Aneurysm

 

When doctors speak of an aneurysm, they mean the bulging of the wall of a blood vessel. Such a pathological bulge, which usually occurs in arteries and only rarely in veins due to the higher blood pressure, can be congenital or develop later in life. An existing aneurysm is not necessarily dangerous in itself, and those affected do not even feel it. But that's the tricky thing: In the long term, there is a risk that the aneurysm will burst, i.e. the bulging vessel wall will tear. Depend on where it is in the body, life-threatening internal bleeding then occurs .

Aneurysms in the head, on the carotid artery or on the abdominal aorta are particularly dangerous. Doctors differentiate between different forms of aneurysm, depending on where it occurs:

• Aortic aneurysm: It affects the aorta, the body's largest artery that runs through the entire trunk between the heart and pelvis. Depending on whether the curvature of the aortic wall occurs at chest or abdominal level, above below the diaphragm, doctors speak of a "thoracic aortic aneurysm" ("thorax" means "chest") or an "abdominal aortic aneurysm".
• Brain aneurysm: The technical term "cerebral aneurysm" arises in the arteries of the brain in the head.
• Cardiac wall aneurysm: This type of aneurysm affects the heart. In this case, it was not the wall of a blood vessel that widened, but that of the heart itself. Most of the time, it happens because someone has already had a heart attack .

Aneurysm can also occur in the carotid artery, kidney, groin or in the leg at the hollow of the knee. Sometimes doctors don't distinguish aneurysms based on where they are on the body, but rather according to their type.

There are these types of aneurysms:

• Aneurysm verum: "Verum" is Latin and means "real". In a verum aneurysm, the bulging affects all three layers that make up a vessel wall. Usually such aneurysms affect the renal arteries.
• Aneurysm dissecans: Here the inner of the three layers of a vessel wall tears, whereupon blood seeps between the wall layers and the vessel literally splits up. Doctors also speak of an "aortic dissection".
• Aneurysm spurium: This form is also called “aneurysm falsum” in technical terms, ie “false aneurysm”. The reason for the name is that this is not a real vasodilation, but simply a bruise that is connected to an artery and gives the appearance of a bulge.

Depending on the underlying cause, doctors describe inflammatory, traumatic or arteriosclerotic aneurysms.

The risk of developing an aneurysm increases as you get older. Men are affected significantly more often than women. Doctors suspect that around 2.6 percent of men and 0.5 percent of women over the age of 60 in Germany have an abdominal aortic aneurysm without knowing about it.

Aneurysm: symptoms

Basically, aneurysms do not cause symptoms. Doctors discover most vascular changes by chance , for example during an ultrasound examination or on an X-ray that they take for another reason. Those affected often do not experience symptoms until the aneurysm ruptures.

Depending on the location, there may be symptoms beforehand:

An aortic aneurysm in the chest area can cause the following symptoms:

• Breathing problems
• to cough
• hoarseness
• difficulties swallowing 
• Circulatory disorders in the arms

With an existing abdominal aortic aneurysm, people sometimes have:

• Back pain
• a stomach ache

Symptoms of the cardiac wall aneurysm:

• Patients have symptoms similar to those of cardiac insufficiency or cardiac arrhythmias .
• shortness of breath
• Inefficiency
• exhaustion
• Shortness of breath
• Edema
• An irregular heartbeat or drowsiness can also be the result of a heart wall aneurysm.

Symptoms of an aneurysm in the brain:

An aneurysm in the head does not cause symptoms until it bursts. Those affected then suddenly have very severe headaches or pain in the face. They often feel sick, some pass out.

It is important to identify an aneurysm as early as possible before it ruptures. This is what doctors call the crack in the vessel wall. Because once an aneurysm has burst, there is no time to lose: if, for example, an abdominal aortic aneurysm ruptures, the person affected can bleed to death internally.

With a cardiac wall aneurysm there is a risk of bleeding into the pericardium, which after a short time leads to shock with cardiac arrest . And a cerebral hemorrhage is also life-threatening and can have consequences that are similar to those of a stroke. Call an ambulance immediate if you suspect that someone has ruptured aneurysm.

Properly treating an aneurysm

The method medical professionals use to treat an aneurysm depends on a number of factors. Above all, the size and length of the bulge are decisive, but also the position in the body, how old the patient is and whether he has concomitant diseases such as high blood pressure or diabetes . For example, doctors often treat young patients with a brain aneurysm directly; for older patients with a small abdominal aortic aneurysm, they often wait and see. In general, the greater the risk that the aneurysm will tear, the more important it is to treat it quickly. In the event of a crack, doctors must intervene immediately, as this is life-threatening.

