Aneurysm

An aneurysm occurs when an artery’s wall weakens and causes an abnormally large
bulge. This bulge can rupture and cause internal bleeding. Although an aneurysm
can occur in any part of your body, they’re most common in the:

 brain
 aorta
 legs
 spleen
PATHOPHYSIOLOGY
Aneurysms form for a variety of interacting reasons. Multiple factors, including
factors affecting a blood vessel wall and the blood through the vessel, contribute.
Atherosclerosis. A variety of different factors, including atherosclerosis, may
contribute to weakening of a blood vessel wall. The repeated trauma of blood
flowing through the vessel may contribute to degeneration of the vessel wall.
Hypertensive injury may compound this degeneration and accelerate the expansion
of the aneurysm. As the aneurysm expands, the wall tension increases.
The pressure of blood within the expanding aneurysm may also injure the blood
vessels supplying the artery itself, further weakening the vessel wall. Without
treatment, these aneurysms will ultimately progress and rupture.
Infection. A mycotic aneurysm is an aneurysm that results from an infectious
process that involves the arterial wall. A person with a mycotic aneurysm has a
bacterial infection in the wall of an artery, resulting in the formation of an
aneurysm. The most common locations include arteries in the abdomen, thigh, neck,
and arm. A mycotic aneurysm can result in sepsis, or life-threatening bleeding if the
aneurysm ruptures. Less than 3% of abdominal aortic aneurysms are mycotic
aneurysms.
Syphilis. The third stage of syphilis also manifests as aneurysm of the aorta, which
is due to loss of the vasa vasorum in the tunica adventitia.
Copper deficiency. A minority of aneurysms are caused by copper deficiency,
which results in a decreased activity of the lysyl oxidase enzyme, affecting elastin, a
key component in vessel walls. Copper deficiency results in vessel wall thinning, and
thus has been noted as a cause of death in copper-deficient humans, chickens and
turkeys.
SIGNS AND SYMPTOMS:
Aneurysm presentation may range from life-threatening complications
of hypovolemic shock to being found incidentally on X-ray. Symptoms will differ by
the site of the aneurysm and can include:
Cerebral aneurysm
Symptoms can occur when the aneurysm pushes on a structure in the brain.
Symptoms will depend on whether an aneurysm has ruptured or not. There may be
no symptoms present at all until the aneurysm ruptures.For an aneurysm that has
not ruptured the following symptoms can occur:
 Fatigue
 Loss of perception
 Loss of balance
 Speech problems
 Double vision
For a ruptured aneurysm, symptoms of a subarachnoid hemorrhage may present:
 Severe headaches
 Loss of vision
 Double vision
 Neck pain or stiffness
 Pain above or behind the eyes
Abdominal aneurysm
Abdominal aortic aneurysm involves a regional dilation of the aorta and is
diagnosed using ultrasonography, computed tomography, or magnetic resonance
imaging. A segment of the aorta that is found to be greater than 50% larger than that
of a healthy individual of the same sex and age is considered aneurysmal. Abdominal
aneurysms are usually asymptomatic but in rare cases can cause lower back pain or
lower limb ischemia.
Renal (kidney) aneurysm
 Flank pain and tenderness
 Hypertension
 Haematuria
 Signs of hypovolemic shock

RISK FACTORS
Risk factors for an aneurysm include diabetes, obesity, hypertension, tobacco
use, alcoholism, high cholesterol, copper deficiency, increasing age, and
tertiary syphilis infection.
Specific infective causes associated with aneurysm include:
 Advanced syphilis infection resulting in syphilitic aortitis and an aortic
aneurysm
 Tuberculosis, causing Rasmussen's aneurysms
 Brain infections, causing infectious intracranial aneurysms
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
 Familial thoracic aortic aneurysms
 Cirsoid aneurysms, secondary to congenital arteriovenous malformations

