An aneurysm is an abnormal bulging or ballooning of an artery caused by a weak spot in the artery wall. Aneurysms are classified by type, morphology, and location. The main types are true aneurysms which involve all layers of the artery wall and false aneurysms where blood leaks between layers. Aneurysms can occur in arteries throughout the body including the brain, heart, and abdomen. Risk factors include conditions like atherosclerosis, smoking, and genetic disorders. Symptoms depend on the location but can include headaches, abdominal pain, and blurred vision. Diagnosis involves scans and angiograms while treatment options are surgical clipping or coiling for brain aneurysms and open surgery or stents for abdominal aneurysms.
2. INTRODUCTION
An aneurysm is an abnormal widening or ballooning of an artery due to weakness
in the wall of the blood vessel. Aneurysms are dangerous because they may burst,
spilling blood in the area surrounding the blood vessel. The disease can occur in
the aorta, in a blood vessel in the brain, or in a peripheral blood vessel.
3. DEFINITION
An aneurysm is an outward bulging, likened to a bubble or balloon, caused by a
localized, abnormal, weak spot on a blood vessel wall.
4. TYPES
Aneurysms are classified by type, morphology, or location.
True and false aneurysms
A true aneurysm is one that involves all three layers of the wall of an artery
(intima, media and adventitia). True aneurysms include atherosclerotic, syphilitic, and congenital
aneurysms, as well as ventricular aneurysms that follow transmural myocardial
infarctions (aneurysms that involve all layers of the attenuated wall of the heart are also considered
true aneurysms).[3]
A false aneurysm, or pseudoaneurysm, is a collection of blood leaking completely out of an artery or
vein but confined next to the vessel by the surrounding tissue. This blood-filled cavity will eventually
either thrombose (clot) enough to seal the leak or rupture out of the surrounding tissue.
Pseudoaneurysms can be caused by trauma that punctures the artery, such as knife and bullet
wounds, as a result of percutaneous surgical procedures such as coronary angiography or arterial
grafting, or use of an artery for injection.[6]
.
5. TYPES OF ANEURYSM BY SHAPE
Aneurysms are also classified based on the shape of the bulge: ( Morphology)
•Fusiform aneurysms: The bulge in this type of an aneurysm is formed on all sides of a blood
vessel.Fusiform aneurysms ("spindle-shaped" aneurysms) are variable in both their diameter and length;
their diameters can extend up to 20 cm (7.9 in). They often involve large portions of the ascending and
transverse aortic arch, the abdominal aorta, or, less frequently, the iliac arteries.
•Saccular aneurysms: The bulge in this type of an aneurysm is formed only on one side of the vessel
.Saccular aneurysms, or "berry" aneurysms, are spherical in shape and involve only a portion of the vessel
wall; they usually range from 5 to 20 cm (2.0 to 7.9 in) in diameter, and are often filled, either partially or
fully, by a thrombus. Saccular aneurysms have a "neck” that connects the aneurysm to its main ("parent")
artery, a larger, rounded area, called the dome.
•Berry aneurysm: The bulge in this type of an aneurysm looks like a berry on a narrow stem. It is the most
common type of brain aneurysm . Pseudo aneurysm or false aneurysm: Sometimes a breach in the
layers of the vessel wall causes blood to leak within. The leakage gets contained by the surrounding soft
tissue or the perivascular tissue of the blood vessel thus creating a pseudo aneurysm. A hole in the vessel
wall acts as direct communication of blood flow between the lumen of the aneurysm and that of the vessel.
False aneurysms require immediate treatment because the poor support of aneurysm wall from the
perivascular tissue poses a higher risk of rupture of a false aneurysm when compared with a true aneurysm
of comparable size.
• Saccular and fusiform
7. TYPES
Location
Arterial and venous, with arterial being more common.
The heart, including coronary artery aneurysms, ventricular aneurysms, (This is a bulge in the wall of your
heart. A previous heart attack is the most common cause. In rare cases, a severe chest injury can also lead to
injury can also lead to it). aneurysm of sinus ofValsalva, and aneurysms following cardiac surgery.
The aorta, namely aortic aneurysms including thoracic aortic aneurysms and abdominal aortic aneurysms.(
An abdominal aortic aneurysm (AAA) occurs when the large blood vessel (the aorta) that supplies
blood to the abdomen, pelvis and legs becomes weakened, enlarged or balloons outward. This
type of aneurysm occurs most often in older men who have at least one or more risk factor,
including emphysema, family history, high blood pressure, high cholesterol, smoking, and
possibly, obesity. Women with AAA generally suffer ruptures more often and with smaller sizes of
aneurysms).
