An aneurysm is a bulge in an arterial wall. Normally, the width of an artery remains constant throughout its course. Due to a variety of causes, the arterial walls in certain areas can get weakened. These weakened areas tend to bulge out like a sac due to the pressure exerted by the flow of blood. This bulged out portion of an artery is referred to as an aneurysm.
An aneurysm can remain asymptomatic for very long periods of time. The person with an aneurysm may not have any problems due to the aneurysm. In a huge majority of cases, the presence of an aneurysm is identified while carrying out diagnostic and imaging tests for other problems.
An aneurysm can occur in almost any artery in the body. Two of the most important arteries that commonly develop aneurysms are, the aorta and the cerebral artery. The aorta is largest artery in the whole body originating from the left ventricle of the heart. The cerebral arteries supply blood to various parts of the brain. A ruptured aortic or cerebral artery aneurysm can turn fatal, if not treated on an emergency basis.
Aneurysm can also occur in peripheral arteries as well as arteries supplying blood to the vital organs of the body. These aneurysms do not rupture as easily as the aorta and cerebral arteries.
Aneurysms are blood filled bulges in the walls of an artery. These occur when the arterial walls get weakened by any structural defects or due to the pressure exerted by the flow of blood. The most common types of aneurysms are those of the aorta and the cerebral arteries. Peripheral artery aneurysms may also occur but are less frequent in comparison.
The aorta is the largest artery in the body. It begins at the left ventricle of the heart and passes through the chest and the abdomen, all the while branching into smaller arteries. The normal width of the aorta is between 2 and 3 centimeters (cm). But in areas where the aneurysms develop, the width can go beyond 5 cm.
The aorta is usually divided into two parts. The thoracic aorta (the part that passes through the thorax or chest cavity) and the abdominal aorta the part passing through the abdominal cavity. Aneurysms may develop on both these parts of the aorta. The symptoms, severity and the management of these aneurysms may vary.
Thoracic artery aneurysms (TAA)
These occur in the thoracic portion of the aorta. These are less common and accounts only for twenty five percent of all aortic aneurysms. Watchful waiting with the help of periodic diagnostic and imaging tests are the first line of treatments. Smoking and high blood pressure are the risk factors for TAA. Surgical treatment called Thoracic aortic aneurysm repair surgery will be needed if the width of the aneurysm is more than six centimeters.
Abdominal Aortic Aneurysm (AAA)
The most common type of aneurysm of the aorta is an abdominal aortic aneurysm (AAA). This occurs in the portion of the aorta that passes through the abdomen. It can be fatal, if not treated on an emergency basis. More than 80% of those with an aneurysm that is over 6cm in width may succumb within a year if treatment is not done. One of the major problems of an aneurysm is the difficulty in identifying the condition because of the absence of obvious symptoms. There are certain risk factors for aneurysm and people falling into the high- risk category should undertake periodic tests to rule out its presence. Surgery called as Abdominal aortic aneurysm repair surgery should be done if the width of the aneurysm is more than six centimetres. Without surgery, the annual survival rate for a AAA of over 6 cm is about 20 percent.
Aneurysms occurring in the cerebral arteries that supply blood to the brain are called as cerebral aneurysms or intracranial aneurysms. They are also called as "berry" aneurysms due to their appearance. A ruptured cerebral aneurysm is a medical emergency. If, left untreated, it can become fatal within 24 hours. Significant neurological impairment or disability may occur in those who survive. Subarachnoid haemorrhage or SAH a common type of stroke is a major complication of cerebral aneurysm repair.
Aneurysms that occur in the peripheral arteries are called peripheral aneurysm. Common types of peripheral aneurysms include:
·Popliteal aneurysm: Occurs in the popliteal artery located behind the knee. This is the most common peripheral aneurysm.
·Femoral artery aneurysm: Occurs in the femoral artery in the groin.
·Carotid artery aneurysm: This occurs in the carotid artery located in the neck.
This occurs in the visceral arteries that supply blood to the various organs like spleen, intestines, kidneys, liver etc.
·Splenic artery aneurysm: This type of aneurysm occurs in the splenic artery supplying the spleen.
·Mesenteric artery aneurysm: This occurs in the mesenteric artery that supply blood to the intestines.
·Renal artery aneurysm: This occurs in the renal arteries supplying blood to the kidneys
·Hepatic artery aneurysm: This occurs in the artery supplying the liver
Aneurysms are also classified according to its shape. The common types are
·Fusiform aneurysms, that bulge to all sides of an artery
·Saccular aneurysms, that bulge only to a particular side, of an artery
An aneurysm is a bulging out of the arterial wall in a particular area. This occurs due to the weakening of the arterial walls at certain places. The pressure exerted by the blood flow on these areas cause the arterial wall to dilate creating a blood-filled sac, called an aneurysm.
