is an aneurysm?
(an-your-ism) is excessive (abnormal) stretching of the wall of an
artery, vein or the heart. By definition this is
usually 1.5-2 times the normal diameter (distance across) of an artery.
This may result from weakening of the wall by injury, disease, or an abnormality
present at birth. Arterial aneurysms may occur in any blood vessel and
are often caused or aggravated by high blood pressure. Aneurysms aren't
always lifethreatening, but bad things can happen if an aneurysm bursts
in the wrong place. A stroke (or brain attack) may occur
if one bursts in the brain. If an aneurysm on a large blood vessel or
the heart wall bursts, a person could bleed to death. Venous aneurysms,
such as varicose veins in the legs, may be annoying but are not life threatening.
Further discussion will focus on arterial aneurysms.
is an aneurysm diagnosed?
can be detected by angiography (x-ray using dye injected into an artery)
or by imaging techniques such as echocardiography ,
an M.R.I. (magnetic resonance imaging) or a computed
tomography (C.T.) scan. The aneurysm may be small and not cause symptoms.
The person's doctor will want to check it regularly to see if it is enlarging.
Which study is used may depend on where the size and location of the aneurysm.
aneurysms can occur in any blood vessel, artery or vein, three areas are
responsible for most serious aneurysms. These areas include:
and thoracic aorta.
will be discussed below.
is the largest artery in the body. It carries oxygen rich blood directly
from the heart. All arteries in the body arise from the aorta or other
arteries that are branches of the aorta. Aortic aneurysms may occurring
in the chest (near the heart) are called thoracic aortic aneurysms. Those
occurring in the portion of the aorta in the abdominal cavity (below the
diaphragm but above the point where the aorta branches into femoral [leg]
arteries) are called abdominal aortic aneurysms.
aneurysms- Occur in 5-7 percent of people over 60
in the United States. About 15,000 Americans die each year from ruptured
abdominal aortic aneurysms (12th to 13th leading cause of death).The
incidence increases with age and is 3 to 11 times more common in men.
75% of abdominal aortic aneurysms occur in people over 60 years of age.
abdominal aortic aneurysms (75%) do not cause any symptoms but
are are detected on routine physical exam (when the doctor feels or
hears a pulsation in the abdomen between the solar plexus and belly
button) or during an unrelated x-ray or ultrasound exam.
can be confirmed using ultrasound, CT scan or MRI-
ultrasound is most commonly used for screening purposes. Some health
care providers recommend screening all men between 60-80 years of
age at least once. The exam is not repeated in men having no evidence
of aneurysm. Routine screening is not currently recommended in women
common symptom of aneurysm is pain in the area where it is located.
Symptoms may be caused by stretching or rupture of the aneurysm,
pressure on nearby organs, or decreased blood flow below the aneurysm.
abdominal, back or flank pain that is not relieved
by changing position
(loss of appetite), nausea and vomiting may occasionally occur.
pain or coolness in the leg or foot may happen if blood flow below
the aneurysm is blocked.
of abdominal aortic aneurysms presenting with the above symptoms rupture
(burst). Most aneurysms that rupture are contained within the tissue
between the abdominal cavity and aorta. Because bleeding is contained
most patients receiving proper medical care survive. Infrequently
an aneurysm breaks through this tissue and bleeds into the abdominal
cavity. Because this space is much larger bleeding is not controlled
and a patient usually dies (70-90%) quickly from excess blood loss.
aneurysms occur in the chest and are usually detected
on chest x-ray or other imaging studies done for an unrelated reason (i.e.-accidently
discovered). Most have no symptoms. Rupture almost always causes death
because of rapid blood loss into the chest cavity.
on the size of the aneurysm and whether or not symptoms are present.
The risk of rupture increases as the aneurysm gets larger. Most aneurysms
are small enough to be followed with ultrasound exam on a yearly basis.
increase in size from 0.3 to 0.5 centimeters (1/8
to 1/4 inch) per year on average. Risk of rupture increases greatly
when size is greater than 5.5 centimeters or the size increases greater
then 0.5 centimeters in less than six months). The risk of heart attack
during surgical repair is as high as 20% during surgical repair done
emergently (after the appearance of symptoms).
follow up is appropriate for patients who are asymptomatic with
an aneurysm less than 3.5 centimeters (yearly ultrasound), asymptomatic
and have an aneurysm 3.5 to 5 centimeters (twice yearly ultrasounds).
repair consists of removal of the aneurysm and replacement of
the affected part of the aorta with a synthetic graft.
Repair is best done electively (before symptoms or rupture occur while
a patient is in relatively good health) . Repair should be strongly
considered for all low risk patients ( those without severe heart
or lung disease and a life expectancy greater than 3-5 years) with
an aneurysm larger than 5 centimeters, patients with aneurysms of
any size that are symptomatic, aneurysms between 4 to 5 centimeters
with an enlargement greater than 0.5 centimeters in less than six
months, or high risk patients (severe heart or lung disease) with
aneurysms that are either symptomatic or larger than 7 centimeters.
of surgical repair include heart attack /death (uncommon during elective
repair), excessive bleeding or injury to the bowel-ureters-kidney,
intestines, or spinal cord (due to blood flow interruption).
Graft Implant is a new and still experimental techique that passes
a synthetic graft through the arteries in the groin to form a "tube
within a tube". That is it expands and lines the inside of the
aortic vessel while allowing blood to pass through the hollow center.