Wait or operate

If the doctor has discovered an aneurysm that is still intact, treatment is not necessarily required. It is often enough to check the aneurysm regularly to detect changes in good time. Because the more pronounced the bulge, the greater the risk that it will tear - because the vessel wall becomes thinner and thinner at the stretched point. If patients know about their aneurysm, doctors advise them to undergo preventive surgery if they are larger than a certain size.

Under no circumstance should you wait until the rupture occurs: the rupture of a vessel is a life-threatening emergency that should be in the hands of a doctor as soon as possible. Because the heart pumps new blood into the defective vessel with every beat, the surgeon does not have much time to save the patient from bleeding to death in an emergency operation.

Brain Aneurysm: Coiling Method

Doctors call one method of operating on an aneurysm in the head "coiling". Specialized vascular surgeons insert tiny platinum spirals ("coils") into the aneurysm using a catheter and close it from the inside: once it is completely filled with the coils, blood can no longer flow into the sac and exert pressure on the thin vessel wall.

Patients with coils must think about follow-up care: once a year they should have their aneurysm examined by magnetic resonance imaging ( MRI ) after the procedure .

Brain Aneurysm: Clipping Method

Another popular surgical method that is often used when coiling is not possible is called "clipping". The surgeons place one or more titanium clips on the protuberance from the outside, thus preventing blood from flowing in and tearing the vessel under pressure.

Aortic aneurysm: stent or vascular prosthesis

Doctors can stabilize an abdominal aortic aneurysm during surgery. They either set a stent through which the blood can flow, or replace the worn area of ​​the vessel wall with a vascular prosthesis that looks like a tube.

A vascular prosthesis is also the method of choice for a thoracic aneurysm in the chest area. How long the operation will last cannot be said in general because the effort involved depends on the type and sizes of the aneurysm and also on the patient's constitution. Sometimes, when the bulge is close to the heart, surgeons also have to replace the aortic valve with an artificial one in the case of an aneurysm in the chest.

Aftercare

How long a patient has to stay in hospital after aneurysm surgery depends on the type and surgical method, the location of the aneurysm and the patient's condition. Doctors can discharge many aneurysm patients home after a few days, while others have to stay in the hospital for two weeks.

 

The causes of an aneurysm

How an aneurysm develops is different for each patient.

Congenital vascular malformations

Sometimes the bulges in the vessel walls are congenital and accidental. People with the hereditary disease “Marfan Syndrome”, for example, have a genetic weakness of the connective tissue and are prone to aneurysms.

Lifestyle and age as risk factors

In other people, aneurysm does not develop until later in life. Then lifestyle often plays a decisive role: about every second aneurysm is caused by calcification of the vessels ( arteriosclerosis ). Smoking is also considered damaging to the blood vessels, as is chronic high blood pressure (hypertension) .

The risk of developing an aneurysm also increases with age because the vessel walls change over the course of life and lose their elasticity. Men are affected more frequently than women. Older men who smoke and suffer from high blood pressure are particularly at risk.

Aneurysm: diagnosis

Often times, an aneurysm is discovered by chance during another examination, such as:

• Magnetic resonance imaging (MRI)
• Chest x-ray
• Ultrasound diagnostics on the abdomen

If a doctor discovers an aneurysm, he will examine it more closely using an MRI, ultrasound or computed tomography (CT) scan and then assess whether treatment is immediately necessary or whether it has yet to be awaited.

The consequences of an aneurysm

How dangerous an aneurysm is depends, among other things, on its diameter.

Biggest danger: the crack

The worst consequences threaten a rupture of the drained vascular wall, known in technical terms as "rupture": The bleeding is then sometimes so severe that the patient bleeds to death within a short time or - in the case of an aneurysm in the head - sustains permanent damage such as after a stroke .

The best for life expectancy would therefore be if a doctor discovered the aneurysm in the brain, heart, brain or abdomen in good time, regularly checked the progression of the vascular changes - and if necessary operated on the aneurysm.

Treat early

Treating the bulge prematurely does involve some risks. After an aneurysm operation on the brain, heart or abdominal cavity, the chance of survival is much greater than with an undiscovered aneurysm that threatens to tear at any time.

Can you prevent an aneurysm?

Anyone can prevent aneurysm: by not smoking and by eating a healthy diet and exercising a lot, contributing to low blood pressure and reducing the risk of atherosclerosis. Hereditary aneurysms cannot be prevented.

Because more than two percent of men between 65 and 75 years of age probably have an abdominal aortic aneurysm without knowing about it, the health insurance companies have been paying for a new early detection measure since 2018: Men of this age have a one-time right to an ultrasound examination of the abdomen so that an aneurysm is detected in good time. The examination may be carried out by a general practitioner, urologist, internist, surgeon or radiologist with the appropriate authorization.