An aneurysm can occur in any artery in the body. The most common arteries that develop an aneurysm that is medically important are the aorta and the cerebral arteries.
Symptoms of a thoracic aortic aneurysm may include:
·Hoarseness of voice
·Difficulty in swallowing
·High-pitched and exerted breathing
·Swelling in the neck
·Pain in the chest or upper back
·Paleness and coldness of skin
·Nausea and vomiting
·Increased heart rate and palpitations
·Feeling of anxiety and nervousness
Symptoms of abdominal aortic aneurysm
·A pulsating sensation in the abdomen
·Persistent abdominal pain
·Persistent lower back pain
Since the above mentioned symptoms can occur in many abdominal problems, itis often difficult to diagnose the presence of an abdominal aortic aneurysm symptomatically.
An abdominal aortic aneurysm if it ruptures, can have the following symptoms
·Severe and sudden onset of pain in the abdomen or lower back
·Dizziness or fainting
·Paleness and coldness of the skin
·Increased heart rate and palpitation
·Shortness of breath
Symptoms of cerebral or brain aneurysm
There are very few symptoms that are specific to a cerebral aneurysm. The symptoms if at all present, are due to the pressure effects exerted by the aneurysm on certain areas of the brain
·Pain above and behind a single eye
·Dilation of pupils
·Numbness of a side of the face
Common signs and symptoms of a ruptured aneurysm include:
An aneurysm repair surgery is a major surgery. The duration of surgery will be in the range of 5 to 6 hours. Recovery from surgery will take a few weeks
Soon after surgery, the patient will be shifted to the intensive care unit for the next two days. The vital signs will be monitored constantly. Breathing assistance will be provided if found necessary.
Intravenous infusions will be given since oral fluids cannot be administered. Blood transfusions will be necessary if there was blood loss during surgery. Painkillers will be administered as and when necessary.
Shifting to the hospital room from the ICU will be done after two days if the progress is on expected lines. The patient will remain in his room for the rest of the hospital stay ,which will be about 8 to 10 days.
In the room the doctors will monitor the progress of the surgery. Oral feeding will start once the tubes are removed. The patient will be instructed regarding suture care. Wound infections can cause complications and proper care should be taken to prevent complications.
Being a major surgery, it is quite natural for the patient to feel very tired after that. Within a few days this will go, and the person will start to feel better.
There are specific timeframes within which the patient will be back to his normal life and indulge in day to day activities.
Exercising-Regular light exercises like short walks with periods of adequate rest are encouraged within a few days after surgery. This helps to get the blood circulation moving.
Driving- Driving can be performed after a period of 3 to 4 weeks after surgery.
Bathing- Bathing instructions include keeping the surgical wound dry to prevent any infections.
Going back to work- a waiting period of 6 to 10 weeks is usually advised before returning to work. The waiting period will depend on the physical intensity of the workload. Mild to moderate office work which require less physical activity, may be started at the earliest, if doctors are satisfied with the progress.
Lifting- Lifting of weights should be kept to the very minimum. Heavy lifting should never be indulged in for quite some time after the surgery.
Sex- Sexual activity may be resumed after about 8 weeks from the time of surgery.
Different types of aneurysm surgeries have certain after effects, that are specific to the site of surgery.
After a brain or cerebral aneurysm surgery the patient
·may feel nervous, angry, confused or irritated
·may have seizures, headaches etc for some time
·may have problems with memory, but usually it improves after a few weeks
·may have trouble with speech or thinking
·may have muscle weakness or numbness in certain areas of the body if the aneurysm had ruptured before the surgery.
Some of these disabilities may be permanent if significant brain damage has occurred due to the rupture.
An aneurysm occurs when a weakened part of an artery bulges out, to create a blood-filled sac. Aneurysms can occur in any of the arteries in the body. Some arteries like the aorta and cerebral arteries that supply the brain are more prone to develop an aneurysm than others. Aneurysms in these arteries are also significant from a medical point of view. A ruptured aortic or cerebral aneurysm is a grave condition. There is not only significant internal bleeding but also damage to various body organs due to a lack of blood supply.
The deposition of atherosclerotic plaques and high blood pressure or hypertension are known to be some of the major factors, in the development of an aneurysm.
The areas of plaque deposition may become hard losing its natural elasticity. This coupled with an increased blood pressure or hypertension, tends to push out the arterial walls creating an aneurysm. Due to a lack of elasticity, the bulged-out portions stay deformed, rather than regaining its original shape.
Occurrence of certain other medical conditions appears to increase the chances of developing aneurysms. These conditions include
·Polycystic kidney disease
·Systemic lupus erythematosus (SLE or lupus)
·Ehlers-Danlos syndrome (EDS), a genetic disease that affects collagen, which is a primary component of connective tissue.
·Certain types of brain tumours
·Arteriovenous malformations (AVM)-This is a defect of the brain's circulatory system where there is an abnormal and direct movement of blood from the arteries to the veins of the brain.