Results thus far look very promising with recovery often taking only
several days instead of the several weeks typical for surgical repair.
be stressed that thoracic aneurysms are much less common than brain
or abdominal aortic aneurysms.
aneurysm- A much more common occurrence in the chest
is a "dissecting aneurysm". Dissecting aneurysms occur when
blood pumped from the heart creates a tear between the tissue layers
of the aorta. Blood is then pumped between the layers of the arterial
wall as well as through the normal artery channel. This tear usually
occurs in the aorta a short distance from the heart. The aorta often
is not excessively dilated before the dissection occurs. Risk factors
include high blood pressure, particularly high diastolic blood pressure.
Dissection can also occur from trauma such as motor vehicle accidents.
severe sudden tearing pain in the back between the shoulder blades,
chest pain or flank pain.
aneurysm is a medical emergency requiring surgery if a patient's health
permits. Complications include paralysis in the lower body (because
the arteries supplying blood to the lower spinal cord arise from the
thoracic aorta), heart attack, kidney failure or rupture (causing
aren't always dangerous, but if one bursts in the brain, a stroke results.
They're often caused or aggravated by high blood pressure but may occur
in young otherwise healthy people. Brain aneurysms (called berry aneurysms)
usually occur at points where the brain arteries branch or are just
about to enter brain tissue in an area known as the subarachnoid
space. Rupture in this area is often very serious because the blood
pressure is higher in this area than in smaller arteries that have already
entered the brain tissue. Ruptured subarachnoid aneurysms cause about
10% of all strokes but cause a higher percent of strokes in younger
people (under 40 years).
or a small leak from a berry aneurysm may cause sudden severe onset
of a headache. The headache is often on the top or back portion of the
head. Neck stiffness may also be present.
describe these headaches as "the worst of my life" or "it
feels like my head is going to explode". If the leaking is more
severe symptoms can vary from mild drowsiness to deep coma. It is important
to realize that many people get headaches, some more frequently than
activities, including sexual intercourse, may precipitate headache due
to aneurysm stretching.
having a headache that is much more severe or different than previous
headaches should contact their doctor or go to an emergency room immediately.
with the above symptoms will usually receive a CT scan in the emergency
department. Newer CT scanners will detect upto 90-95% of leaking aneurysms.
If the CT scan is normal but the doctor still suspects an aneurysm is
present further tests may be ordered.
is concern the aneurysm is leaking (small amount of bleeding into subarachnoid
space) a lumbar puncture (spinal tap) may be performed.
Spinal fluid in the lower spinal cord mixes with spinal
fluid from the subarachnoid space; therefore, bleeding into the subarachnoid
spinal fluid will be detected by lumbar puncture.
a brain angiogram may instead be performed. Dye is injected into an
artery near the brain and a series of x-ray pictures is used to make
a "movie" of the blood as it circulates in brain blood vessels.
Special equipment (not available at most hospitals) is required to perform
a biplanar (3 dimensional) angiogram.
usually the preferred way to follow an aneurysm electively. That is
an aneurysm is present but does not have to be operated on because it
is small enough and not causing symptoms.
by a patient's doctor. This will often be a neurologist in consultation
with a neurosurgeon. Small asymptomatic aneurysms may be followed with
yearly or twice yearly imaging studies. Larger or frequently symptomatic
aneurysms are treated surgically by "clipping" the aneurysm.
"Stroke" for more information
Aneurysms, although rare, typically occur within the
first two weeks after a large heart attack. Following a large heart attack
much of the heart muscle in the left ventricle (main pumping
chamber of the heart) may be dead. Dead muscle and scar tissue may stretch
and dilate to form an aneurysm. Symptoms may include chest pain or pressure,
pain in the jaw or arms, trouble breathing or fainting spells. Rupture of
a ventricular aneurysm is usually fatal.
a blood vessel that carries oxygenated blood from the heart
to the body.
up af fat and cholesterol deposits within the wall of an artery.
Atherosclerotic arteries lose their elasticity (become more
unit of measurement. Approximately 0.4 inches. 100 cm equals
of arteries supplying heart muscle with blood from atherosclerosis.
tomography uses a x-ray beam to scan the selected body part.
With computer enhancement pictures of the body's internal
structures are created.
uses high frequency sound waves and a computer to "see"
inside the body.
in the back over the kidneys (near bottom of ribs)
the heart chamber pumping oxygenated blood to the entire body.
needle is placed into the spinal canal (below where the spinal
cord ends) in the lower back to obtain spinal fluid. Spinal
fluid is analyzed to determine if infection or bleeding is
present in the brain.
resonance imaging machine uses a special magnet to polarize
hydrogen molecules present in body tissues and computer to
interpret this information and create a picture. Excellent
pictures of body tissues and blood vessels can be obtained.
special fluid produced by structures near the brain that bathes
the brain and spinal cord.
injury to a part of the brain due to interrupted blood flow
from either blockage or rupture of an artery in the brain
space between the inside of the skull and brain surface that
is filled with cerebral spinal fluid.
tube or hose shaped artificial material that replaces the
portion of an artery that was removed.
vessels returning blood from the body to the heart. Veins
are much thinner than arteries and under much lower blood
Sites with information about aneurysms
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