Aneurysm is one of the most common words we see in our pathology books. Every year in India, around 76,000-200,000 cases of cerebral aneurysms are reported to have occurred. An estimated 6.5 million people in the United States have an unruptured brain aneurysm, or 1 in 50 people. The Centre for Disease Control and Prevention (CDC) states that aortic aneurysms contribute to over 25,000 deaths each year in United States. Let’s see what the word actually means and it’s related causes.

The word “aneurysm” comes from the Greek word “aneurysma” meaning “a widening”.

An aneurysm refers to a weakening of an artery wall that creates a bulge, or distension of the artery.

Types of aneurysms :

Aneurysms are classified by their location in the body. The arteries of the brain and the heart are the two most common sites of a serious aneurysm.

The bulge can take two main shapes:

  • Fusiform aneurysms bulge all sides of a blood vessel
  • Saccular aneurysms bulge only on one side

Aortic aneurysm : the aorta is the large artery that begins at the left ventricle of the heart and passes through the chest and abdominal cavities. The most common aneurysm of the aorta is an abdominal aortic aneurysm (AAA). Less commonly, a thoracic aortic aneurysm (TAA) can affect the part of aorta running through the chest.

Cerebral aneurysm : aneurysms of the arteries that supply the brain with blood are known as intracranial aneurysms. Ruptured cerebral aneurysms are the most common cause of a type of stroke known as “subarachnoid hemorrhage”.

Peripheral aneurysm : an aneurysm can also occur in a peripheral artery. Peripheral arteries are less likely to rupture than aortic aneurysms. Types of peripheral aneurysm include:

  • Popliteal aneurysm : this happens behind the knee. It is the most common peripheral aneurysm
  • Splenic artery aneurysm : this type of aneurysm occurs near the spleen
  • Mesenteric artery aneurysm : this affects the artery that transports blood to intestines
  • Femoral artery aneurysm : the femoral artery is in the groin
  • Carotid artery aneurysm : this occurs in the neck
  • Visceral aneurysm : this is the bulge of arteries that supply blood to the bowel or kidneys

Cause of aneurysm : aortic dissection is one identifiable cause of an aortic aneurysm. The arterial wall has three layers. Blood can burst through a tear in the weakened wall of the artery, splitting these layers. It can then fill the cavity surrounding the heart. Dissection leads to compression. Compression prevents blood from returning to the heart. This is also known as a pericardial tamponade.

Risk factors : smoking tobacco, hypertension or high blood pressure, poor diet, inactive lifestyle, obesity

Symptoms : most aneurysms are clinically silent. Symptoms donot usually occur unless an aneurysm ruptures. Rapidly growing abdominal aneurysms are sometimes associated with symptoms. Some people with abdominal aneurysms report abdominal pain, lower back pain, or a pulsating sensation in the abdomen. Similarly, thoracic aneurysms can affect nearby nerves and other blood vessels causing swallowing and breathing difficulties, and pain in the jaw, chest and upper back.

Complications : thromboembolism, severe chest or back pain, angina, a sudden extreme headache

Diagnosis : an MRI scan can identify an aneurysm that has not yet ruptured. CT scans are usually preferred for ruptured aneurysms

Treatment : a ruptured aneurysm needs emergency surgery. Without immediate repair, patients have a low chance of survival.

A large or growing aortic aneurysm is more likely to need surgery. There are two options for surgery

  • Open surgery to fit a synthetic or stent graft
  • Endovascular stent graft surgery

In the Endovascular surgery, the surgeon accesses the blood vessels through a small incision near the hip. Stent graft surgery inserts an endovascular graft through this incision through a catheter. The graft is then positioned in the aorta to seal off the aneurysm.

In the open AAA repair, a large incision is made in the abdomen to expose the aorta. A graft can then be applied to repair the aneurysm.

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