Aneurysm: Types, warning signs, causes, first aid!
An aneurysm is a balloon-like bulge in the wall of blood vessels, usually arteries. Aneurysms develop at weak points in the vascular wall and can be congenital or develop only in the course of life. Usually you don’t feel them. It’s dangerous when the aneurysm ruptures. Then life-threatening bleeding can occur. Read here which symptoms can occur, who is particularly at risk and what you should do then.
Aneurysm: short overview
- Description: pathological bulging of a blood vessel, most frequently affected is the abdominal aorta, followed by the thoracic and cerebral arteries, in case of rupture, life-threatening bleeding is imminent.
- Symptoms: often asymptomatic, but depending on the situation, pain, digestive problems, coughing, shortness of breath, headaches, visual disturbances or facial paralysis. Extreme pain during tearing, circulatory collapse, coma
- Causes: congenital malformations, family predisposition, arteriosclerosis, high blood pressure, rarely bacterial infections
- Diagnosis: mostly random findings with abdominal ultrasound, brain scan or chest X-ray
- Treatment: Closure of the aneurysm, usually minimally invasive, by vascular prosthesis, stent, bypass, coiling, clipping, wrapping or trapping (see text). Smaller aneurysms often only need to be observed.
- Forecast: if detected in time, the forecast is good. If an aneurysm ruptures, more than 50 percent of patients die.
An aneurysm is a pathological weakness of a blood vessel, where the vessel wall usually dilates in the shape of a sack, berry or spindle. In most cases, aneurysms form in arteries because they are under higher pressure than the veins.
Mostly the abdominal aorta is affected
In about 75 percent of cases, the balloon-shaped vascular sacculations occur in the course of the aorta in the abdominal cavity. However, aortic aneurysms in the chest area are also common, as are aneurysms in the brain and in the popliteal fossa. Even a heart aneurysm is possible.
Often free of complaints for a long time
Aneurysms often do not cause any complaints. They are therefore often only discovered by chance during an examination by ultrasound or brain scan – or at worst only when they tear. Then there is acute danger to life – because of the massive blood loss or in the head also because of brain damage.
However, many people live with the vascular changes for decades without ever knowing about them. Experts estimate that two to three percent of the adult population carry an aneurysm.
What forms of aneurysms are there?
Depending on the type of vascular wall alteration, doctors distinguish the following types of aneurysms:
“Real” aneurysm (Aneurysma verum): In the so-called “real” aneurysm, the various layers in the blood vessel wall are all preserved throughout, but the vessel wall is sack-like dilated.
Split aneurysm (aneurysm dissecans): A layer in the wall of the blood vessel is ruptured and blood collects between the vessel wall layers.
“Wrong” aneurysm (aneurysm spurium): This is not an aneurysm in the true sense. In the case of the aneurysm spurium, there is a leak in the vessel wall which is sealed from the outside (e.g. by the surrounding tissue). Then an effusion of blood (haematoma) forms around the blood vessel, which in the long term converts into connective tissue.
If an aneurysm is not yet too large, it is usually not even noticeable. Which symptoms larger specimens cause depends on their location.
Aneurysms can be congenital (especially in the brain arteries) or can develop over the course of a lifetime. This is predominantly the case with aneurysms of the aorta. Men over 50 are most commonly affected, especially if they smoke and/or suffer from high blood pressure. The big danger is that aneurysms will burst one day. The resulting internal bleeding is often fatal, as surgery can rarely be performed quickly enough.
Aneurysms often only become noticeable through the life-threatening internal bleeding. However, anyone who feels a noticeable pulsation somewhere in the body, e.g. in the abdomen, should definitely have this checked by a doctor. But also all others should have regular ultrasound examinations of the heart (for the thoracic artery) and the abdomen (for the abdominal artery) from the age of 50.
Not necessarily. If a certain size is exceeded, surgery is recommended. Even in the case of aneurysms whose diameter increases in the short term, the operation should not be delayed too long. Therefore, once an aneurysm is detected, regular check-ups are necessary.
If an aortic aneurysm of the abdominal artery becomes so large that it presses on surrounding structures, the following symptoms may occur.
- Pain, especially in the lower abdomen, usually stabbing and persistent, regardless of body position
- Back pain radiating into the legs
- less frequent digestive problems
- palpable, pulsating structure under the abdominal wall
Ruptured abdominal aortic aneurysm
The larger the aneurysm, the greater the risk of rupture. This is particularly true for aortic aneurysms with a diameter of more than six centimetres.
If such an aortic aneurysm ruptures, unbearable abdominal pain suddenly occurs, which radiates into the back. In addition, nausea and nausea.
Due to the massive blood loss, the blood pressure drops rapidly. The patient suffers a circulatory shock. Such a bleeding is an absolute emergency! About half of those affected do not survive a ruptured aortic aneurysm.
