What is an Aneurysm?
An aneurysm is a localised enlargement or ballooning of a blood vessel caused by a weakened vessel wall. It most commonly occurs in arteries rather than veins. The abnormal bulge is typically more than 50% greater than the vessel's normal diameter. Aneurysms can occur in various parts of the body, including the aorta (the body's largest artery), the blood vessels in the neck, intestines, kidneys, spleen, or legs (iliac, femoral, and popliteal aneurysms). The most common site is the aorta, particularly in the thoracic (chest) or abdominal regions.
Types of Aneurysms
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Aneurysms are classified by their shape, location, and cause. The two primary shapes are fusiform, where the blood vessel balloons out on all sides, and saccular, where the bulge occurs on only one side. In addition to these true aneurysms, there are pseudoaneurysms or false aneurysms, which result from a prior injury or surgery and involve blood collecting between the layers of the vessel wall. Dissecting aneurysms occur when a tear in the vessel wall causes the layers to separate, rather than the entire wall ballooning out.
Causes of Aneurysms
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Aneurysms can be caused by a variety of factors that weaken the structural integrity of the blood vessel wall. While the exact cause is not always clear, atherosclerosis (the hardening of arteries due to plaque buildup) is a significant contributor to aneurysm formation. Other risk factors include older age, male gender, family history, genetic predispositions, high cholesterol levels, high blood pressure, smoking, diabetes, and obesity. Additional causes can depend on the aneurysm's location, such as genetic disorders, infections, or specific inflammatory conditions.
Symptoms of Aneurysms
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Symptoms of an aneurysm vary based on its location and whether it is symptomatic or asymptomatic. For instance:
- Abdominal Aortic Aneurysm (AAA): May cause constant pain in the abdomen, chest, lower back, or groin.
- Common Iliac Artery Aneurysm: Often causes lower abdominal, back, and/or groin pain.
- Femoral and Popliteal Artery Aneurysms: May result in a palpable pulsation in the groin or behind the knee, leg pain, or sores on the feet or lower legs.
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Diagnosis of Aneurysms
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Diagnosing an aneurysm involves a variety of imaging techniques, depending on its location. These may include:
- CT or CAT Scan: Provides detailed cross-sectional images of the body.
- MRI: Offers highly detailed images of organs and tissues using magnets and radio waves.
- Echocardiogram: Evaluates the heart's structure and function using sound waves.
- Arteriogram (Angiogram): An X-ray of the blood vessels, enhanced with a contrast dye.
- Ultrasound: Uses sound waves to create images of blood vessels and assess blood flow.
Treatment for Aneurysms
Treatment for an aneurysm depends on various factors, including the size, location, and growth rate of the aneurysm, as well as the patient’s overall health.
Treatment options may include:
- Monitoring: Routine ultrasound exams every 6 to 12 months to monitor smaller aneurysms.
- Risk Factor Management: Lifestyle changes, such as quitting smoking, controlling diabetes, and reducing dietary fat, can help slow the aneurysm's progression.
- Medication: Prescribed to manage high blood pressure or cholesterol levels.
- Surgery:
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- Open Repair: Involves making an incision to directly access and repair the aneurysm with a synthetic graft.
- Endovascular Aneurysm Repair (EVAR): A minimally invasive procedure using X-ray guidance and specialised instruments to place a stent-graft inside the artery via small incisions in the groin. The stent-graft supports the weakened vessel and helps prevent rupture.
Each treatment plan is individualised based on the patient's unique condition and preferences. Regular monitoring and timely intervention are key to preventing complications such as rupture, which can lead to life-threatening bleeding and possibly death.
Specialists in minimally invasive vascular treatments