An aneurysm is a widening of an artery, which can weaken the arterial wall and lead to a tear or rupture.
The ruptured aneurysm can cause severe bleeding (hemorrhage), stroke, or death. An aneurysm usually develops in the aorta, but can also occur in the brain, carotid arteries in the neck, groin, or back of the legs.
Aneurysms usually develop in your abdomen and chest in the aorta (the main artery that starts from your heart and runs through your chest). They are known as abdominal and thoracic aortic aneurysms.
Aneurysms can also occur in the brain. This is called a cerebral or intracranial aneurysm. Aneurysms that form in the carotid arteries in the neck, groin, or back of the legs are called peripheral aneurysms.
The causes of aneurysm
Risk factors for aneurysms include:
- Some types of aneurysm, such as those in the abdomen, are more common in older men. Brain aneurysms are more common in women after age 45.
- Research suggests that genetic mutations may contribute to the development of aneurysms.
- Smoking: former and current smokers
- High blood pressure
- Atherosclerosis and high cholesterol
- Obesity
- Alcoholism
- car accidents
- Chest trauma
- Previous aneurysms
A decreased risk of abdominal aneurysm is associated with:
- female gender
- non-white race
- Diabetes
Symptoms
Small aneurysms usually cause no symptoms. However, depending on the location and size of the aneurysm, it can also cause pain in the groin, lower back, lower abdomen, chest, or above or behind the eye.
Larger aneurysms can also lead to:
- fainting spells
- vision changes
- a droopy eyelid
- numbness or weakness on one side of your face or body
- heart failure symptoms (shortness of breath, swelling)
- abdominal pulsation
Diagnosis and tests
There are several tests available that can help diagnose an aneurysm.
Physical examination
When your healthcare professional presses on your abdomen during a physical exam, they may be able to detect an abdominal aortic aneurysm.
However, aneurysms often do not cause symptoms and cannot be found during a physical exam. « Silent » aneurysms are sometimes discovered during surgery or when an X-ray, ultrasound, CT scan, MRI, or echocardiogram is done for another reason.
There is currently insufficient evidence to recommend that women undergo a screening abdominal ultrasound, regardless of their smoking history.
Ultrasound
This procedure uses sound waves to create an image of the inside of your body and can reveal an aneurysm and its size.
Depending on your symptoms, your doctor may recommend other tests, including:
CT-scan
These use x-rays to take pictures of your internal organs. The technician will inject a dye into your vein, which will appear on x-ray images, revealing the size and shape of the aneurysm. A CT scan provides a more detailed image than an ultrasound.
MRI
This test is very accurate in detecting aneurysms and identifying their exact size and location.
Angiography
During an angiogram, a special dye is injected into a blood vessel so that it can be seen and examined for problems.
Aneurysm care and treatment
If an aneurysm is found, your healthcare provider can monitor it closely to see if it gets bigger over time. This is called “watchful waiting”. Your provider will order regular ultrasounds every 3 to 12 months, depending on the size and location of the aneurysm. If the aneurysm is large, it may need to be repaired immediately before it ruptures or leaks.
Medications
During watchful waiting, your healthcare professional may prescribe high blood pressure medication to keep your aneurysm from growing. The drugs will decrease the force of the blood flowing against the walls of the arteries. These drugs include those that help relax blood vessels, such as:
- Vasodilators
- Angiotensin converting enzyme inhibitors
- Angiotensin II receptor blockers
- Calcium channel blockers
Your healthcare professional may also prescribe blood thinners (sometimes called “blood thinners”) to help prevent blood clots from forming in the affected part of the artery.
Surgery
If an aneurysm grows too large, or if it grows too quickly, or if it puts pressure on other important parts of your body and causes symptoms, your doctor may recommend surgery to repair the aneurysm and prevent it from rupturing. Several new, less invasive techniques have been developed to repair aneurysms.
Surgery involves removing the damaged part of your artery and replacing it with a synthetic (artificial) tube called a graft. This can be achieved through open surgery or by threading the graft through a small incision in your artery and securing it over the site of the aneurysm (this is called endovascular surgery).
The type of surgery recommended by your healthcare professional will depend on:
- The location and size of the aneurysm
- Other illnesses that may affect your tolerance to surgery and any complications that may arise during or after surgery
Your healthcare professional can perform emergency surgery in the event of a ruptured aneurysm, but the surgical risks are much higher and the survival rate is lower.
Aneurysm lifestyle and management
You can reduce your risk of developing an aneurysm by making sensible lifestyle changes, including:
- Quitting smoking or using tobacco products
- Lose weight if necessary
- Reduce cholesterol and fats in your diet
- Get screened by ultrasound, if appropriate for your age and gender