The brain, including cerebral aneurysms, berry aneurysms, and Charcot–Bouchard aneurysms. (Cerebral
aneurysms, which affect about 3-5% of the U.S. population, occur when the wall of a blood vessel
in the brain becomes weakened and bulges or balloons out. The three types of cerebral aneurysms
are: berry (saccular), fusiform and mycotic.
The most common, "berry aneurysm," occurs more often in adults. It can range in size from a few
millimeters to more than two centimeters. A family history of aneurysms may increase your risk).
8. RISK FACTOR OF ABDOMINAL ANEURYSM
The rupture of an abdominal aortic aneurysm is a medical emergency, and only about 20% of
patients survive. someone you know has extreme pain in the belly or back that doesn't go
away.
Risk: In 2018, about 58% of people who died from an aortic aneurysm or aortic
dissection were male.
Besides advanced age and genetics or family history, people who have the
following conditions may be at higher risk for an aortic aneurysm or dissection:
•High blood pressure. The increased force of blood can weaken the artery walls.
•Genetic conditions, such as Marfan’s Syndrome, decrease the body’s ability to
make healthy connective tissue.
•High cholesterol or atherosclerosis. A build-up of plaque may cause increased
inflammation in and around the aorta and other blood vessels.
•Inflamed arteries. Certain diseases and conditions, such as vasculitis, can cause
the body’s blood vessels to become inflamed.
•Trauma, such as car accidents.
•Smoking. People with a history of smoking make up 75% of abdominal aortic
9. RISK FACTOR OF CEREBRAL ANEURYSM
Cerebral aneurysms, which affect about 3-5% of the U.S. population, occur when the wall of
a blood vessel in the brain becomes weakened and bulges or balloons out. The three types
of cerebral aneurysms are: berry (saccular), fusiform and mycotic.
The most common, "berry aneurysm," occurs more often in adults. It can range in size from
a few millimeters to more than two centimeters. A family history of aneurysms may increase
your risk.
Conditions that injure or weaken the walls of the blood vessel, including atherosclerosis,
trauma or infection, may also cause cerebral aneurysms. Other risk factors include
polycystic kidney disease, narrowing of the aorta and endocarditis.
10. RISK FACTOR OFTHORACIC AORTIC ANEURYSM
A thoracic aortic aneurysm is an abnormal bulging or ballooning of the part of the aorta that
passes through the chest down to the diaphragm. A common cause is atherosclerosis, or
hardening of the arteries.
Other risk factors include:
•Aging
•Genetic conditions, such as Marfan syndrome
•Inflammation of the aorta
•Injury from chest wall trauma
•Infections, such as syphilis and tuberculosis
A person with an aneurysm may not experience any symptoms until the aneurysm begins to “leak” blood into
nearby tissue or expand.
11. CAUSES
•Degradation of the elastic lamellae of the blood vessel
•Accumulation of a leukocytic infiltrate
•Enhanced proteolysis within the wall
•Smooth muscle cell loss within the wall
•Atherosclerosis: Accumulation of fat-like substances leads to the formation of plaques within the lining of a blood vessel,
causing them to harden and weaken up.
•High blood pressure: A persistently untreated high blood pressure damages and weakens the walls of blood vessels like the
aorta.
•Diseases of blood vessels: Certain systemic conditions may cause vasculitis or inflammation of the blood vessels, thereby
damaging and weakening of the walls.
•Mycotic or infected aneurysm: Sometimes, the wall of an artery may dilate due to damage by an underlying infection
somewhere in the body. Different types of microorganisms, primarily bacteria, can cause an infected aneurysm.
Advanced syphilis infection resulting in syphilitic aortitis and an aortic aneurysm
•Tuberculosis, causing Rasmussen's aneurysms
•Brain infections, causing infectious intracranial aneurysms
12. RISK FACTOR
Risk factors for an aneurysm include diabetes, obesity, hypertension, tobacco use, alcoholism,
high cholesterol, copper deficiency, increasing age, and tertiary syphilis infection. Connective
tissue disorders such as Loeys-Dietz syndrome, Marfan syndrome, and certain forms of Ehlers-
Danlos syndrome are also associated with aneurysms. Aneurysms, dissections, and ruptures in
individuals under 40 years of age are a major diagnostic criteria of the vascular form of Ehlers-
Danlos syndrome (vEDS).
Specific infective causes associated with aneurysm include:
A minority of aneurysms are associated with genetic factors. Examples include:
•Berry aneurysms of the anterior communicating artery of the circle of Willis, associated
with autosomal dominant polycystic kidney disease[22]
•Familial thoracic aortic aneurysms
•Cirsoid aneurysms, secondary to congenital arteriovenous malformations
13.
