Aortic Aneurysms:
An aneurysm that occurs in the part of the aorta that’s located in the abdomen is called an abdominal aortic aneurysm. AAAs account for 3 in 4 aortic aneurysms. They’re found more often now than in the past because of computed tomography (to-MOG-rah-fee), or CT, scans done for other medical problems.

Small AAAs rarely rupture. However, an AAA can grow very large without causing symptoms. Thus, routine checkups and treatment for an AAA are important to prevent growth and rupture.

Thoracic Aortic Aneurysms
:
An aneurysm that occurs in the part of the aorta that’s located in the chest and above the diaphragm is called a thoracic aortic aneurysm. TAAs account for 1 in 4 aortic aneurysms.

TAAs don’t always cause symptoms, even when they’re large. Only half of all people who have TAAs notice any symptoms. TAAs are found more often now than in the past because of chest CT scans done for other medical problems.

With a common type of TAA, the walls of the aorta weaken, and a section close to the heart enlarges. As a result, the valve between the heart and the aorta can’t close properly. This allows blood to leak back into the heart.

A less common type of TAA can develop in the upper back, away from the heart. A TAA in this location may result from an injury to the chest, such as from a car crash.

Other Types of Aneurysms:-
Brain Aneurysms
When an aneurysm occurs in an artery in the brain, it’s called a cerebral (seh-RE-bral or SER-eh-bral) aneurysm or brain aneurysm. Brain aneurysms also are sometimes called berry aneurysms because they’re often the size of a small berry.
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The illustration shows a typical location of a brain (berry) aneurysm in the arteries supplying blood to the brain. The inset image shows a closeup view of the sac-like aneurysm.

Most brain aneurysms cause no symptoms until they become large, begin to leak blood, or rupture. A ruptured brain aneurysm causes a stroke.

Peripheral Aneurysms:
Aneurysms that occur in arteries other than the aorta and the brain arteries are called peripheral aneurysms. Common locations for peripheral aneurysms include the popliteal (pop-li-TE-al), femoral (FEM-o-ral), and carotid (ka-ROT-id) arteries.

The popliteal arteries run down the back of the thighs, behind the knees. The femoral arteries are the main arteries in the groin. The carotid arteries are the two main arteries on each side of your neck.

Peripheral aneurysms aren’t as likely to rupture or dissect as aortic aneurysms. However, blood clots can form in peripheral aneurysms. If a blood clot breaks away from the aneurysm, it can block blood flow through the artery.

If a peripheral aneurysm is large, it can press on a nearby nerve or vein and cause pain, numbness, or swelling.

Symptoms:
Symptoms are linked to how big the aneurysm is, how fast it is growing and its location. Very small aneurysms which do not grow may go completely unnoticed. A large cerebral aneurysm (in the brain) may press on nerve tissue and trigger numbness in the face, or problems with the eyes.

Cerebral (brain) aneurysm symptoms:

The following symptoms may be experienced before a cerebral aneurysm ruptures:

Very severe headache that occurs suddenly
#Nausea
#Vomiting
#Eyesight problems
#Seizures (fits)
#Loss of consciousness
#Confusion
#A drooping eyelid
#Stiff neck
#Light sensitivity
If the cerebral aneurism bursts it will cause bleeding in the brain and a hemorrhagic stroke – it can also cause intracranial hematoma (blood leaks into the area surrounding the brain causing a blood clot in the skull).

Aortic aneurysm symptoms:

The vast majority of aortic aneurysms occur in the patient’s abdominal aorta. It is not uncommon for a patient to have an aneurysm and experience no symptoms for several years. Many of them are difficult to detect because of this. Some aortic aneurysms will never rupture. It is hard to predict which ones will never grow, which grow slowly, and which ones grow rapidly.

When symptoms occur, they tend to include:
A throbbing sensation in the abdomen
#Back pain
#Abdominal pain – this pain frequently spreads towards the back If the aneurysm continues to grow and presses on the spine or chest organs the patient may #experience:
#Coughing
#Loss of voice
#Breathing difficulties
#Problems swallowing

Sometimes an aortic aneurysm can be discovered by a GP (general practitioner, primary care physician) when performing a routine examination of the abdomen. He/she may detect a lump that pulses at the same rate as the patient’s heartbeat – it is often located high up in the abdomen, slightly to the right.

