Content

Introduction

An aneurysm is an abnormal and permanent dilation of the arterial or venous wall, caused by trauma or an alteration that weakens it (Video). When the dilation of the wall reaches critical levels, the vessel can rupture, resulting in internal bleeding that can lead to death.

The causes of the weakening of the artery or vein can be:

  • present at birth (congenital), such as Marfan syndrome, Ehlers-Danlos syndrome, and polycystic kidney disease
  • mechanical, such as damage caused by trauma
  • degenerative, such as atherosclerosis
  • inflammatory, as in Takayasu's disease
  • infectious, caused by syphilis, mycosis, viruses

The formation of aneurysms, therefore, is a process linked to many factors (multifactorial) with both genetic and environmental influences. Having family members affected by an aneurysm can increase the risk of developing an aneurysm at any time in your life.

The most common risk factors in adults are:

  • smoke
  • alcohol
  • high cholesterol
  • obesity
  • hypertension
  • diabetes

The development of infantile aneurysms may be due to factors already present at birth such as, for example, type III collagen deficiency or trauma occurring during the period of increased intracranial pressure in the early stages of development.

Aneurysms can occur in any artery or vein but the most common are:

  • aortic aneurysm, occurs in the aorta, the main artery that carries oxygen-rich blood to all parts of the body
  • aneurysm of the thoracic aorta, concerns the segment of the aorta that passes through the chest
  • aneurysm of the abdominal aorta, occurs in the tract of the aorta that passes through the abdomen
  • brain aneurysm or hemorrhagic stroke, occurs in the blood vessels that supply blood to the brain
  • aneurysm of the popliteal artery, occurs in the leg, in the hollow behind the knee
  • mesenteric artery aneurysm, occurs in the intestine
  • aneurysm of the splenic artery, it concerns an "artery of the spleen

Symptoms

The aneurysm usually does not cause disturbances (symptoms), it can develop slowly for many years and, often, do not show signs of its presence until it ruptures. Sometimes it can cause disturbances related to the compression of the surrounding anatomical structures.

If an aneurysm rapidly expands, or ruptures, disturbances can come on suddenly and include:

  • ache
  • high sweating
  • dizziness
  • nausea and vomit
  • rapid heartbeat
  • shock / fainting
  • low blood pressure

Diagnosis

Aneurysms are often found (diagnosed) by chance during tests performed for other reasons.

To ascertain the presence of an aneurysm the doctor can use:

  • echocolordoppler ultrasound
  • computed angiotomography (angio-CT)
  • magnetic resonance angiography (MR angiography)

Ultrasound with echocolordoppler

It is a non-invasive method that allows you to view the main blood vessels (arteries, supra-aortic trunks, abdominal vessels and venous vessels) and to study the flow of blood within them. It provides color images (blue and red) of venous and arterial flows highlighting any lesions of the vessel walls.

Computed angiotomography (CT angiography)

It allows to study the arteries of the brain, of the supra-aortic trunks (TSA), of the aorta ascending and descending, of the vessels of the abdomen and limbs in search of abnormal alterations. The angio-CT, thanks to its high ability to provide detailed images and to reconstruct three-dimensional volumetric images, represents the main method in planning therapy.

Magnetic resonance angiography (MRA)

Since it is not linked to the presence of ionizing radiation, it is not an invasive examination, it involves rapid execution times, high sensitivity and specificity and allows you to view the large arterial and venous trunks, even in the brain, without the need for a contrast medium. MRA, thanks to recent technical advances, has become a viable alternative for the surveillance of diseases of the aorta, especially in children.

Therapy

In order to clarify the risk of rupture of an aneurysm, the doctor evaluates its size, position, appearance and inquires about the person's state of health and the presence of other cases in the family (family history). evaluation, compares the risk of rupture with that resulting from the treatment and decides whether to manage or operate the aneurysm surgically.

There are two main treatments in severe aneurysms:

  • intervention in the open, the surgeon makes an incision in the point closest to the aneurysm, reaches it inside the body and proceeds to close it and its subsequent removal from the blood vessel on which it was placed. This type of surgery usually requires general anesthesia and, consequently, involves longer recovery times before returning to normal activities. General anesthesia, moreover, can pose a risk in the presence of cardiac disorders, breathing difficulties and old age
  • surgery with insertion of an endovascular stent, the stent is a device that is placed inside the vessel affected by an aneurysm, isolating and reinforcing it.It is a minimally invasive technique that allows for shorter recovery times and lower risks deriving from anesthetics since it is practiced, most of the time, under local anesthesia.

    The endovascular stent is applied via:

    • catheter, inserted into an "artery in the leg near the groin" to deliver the stent
    • advanced live radiographic imaging methods, the surgeon guides the catheter that carries the stent from the groin to the point where the aneurysm is located
    • stent placement and catheter removalOnce guided to its destination, the surgeon releases and expands the stent and then removes the delivery catheter

Treatment and prevention

A ruptured aneurysm is a "medical emergency. If it occurs, call 118, 112 or 113 immediately and seek immediate medical assistance.

If a person has already been ascertained (diagnosed) with an aneurysm, he must remain in close contact with his doctor to check its evolution over time and, above all, he must warn all the people he attends (family members, work colleagues, school, etc.) of their condition so that, in case of sudden illness, they can call the emergency numbers without wasting time.

The aneurysm wearer must undergo regular checks depending on the size and the area in which it is placed.

To reduce the risk of an aneurysm appearing, it is recommended to follow a few rules to keep blood vessels healthy and clean. They include:

  • check your blood pressure regularly
  • eat healthy foods
  • exercise regularly
  • stop smoking
  • manage stress

Bibliography

Mayo Clinic. Aneurysms (English)

MedlinePlus. Aneurysms (English)

National Institutes of Health (NIH). National Heart, Lung, and Blood Institute. Aortic Aneurysm (English)

Michael L. Levy, Danielle M. Levy, Biagio Manna. Pediatric Cerebral Aneurysm. StatPearls [Internet]. 2020; Jul 21

American Heart Association. Aortic Aneurysm (English)

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