Aortic aneurysm in the chest area: Symptoms
If the aneurysm is located on the aorta at the level of the thorax (thoracic aortic aneurysm), the following symptoms may occur:
- Chest pain
- abnormal sound of breathing (stridor)
- Swallowing disorders
- Shortness of breath (dyspnea)
If the airways are severely constricted in a thoracic aortic aneurysm, pneumonia can occur repeatedly.
Burst aortic aneurysm in the chest
Thoracic aneurysms over five and a half centimeters in diameter are particularly dangerous. If they tear, there is usually severe chest pain. The symptoms are similar to those of a heart attack. A rupture is fatal in three out of four cases.
Symptoms of a brain aneurysm
Some aneurysms in the brain (intracranial or cerebral aneurysm) push on individual neurons. The eyes are particularly frequently affected, and facial paralysis also occurs.
Ruptured brain aneurysm
If the vessel wall ruptures during an aneurysm in the brain, massive symptoms occur. The most common form of bleeding is subarachnoid hemorrhage, SAB for short. It bleeds into the space between the brain and the meninges, more precisely the spider skin (arachnoidea).
Due to the firm skullcap, the blood cannot escape and quickly puts increased pressure on the brain. The symptoms of an aneurysm in the brain occur due to increased intracranial pressure:
- Sudden onset of severe headache
- Neck stiffness
- Unconsciousness or coma
If the patient survives, stroke-typical consequential damages such as hemiplegia are possible.
Symptoms of aneurysm in the hollow of the knee
Also an aneurysm of the popliteal artery (A. poplitea) usually goes unnoticed. However, if the popliteal aneurysm has a diameter of more than three centimetres, a blood clot (thrombosis) may form.
As a result, the lower leg is no longer sufficiently supplied with blood. Especially the calf hurts, and feelings of numbness and cold appear.
If the blood clot is carried along by the bloodstream, it can block a vessel at a narrower location, for example in the lung (pulmonary embolism).
Whether it is an aortic aneurysm or an aneurysm in the brain – the vascular sacculations can be congenital or develop only in the course of life. Unfavourable genetic predisposition plays a role in this, but also a lifestyle that is harmful to the vessels.
Sometimes aneurysms occur more frequently within a family, for example due to a hereditary weakness of the connective tissue. For example, the risk of an aneurysm increases from one to two percent if an aneurysm has already been detected in a first-degree relative, and to four percent if two close relatives are affected.
Genetic diseases such as Marfan syndrome or Ehlers-Danlos syndrome also frequently cause aneurysms.
However, many aneurysms also occur due to a congenital malformation of the blood vessels, without there being a familial clustering.
The risk of an aortic aneurysm increases with age. The reason is that the structure of the vessel wall changes over the years. It is less elastic and can absorb the high pressure in the aorta more reliably. Weak points in the vessel wall develop, which eventually give way – an aneurysm develops.
High blood pressure
Another important risk factor is high blood pressure (hypertension). With every heartbeat a pressure wave rolls over the arteries of the body. If the blood exerts particularly high pressure from the inside, it damages the vessel walls.
In more than 50 percent of cases, vascular calcification (arteriosclerosis) is the cause of an aneurysm. Lime and fat deposits (plaques) on the vessel walls cause them to lose elasticity. The vessels can absorb the pressure less and less with increasing age.
Bacterial infections are rarely involved in the development of an aneurysm – for example in syphilis or tuberculosis. In the course of the infection the vessel wall becomes inflamed. Eventually a vascular sacking develops. This is called a mycotic aneurysm.
Mechanical injuries to the vessel walls
The most common cause of an aneurysm spurium – the “false aneurysm” – is injury to the vessel wall. For example, during a cardiac catheter examination, during which a narrow, flexible tube is pushed over the leg artery to the heart, the vessel wall can be damaged.
Doctors often discover an aneurysm by chance during a routine examination, such as an abdominal ultrasound, lung X-ray or brain scan. It indicates an aneurysm.
Even when listening with a stethoscope, the doctor sometimes notices suspicious flow noises above the vascular sacculation. In slim people, an abdominal aortic aneurysm with a diameter of more than five centimetres can usually be felt as a pulsating swelling through the abdominal wall.
Details about the size and danger of an aneurysm are provided by a heart ultrasound, a computer tomography (CT) or magnetic resonance imaging (MRI) and possibly an angiography (imaging of the vessels), depending on the location. In the case of an aortic aneurysm in the breast section, a special ultrasound procedure is also used. The transducer is introduced via the oesophagus (transesophageal sonography).
There are different procedures for the treatment of an aneurysm. Whether one is treated at all, and if so, how, depends on various factors:
- Aneurysm size
- Probability of a rupture
- Operational risk
- Condition of the patient
- Wish of the patient
Aneurysm – operate or wait?