Causes:
The force of blood pushing against the walls of an artery combined with damage or injury to the artery’s walls can cause an aneurysm.

A number of factors can damage and weaken the walls of the aorta and cause aortic aneurysms.

Aging, smoking, high blood pressure, and atherosclerosis (ath-er-o-skler-O-sis) are all factors that can damage or weaken the walls of the aorta. Atherosclerosis is the hardening and narrowing of the arteries due to the buildup of a fatty material called plaque (plak).

Rarely, infections, such as untreated syphilis (a sexually transmitted infection), can cause aortic aneurysms. Aortic aneurysms also can occur as a result of diseases that inflame the blood vessels, such as vasculitis (vas-kyu-LI-tis).

Family history also may play a role in causing aortic aneurysms.

In addition to the factors above, certain genetic conditions may cause thoracic aortic aneurysms (TAAs). Examples include Marfan syndrome, Loeys-Dietz syndrome, and Ehlers-Danlos syndrome (the vascular type).

These conditions can weaken the body’s connective tissues and damage the aorta. People who have these conditions tend to develop aneurysms at a younger age and are at higher risk for rupture or dissection.

Trauma, such as a car accident, also can damage the aorta walls and lead to TAAs.

Researchers continue to look for other causes of aortic aneurysms. For example, they’re looking for genetic mutations that may contribute to or cause aneurysms.

Risk Factors:-

Who Is At Risk for an Aneurysm?
Certain factors put you at higher risk for an aortic aneurysm. These include:

#Male gender. Men are more likely than women to have abdominal aortic aneurysms (AAAs)-the most common type of aneurysm.
#Age. The risk for AAAs increases as you get older. These aneurysms are more likely to occur in people who are 65 or older.
#Smoking. Smoking can damage and weaken the walls of the aorta.
#Family history of aortic aneurysm. People who have family histories of aortic aneurysm are at higher risk of having one, and they may have aneurysms before the age of 65.
#Certain diseases and conditions that weaken the walls of the aorta. For more information.

Car accidents or trauma also can injure the arteries and increase your risk for an aneurysm.
Diagnosis:
If you have aortic aneurysm, but no symptoms, your doctor may find it by chance during a routine physical exam. More often, doctors find aneurysms during tests done for other reasons, such as chest or abdominal pain.

If you have an abdominal aortic aneurysm (AAA), your doctor may feel a throbbing mass in your abdomen. A rapidly growing aneurysm about to rupture can be tender and very painful when pressed. If you’re overweight or obese, it may be hard for your doctor to feel even a large AAA.

If you have an AAA, your doctor may hear rushing blood flow instead of the normal whooshing sound when listening to your abdomen with a stethoscope.

Specialists Involved
Your primary care doctor may refer you to a cardiothoracic or vascular surgeon for diagnosis and treatment of an aortic aneurysm.

A cardiothoracic surgeon performs surgery on the heart, lungs, and other organs and structures in the chest, including the aorta. A vascular surgeon performs surgery on the aorta and other blood vessels, except those of the heart and brain.

Diagnostic Tests and Procedures:-
To diagnose and evaluate an aneurysm, your doctor may recommend one or more of the following tests.

Ultrasound :
This simple, painless test uses sound waves to create pictures of the structures inside your body. Ultrasound shows the size of an aneurysm, if one is found.

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Computed Tomography Scan:
A computed tomography (CT) scan is a painless test that uses x rays to take clear, detailed pictures of your internal organs.

During the test, your doctor will inject a special dye into a vein in your arm. This dye highlights the aorta on the CT scan images.

Your doctor may recommend this test if he or she thinks you have an AAA or a thoracic aortic aneurysm (TAA). A CT scan can show the size and shape of an aneurysm. This test provides more detailed images than an ultrasound.

Magnetic Resonance Imaging:
Magnetic resonance imaging (MRI) uses magnets and radio waves to create images of the organs and structures in your body. This test is very accurate at detecting aneurysms and pinpointing their size and exact location.