Other risk factors include:
·Excess alcohol consumption
·Smoking can significantly increase the risk of developing a brain aneurysm.
·A family history of brain aneurysm.
·High blood pressure cause increased pressure on the walls of the blood vessels inside the brain
·Risk of developing a brain aneurysm increases with age
·Women are more likely to develop a brain aneurysm than men.
·Pre-existing weakness in the blood vessels like coarctation of aorta
·A brain aneurysm can develop after a severe brain injury if the blood vessels in the brain are damaged, although this is very rare.
There are two types of aortic aneurysms. Thoracic aortic aneurysm is a type of aneurysm that forms in the thoracic part of the aorta. Abdominal aortic aneurysms occur in the abdominal part of the aorta. An abdominal aortic aneurysm develops when a blood-filled bulge develops in a particular area of the aortic walls. An aortic aneurysm can rupture and create various life-threatening complications.
The treatment for aortic aneurysms depend on the size of the aneurysm and its potential for rupture.
Treatment for small aortic aneurysms
·Aneurysms less than 5cm in diameter are called small aneurysm
·The risk of rupture of small aneurysms are very low.
·Watchful waiting is the first line of treatment
·An ultrasound scan is performed every five to six months to evaluate the size
·Lifestyle modifications are advised to reduce hypertension, one of the most important causative factors
·Smoking should be avoided
·Daily exercises should be practised.
Treatment for large aortic aneurysms
Aneurysms larger than 5.5 cm are referred to as large aneurysms. Aneurysm repair surgery is done if the enlargement occurs in a rapid manner.
There are two types of aortic aneurysm repair surgery.
Open repair surgery
The main steps involved this surgery are:
·A large incision is made in the abdomen to expose the aneurysm.
·The aneurysm is then opened till a healthy portion of the aorta is reached
·The aneurysm is then removed from both sides
·A Dacron graft is sutured to the healthy ends of the aorta
·Blood flow is reconstituted to assess the patency of the graft
·If satisfied, the surgical incisions are closed and sutured
·Drains are left in place to remove the fluids that accumulate in the surgical site
·The duration of the surgery will be about three to four hours. The patient will remain in the ICU for about two days. The hospital stay will be about 10 days.
Some of the common complications of open repair surgery are
·Deep vein thrombosis and pulmonary embolism
·Chest infections, especially in those who smoke
·Surgical wound infections
·Oozing of fluids from the surgical wound
Endovascular aneurysm repair surgery (EVAR)
This is a minimally invasive treatment. The complications of the surgery are less as compared to an open repair surgery. The main steps involved in an endovascular repair surgery are:
·Two small incisions are made in the groin to access the arteries
·By using imaging tools, a tiny stent like device is introduced into the area of aneurysm
·The stent is placed in the area of the aneurysm
·The stent contains small barbs with the help of which it attaches to the walls of the aorta
·The stent reinforces the aortic walls and excludes the aneurysm
Being a minimally invasive surgery, the recovery is much faster. Complications are also comparatively low.
There are different ways of treating an intracranial aneurysm. The treatment usually depends on the location, size and the potential for rupture. Due consideration is also given to the overall health of the patient as well as other risk factors that may affect the outcome of the treatment. The potential for an aneurysm to rupture is also a major consideration.
If the aneurysm is very small and at low risk of a rupture, watchful waiting is considered as the first line of treatment. Lifestyle changes like quitting smoking are suggested. Blood pressure is kept within normal limits.
For those who are at a higher risk of aneurysm rupture, surgical treatment may be considered. This is especially so for those who have a history of a previous aneurysm rupture. Also, aneurysm that press against certain areas of the brain creating other complications may also be treated with immediate effect.
Some of the common treatments are given below.
·Surgical clipping-This is an invasive surgical procedure. The aneurysm is exposed by removing a section of the skull. This procedure of removing a part of the skull bone is referred to as ‘craniotomy. The blood vessel that feeds the aneurysm is isolated from rest of the brain tissues. A surgical clip made of titanium is placed on either side of the aneurysm. This prevents the flow of blood to the aneurysm and removes the complication of a rupture. But the surgery as it is a major and critical one. It should be attempted only if the doctor feels that the potential benefits outweighs the risks.
·Endovascular coiling -This is a minimally invasive procedure. In this procedure a catheter is introduced into an artery in the groin. It is then threaded up towards the aneurysm. A coil shaped platinum wire is introduced to the aneurysm. This coil disrupts the flow of blood into the aneurysm
Some of the complications of cerebral aneurysm surgery are:
·Development of blood clots
·Oedema or swelling of brain
·Confusion or disorientation
·Speech and vision problems
·Weakness of the muscles
All types of brain aneurysm surgeries are complicated and have potential for development of various complications. Surgery should be attempted only if the benefits associated with it far outweighs the risks that may occur.