Smaller, asymptomatic aneurysms often do not require immediate treatment. The doctor checks them once a year, 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 purpose, a drug that lowers blood pressure may be used.
If an aortic aneurysm reaches a diameter of six centimetres in the abdominal aorta or five and a half centimetres in the chest, the risk of the vessel wall tearing increases. In this case an aortic aneurysm must be treated. However, there is a risk that the vessel will rupture even during the procedure.
With an aneurysm in the brain, the situation is often even more delicate. Depending on the position and condition of the vessel, the risk of causing brain injury during surgery, which can have serious permanent damage, varies. Surgery or not – this decision must be weighed up individually by doctor and patient.
Surgical treatment for aortic aneurysm
Two surgical methods are available for larger aortic aneurysms in the chest or abdomen:
Stent (endovascular procedure)
An aortic aneurysm can often be stabilized with a stent. Through a small incision in the inguinal artery, the doctor pushes a small tube forward until it reaches the wall bulge. This way the weak point is bridged.
When operating on an aortic aneurysm, the surgeon removes the dilated part of the arterial wall via an incision and replaces it with a tubular or Y-shaped vascular prosthesis.
If there is an enlargement near the heart, the aortic valve often has to be replaced as well (artificial valve).
Treatment Brain aneurysm
There are two main methods of treating a brain aneurysm that complement each other: clipping or coiling. It depends especially on the shape of the aneurysm which method e is more promising for the individual.
During coiling, the physician usually stabilizes the vessel with the help of a wire mesh (stent) and uses special platinum spirals to wear down the aneurysm in the brain from within. To do this, he first slides a microcatheter, usually over the groin, into the relevant brain artery. These microcoils only partially fill the brain aneurysm. However, blood platelets accumulate and clump together, sealing the aneurysm.
The advantage of this method is the minimally invasive and gentle access to the aneurysm. However, it cannot be used for aneurysms with a broad base. Another disadvantage of the method is that it so often does not completely close the aneurysms. They have to be checked regularly and treated again if necessary.
If coiling is not possible or if the aneurysm has already ruptured, clipping is usually performed. The surgeon closes the aneurysm in the brain using a Minclip. To do this, he first opens the skull. It creates between the natural coils of the brain a gentle access to the vascular bagging. Closure of the aneurysm is performed 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.
Another neurosurgical option is wrapping. It is used in complicated cases when clipping is not possible. The unstable part of the vessel is stabilized from the outside by wrapping the vessel around it. This can be done using the body’s own tissue or with gauze or plastic. Therefore a connective tissue capsule is formed.
Another method is the so-called trapping. The aneurysm in the brain is relieved by placing clips or balloons in front and behind it. However, this procedure is only possible if the affected cerebral artery is not the only supply channel for certain areas of hearing.
Treatment of a knee artery aneurysm
In the case of an aneurysm of the popliteal artery, the treatment is usually a bypass operation. The surgeon transplants a piece of a blood vessel that he has previously removed from another part of the body, thereby bypassing the aneurysm.
Living with aneurysm
In addition to stabilizing the vessel, it is crucial to consistently minimize the causes of the aneurysm. This is especially true for patients whose aneurysm is observed but not surgically stabilized.
- Most important measure: Keep blood pressure low! This is usually done with the help of beta-blockers or ACE inhibitors
- balanced diet with little animal fats, a lot of fibre and vegetables
- Sports activity
- Avoidance or reduction of overweight
- Abstinence from nicotine
- Little alcohol
Avoid blood pressure spikes!
Patients with untreated aneurysm must avoid sudden blood pressure spikes that could provoke rupture.
- Avoid heavy lifting.
- Learn to breathe properly under stress.
- Get the best possible treatment for asthma or chronic bronchitis. Coughing causes blood pressure to rise!
- Avoid blockages and treat them if necessary. Blood pressure also rises when pressing in the toilet.
- Do not overdo it when doing sports, especially strength training.
- Strive for a relaxed attitude to life.
Aneurysm: course of disease and prognosis
The prognosis for an aneurysm depends on various factors. The diameter of the vasodilatation and the speed at which it increases are the most important factors.
High death risk in case of a crack
The most serious complication is the rupture of the aneurysm (rupture) – it can lead to life-threatening bleeding. In such a case, mortality depends on where the aneurysm is located.
For example, mortality from a ruptured abdominal aortic aneurysm is over 50 percent, and if the main artery in the chest ruptures, it can be 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. Others suffer lifelong damage typical of a stroke, including hemiplegia and reduced speech and vision.
If an aneurysm is discovered and treated in time, the chances of recovery are good. However, an operation, especially in the brain, also carries its own risks.