14. SIGNS AND SYMPTOMS
In most of the cases, an aneurysm may be clinically silent i.e it does not present with any
symptoms unless it ruptures. However, when present, the symptoms usually depend on the
location of the aneurysm.
Abdominal aortic aneurysms (AAA) may be difficult to detect as it is often asymptomatic and slow-
growing. In some cases, the aneurysm may never rupture. An enlarging AAA may present with:
•Back pain
•Deep, constant pain in the person’s abdomen or on the side of the abdomen
•Pulsation near the bellybutton
Similarly, due to its effect on nearby nerves and other blood vessels, a TAA can cause symptoms
like:
•Breathing difficulties
•Difficulty in swallowing
•Pain in the jaw, chest, and upper back
•Hoarseness of voice
•Persistent cough
•Shortness of breath
15. SIGNS AND SYMPTOMS
In case of an unruptured cerebral aneurysm, symptoms may include:
•Blurred or double vision
•Pain above and behind one eye and a dilated pupil
•Numbness of one side of the face
A ruptured aneurysm may present with:
•Blurred or double vision
•Confusion
•Drooping of eyelid
•Loss of consciousness
•Nausea and vomiting
•Seizure
•Sensitivity to light
•Stiff neck
•Sudden, extremely severe headache
16. DIAGNOSTIC EVALUATION
An MRI scan is usually used to look for aneurysms in the brain that haven't ruptured. This type
of scan uses strong magnetic fields and radio waves to produce detailed images of your brain.
A CT scan is usually preferred if it's thought the aneurysm has ruptured and there's bleeding
on the brain (subarachnoid haemorrhage).
This type of scan takes a series of X-rays, which are then assembled by a computer into a
detailed 3D image.
A lumbar puncture is a procedure where a needle is inserted into the lower part of
the spine to remove a sample of the fluid (cerebrospinal fluid) that surrounds and
supports the brain and spinal cord. This fluid can be analysed for signs of
bleeding.
•Angiogram: Severe or ruptured aneurysm in the brain or heart requiring
emergency surgery, can be evaluated with an angiogram to identify the exact area
that requires surgical repair.
•Doppler ultrasound
17. PROCEDURE FOR ANEURYSM
Flow diverters for aneurysms in brain: These are newer treatment options for a
brain aneurysm, especially the larger ones which are not amenable to other forms
of treatment. Flow diverters are tubular stent-like implants that act by diverting the
blood flow away from the sac of an aneurysm. Once the blood movement within
the aneurysm stops, the body is stimulated to heal the site and reconstruction of
the parent artery is encouraged. This immediately reduces blood flow to the
aneurysm, which should close completely in six weeks to six months.
18. SURGICAL MANAGEMENT
Repair is generally recommended if your aneurysm is 1.9 to 2.2 inches (4.8 to 5.6 centimeters) or larger or if it’s
growing quickly. Also, your doctor might recommend surgery if you have symptoms such as stomach pain or you
have a leaking, tender or painful aneurysm.
Depending on several factors, including location and size of the aneurysm, your age, and other conditions you have,
repair options might include:
Open abdominal surgery for AAA: With open surgical repair, the surgeon makes a large cut, or incision, into your
abdomen where the aneurysm exists. The area damaged by the aneurysm is then separated surgically from the
main part of the aorta and replaced with a synthetic tube (known as an aortic graft), that is sewn into place.
Open surgical repair of an abdominal aortic aneurysm is performed under general anesthesia and takes about 3 to 4
hours. You can expect to spend 3 days in an intensive care unit and remain in the hospital for 7 to 10 days.
Endovascular repair: A less invasive alternative to open surgical repair is endovascular aneurysm repair (EVAR)
using a special device called an endovascular stent graft. The stent graft is placed inside the damaged area of the
aorta to separate the aneurysm from the normal blood flow. It is designed to be placed without surgically opening the
aorta.
Because endovascular aneurysm repair is less invasive than open surgery, you can expect your hospital stay to be
shorter – typically as short as 2 to 4 days.
Endovascular surgery isn’t an option for about 30 percent of people with an aneurysm. After endovascular surgery,
you’ll need regular imaging tests to ensure that the repair isn’t leaking.
Long-term survival rates are similar for both endovascular surgery and open surgery.
19. SURGICAL MANAGEMENT
Neurosurgical clipping
Neurosurgical clipping is carried out under general anesthetic, so you'll be asleep throughout the operation.
A cut is made in your scalp, or sometimes just above your eyebrow, and a small flap of bone is removed so
the surgeon can access your brain.
When the aneurysm is located, the neurosurgeon will seal it shut using a tiny metal clip that stays
permanently clamped on the aneurysm. After the bone flap has been replaced, the scalp is stitched
together.