Angiography:
Angiography (an-jee-OG-ra-fee) uses a special dye injected into the bloodstream to highlight the insides of arteries on x-ray pictures. An angiogram shows the amount of damage and blockage in blood vessels.

An angiogram of the aorta is called an aortogram. An aortogram may show the location and size of an aortic aneurysm.

Treatment:
Aortic aneurysm treatment:

The aim is to prevent the aneurysm from bursting. There are usually two choices – 1. Watch and wait. 2. Surgery. How big the aneurysm is, how fast it’s growing, and sometimes its location are vital factors in determining what treatment to use.

#If the aneurysm is small – if the patient’s aneurysm is no bigger than 1.6 inches (about 4cm) in diameter, and there are no symptoms, it may be best to tack the approach of watching-and-waiting, instead of surgery. This is also known as “watchful waiting”. In most cases the risks caused by surgery are greater than the likely risks caused by a small aneurysm. Watchful waiting usually involves an ultrasound scan every 6 to 12 months. The patient will be asked to be alert for any signs or symptoms of dissection or rupture.

Small observational studies have suggested that statins can significantly reduce the growth rate of small abdominal aortic aneurysms, Janet T. Powell, M.D., Ph.D., Professor at Imperial College and Honorary Consultant for United Healthcare in London revealed.

#If the aneurysm is medium-sized – a medium-sized aneurysm is no bigger than 2.2 inches (5.5 cm) in diameter and bigger than 1.6 inches (4 cm). It is more difficult now to weigh up the risks of surgery against the risks of a medium-sized aneurysm. The chances of both patient and doctor deciding on one or the other are pretty even.

#Large-sized or rapidly-growing aneurysm – a large aneurysm is larger than 2.2 inches (5.5 cm) in diameter, while a rapidly growing one is expanding at more than 0.5 cm every six months. In most cases the patient will require surgery. The damaged section of the aorta will be removed and replaced with a graft (synthetic tube) which is sewn into place. This is major surgery – open-abdominal or open-chest surgery. The patient will take several months to recover completely.

Endovascular surgery – this is a less invasive procedure to repair an aneurysm. A graft is attached to the end of the catheter which is inserted through an artery and threaded up into the aorta. The graft – consisting of a woven tube covered by a metal mesh support – is placed at the site of the aneurysm and stuck there will pins or small hooks. This graft strengthens the weakened section of the aorta and prevents the aneurysm from rupturing. Patients recover much faster with this procedure, and seem to have fewer complications.

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The illustration shows the placement of an endovascular stent graft in an aortic aneurysm. In figure A, a catheter is inserted into an artery in the groin (upper thigh). The catheter is threaded to the abdominal aorta, and the stent graft is released from the catheter. In figure B, the stent graft allows blood to flow through the aneurysm.

Endovascular repair reduces recovery time to a few days and greatly reduces time in the hospital. However, doctors can’t repair all aortic aneurysms with this procedure. The location or size of the aneurysm may prevent a stent graft from being safely or reliably placed inside the aneurysm.

Long-term survival for patients undergoing surgical repair of intact abdominal aortic aneurysms has improved in recent decades, according to a Swedish study.

Thoracic aortic aneurysm treatment:

Surgery is usually required as soon as the aneurysm reaches a diameter of 2.2 inches (5.5 cm). Patients with Marfan syndrome, as well as those with close relative who had an aortic dissection may undergo surgery if the aneurysm is smaller. Beta blockers have been shown to slow down the growth of thoracic aortic aneurysms for patients with Marfan syndrome.

Cerebral (brain) aneurysm treatment:

Ruptured cerebral aneurysm treatment

Patients with brain aneurysms have two options if the aneurysm has ruptured: 1. Surgical clipping. 2. Endovascular coiling.

#Surgical clipping – the aneurysm is closed off. The surgeon removes a section of the skull to get to the aneurysm and finds the blood vessel that feeds it. A tiny metal clip is placed on the neck of the aneurysm to block off the blood flow to it.