Diagnosis
Diagnosis of a ruptured cerebral aneurysm is commonly made by finding signs of
subarachnoid hemorrhage on a computed tomography (CT) scan. If the CT scan is
negative but a ruptured aneurysm is still suspected based on clinical findings,
a lumbar puncture can be performed to detect blood in the cerebrospinal
fluid. Computed tomography angiography (CTA) is an alternative to traditional
angiography and can be performed without the need for arterial catheterization.
This test combines a regular CT scan with a contrast dye injected into a vein. Once
the dye is injected into a vein, it travels to the cerebral arteries, and images are
created using a CT scan. These images show exactly how blood flows into the brain
arteries.
Treatment
Historically, the treatment of arterial aneurysms has been limited to either surgical
intervention, or watchful waiting in combination with control of blood pressure. At
least, in case of Abdominal Aortic Aneurysm (AAA) the decision does not come
without a significant risk and cost, hence, there is a great interest in identifying
more advanced decision making approaches that are not solely based on
the AAA diameter, but involve other geometrical and mechanical nuances such as
local thickness and wall stress. In recent years,[when?] endovascular or minimally
invasive techniques have been developed for many types of aneurysms. Aneurysm
clips are used for surgical procedure i.e. clipping of aneurysms.
 Intracranial aneurysms
There are currently two treatment options for brain aneurysms: surgical clipping or
endovascular coiling. There is currently debate in the medical literature about
which treatment is most appropriate given particular situations.
Surgical clipping was introduced by Walter Dandy of the Johns Hopkins Hospital in
1937. It consists of a craniotomy to expose the aneurysm and closing the base or
neck of the aneurysm with a clip. The surgical technique has been modified and
improved over the years.
Endovascular coiling was introduced by Italian neurosurgeon Guido
Guglielmi at UCLA in 1989. It consists of passing a catheter into the femoral artery in
the groin, through the aorta, into the brain arteries, and finally into the aneurysm
itself. Platinum coils initiate a clotting reaction within the aneurysm that, if
successful, fills the aneurysm dome and prevents its rupture.[36] Flow diverter can
be used but not without complications sometimes.[37]
 Aortic and peripheral aneurysms
For aneurysms in the aorta, arms, legs, or head, the weakened section of the vessel
may be replaced by a bypass graft that is sutured at the vascular stumps. Instead of
sewing, the graft tube ends, made rigid and expandable by nitinol wireframe, can be
easily inserted in its reduced diameter into the vascular stumps and then expanded
up to the most appropriate diameter and permanently fixed there by external
ligature. New devices were recently developed to substitute the external ligature by
expandable ring allowing use in acute ascending aorta dissection, providing airtight
(i.e. not dependent on the coagulation integrity), easy and quick anastomosis
extended to the arch concavity. Less invasive endovascular techniques allow
covered metallic stent grafts to be inserted through the arteries of the leg and
deployed across the aneurysm.
 Renal aneurysms
Renal aneurysms are very rare consisting of only 0.1–0.09% while rupture is even
more rare. Conservative treatment with control of concomitant hypertension being
the primary option with aneurysms smaller than 3 cm. If symptoms occur, or
enlargement of the aneurysm, then endovascular or open repair should be
considered. Pregnant women (due to high rupture risk of up to 80%) should be
treated surgically.
PREVENTION
Preventing an aneurysm is not always possible, as some are congenital, meaning
they are present from birth.

However, some lifestyle choices can affect the risk:

Smoking is a risk factor for both aortic aneurysms and the rupture of an aneurysm
anywhere in the body. Quitting smoking can reduce the risk of a severe aneurysm.

Managing blood pressure can also minimize the risk of an aneurysm. Healthful
blood pressure can be achieved through dietary measures, regular exercise, and
medications.

Obesity can put extra pressure on the heart, so taking these steps is important for
reducing stess on the artery walls.

A healthful diet can also reduce cholesterol and decrease the risk of atherosclerosis.
Fusiform aneurysms are often linked to atherosclerosis.

Anyone diagnosed with an aneurysm and prescribed a conservative treatment plan can
work with a healthcare practitioner to address any risk factors.