Over time, the blood vessel lining will heal along the line where the clip is placed, permanently sealing the
aneurysm and preventing it growing or rupturing in the future.
Clipping the artery the aneurysm is formed on, as opposed to clipping the aneurysm itself, is rarely
necessary. This is usually only carried out if the aneurysm is particularly large or complex.
When this is necessary, it's often combined with a procedure called a bypass. This is where the blood flow
is diverted around the clamped area using a blood vessel removed from another place in the body, usually
the leg.
20. SURGICAL MANAGEMENT
Endovascular coiling
Endovascular coiling is also usually carried out under general anesthetic.
The procedure involves inserting a thin tube called a catheter into an artery in your leg or groin.
The tube is guided through the network of blood vessels, up into your head and finally into the aneurysm.
Tiny platinum coils are then passed through the tube into the aneurysm.
Once the aneurysm is full of coils, blood cannot enter it. This means the aneurysm is sealed off from the main
artery, which prevents it growing or rupturing. With coiling, there's also a small chance you'll need to have the
procedure more than once to reduce your chances of the aneurysm rupturing.
About 1 in 5 people who have the coiling procedure need further treatment.
But as coiling is a less invasive procedure, you can usually leave hospital sooner after the operation.
After clipping, you'll usually need to stay in hospital for around 4 to 6 days, whereas you can usually go home 1
or 2 days after coiling.
The time it takes to fully recover is also typically shorter with coiling. Many people make a recovery within a few
weeks of coiling, whereas recovering from clipping may take longer.
21. SURGICAL MANAGEMENT
Treatment options for peripheral aneurysms are
similar to aortic aneurysm, common treatment options
for a peripheral aneurysm also include:
•Continued observation for small aneurysm
•Conventional surgical repair (usually a bypass)
•Endovascular repair
22. OTHER PROCEDURE
Flow diverters
Flow diverters are a relatively new treatment option for berry aneurysms. They involve
a small tube, called a stent, which is placed on the aneurysm’s parent blood vessel. It
redirects blood away from the aneurysm.
23. COMPLICATION
Thromboembolism: An aneurysm may pose to be an obstruction to the flow of blood to adjacent tissues
and organs. Turbulence in blood flow leads to the formation of blood clots or thrombi that may get
disseminated and obstruct smaller blood vessels, and the condition is known as thromboembolism. A
thrombus on reaching the brain may obstruct the blood flow to the brain and lead to ischemic stroke
emergency complications:
•Severe pain in the chest or back: Rupture of an aortic aneurysm may cause severe unbearable pain in
the chest or back region.
•Angina pectoris: Sometimes an aneurysm can cause angina pain or sudden pain in the chest that can
lead to the obliteration of the blood flow to the heart, thereby causing myocardial ischemia or heart
attack.
•Subarachnoid hemorrhage (SAH) and stroke: Rupture of an aneurysm in the brain is life-threatening
due to the chances of bleeding into the space surrounding the brain. This is manifested by sudden
extreme headaches. Emilia Clarke, a famous actor of the west, from the popular TV series Game of
Thrones, suffered from complications of two brain aneurysms in February 2011.
•Hydrocephalus: Collection of fluid in the brain
•Coma: A state of prolonged unconsciousness
•Vasospasm: Constriction of blood vessels
•Long- or short-term brain damage
24. PREVENTION
Healthy diet
Cut down on the amount of salt in your food and eat plenty of fruit and vegetables.
The Eatwell Guide highlights the different types of food that make up our diet, and
shows the proportions we should eat them in to have a well-balanced and healthy
diet.
Limit your alcohol intake
Regularly drinking too much alcohol can raise your blood pressure over time.
Staying within the recommended levels is the best way to reduce your risk of
developing high blood pressure:
•men and women are advised not to regularly drink more than 14 units a week
•spread your drinking over 3 days or more if you drink as much as 14 units a week
Lose weight
Being overweight forces your heart to work harder to pump blood around your body,
which can raise your blood pressure.
25. PREVENTION
Get active
Being active and taking regular exercise lowers blood pressure by keeping your heart
and blood vessels in good condition.
Regular exercise can also help you lose weight, which will also help lower your blood
pressure.
Adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity
aerobic activity, such as cycling or fast walking, every week.
Cut down on caffeine
Drinking more than 4 cups of coffee a day may increase your blood pressure.
If you're a big fan of coffee, tea or other caffeine-rich drinks, such as cola and some
energy drinks, consider cutting down.
It's fine to drink tea and coffee as part of a balanced diet, but it's important that these
drinks are not your main or only source of fluid. Stop smoking
Smoking does not directly cause high blood pressure, but it puts you at much higher risk
of a heart attack and stroke.
Smoking, like high blood pressure, will cause your arteries to narrow