#Endovascular coiling – a catheter is inserted, usually in the groin, and is threaded through the body to the brain where the aneurysm is located. A guide wire is used to push a soft platinum wire through the catheter and into the aneurysm. The wire coils up inside the aneurysm and disrupts the blood flow, making it clot. The clotting of the blood effectively seals off the aneurysm from the artery.

#Endovascular, noninvasive thoracic aortic aneurysm repair (TEVAR) is safer than open aneurysm repair (OAR) as it is associated with fewer cardiac, respiratory, and hemorrhagic complications, as well as a shorter hospital stay, this study revealed.

Patients whose aneurysms are coiled instead of clipped have a better survival rate over five years, according to a long-term study of the International Subarachnoid Aneurysm Trial (ISAT). However, another study found that over time outcomes are similar.

Smokers who undergo coil embolization are at a high risk of having another aneurism elsewhere later on, this study revealed .

The following cerebral aneurysm treatments help relieve symptoms as well as managing complications:

#Painkillers – usually for headaches.

#Calcium channel blockers – these stop calcium for entering cells of the blood vessel walls. They reduce the amount of widening and narrowing of blood vessels; often a complication of a ruptured aneurysm.

#A vassopressor – this is an injected drug which raises blood pressure; widens blood vessels which have remained stubbornly narrowed. The aim is to prevent stroke.

#Anti-seizure drugs – seizures may occur after an aneurysm has ruptures. Examples include levetiracetam (Keppra), phenytoin (Dilantin, Phenytek, others) and valproic acid (Depakene).

#A ventricular catheter – this can reduce the pressure on the brain caused by hydrocephalus (excess cerebrospinal fluid). The catheter, which is placed in the spaces filled with fluid inside the brain, drains the excess liquid into an external bag. It may be necessary to place a shunt system – a shunt (flexible silicone rubber tube) and a valve. The shunt system is a drainage channel that starts in the brain and ends in the patient’s abdominal cavity.

#Rehabilitation therapy – sometimes a subarachnoid hemorrhage causes brain damage, resulting in impaired speech and bodily movements. Rehabilitation therapy helps the patient relearn vital skills.

Unruptured cerebral aneurysm treatment:

The unruptured cerebral aneurysm can be sealed off with surgical clipping or endovascular coiling. Deciding on this is not easy as the risks are often equal, and sometimes higher than the potential benefits. The following will help the surgeon determine what to do:

#Exactly where the aneurysm is.
#How big the aneurysm is.
#The patient’s age.
#The patient’s general state of health
#Whether the patient has a family history of ruptured aneurysms.
#Whether the patient has any congenital conditions which may raise the risk of the aneurysm rupturing.

Patients with hypertension (high blood pressure) need to have their condition carefully monitored – proper control of hypertension significantly reduces the likelihood of a rupture.
Prevention:
The best way to prevent an aortic aneurysm is to avoid the factors that put you at higher risk for one. You can’t control all of the risk factors for aortic aneurysm, but lifestyle changes can help you reduce some risks.

Lifestyle changes include quitting smoking and controlling conditions such as high blood pressure and high blood cholesterol.

Talk to your doctor about programs and products that can help you quit smoking. Also try to avoid secondhand smoke.

Follow a healthy diet and be as physically active as you can. 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.

For more information on following a healthy diet, see the National Heart, Lung, and Blood Institute’s (NHLBI’s) Aim for a Healthy Weight Web site, “Your Guide to a Healthy Heart,” and “Your Guide to Lowering Your Blood Pressure With DASH.” All of these resources include general information about healthy eating.

Talk to your doctor about the amounts and types of physical activity that are safe for you. For more information on physical activity, see the Diseases and Conditions Index Physical Activity and Your Heart article and NHLBI’s “Your Guide to Physical Activity and Your Heart.”

Follow your treatment plans for any other medical conditions you have. Take all of your medicines as prescribed.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources;
http://www.nhlbi.nih.gov/health/dci/Diseases/arm/arm_treatments.html
http://en.wikipedia.org/wiki/Aneurysm
http://www.medicalnewstoday.com/articles/156993.php

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