Overview and Facts

Aneurysm is a condition of arteries – blood vessels carrying oxygen-rich blood to body tissues from the heart – in which its walls bulge like a balloon. Weakening, stiffening or blocking of arterial walls and irregular blood pressure are the main causes of aneurysm.

It is generally hard to detect as most of the times, it doesn’t show any prominent symptom. Most aneurysms are small of around 2-3 centimeters in diameter, and around 50%-60% of these do not rupture during the lifetime of a person. Aneurysm larger than 3 centimeters in diameter are known as giant aneurysms that need immediate treatment.

It can develop in any part of the body and is classified as aortic aneurysm, cerebral aneurysm and peripheral aneurysm depending upon its location.

Aneurysms affect in two ways:

1. These can cause artery walls to split into two, causing leakage of blood. This is known as dissection.

2. Aneurysm can burst and cause internal bleeding; known as rupture.

Generally, aneurysm develops between 35-65 years of age, but can affect lower age groups as well.

According to Dr. Eser Tolunay of NIH’S National Heart, Lung and Blood Institute, in nearly 20% of the cases of aortic aneurysm, some genetic factors are found to be responsible. Factors that can increase the chances of abdominal aortic aneurysm (AAA) by weakening the walls of arteries include smoking, high blood pressure, infection, fatty deposits, among others.

Around 1 in every 50 people in the U.S. have unruptured brain aneurysm, and the annual rate of rupture is around 10 per 100,000 people. Rupturing of Cerebral aneurysm can cause subarachnoid hemorrhage (SAH) and around 15% of people with SAH die before reaching the hospital. Around half the people, who recover from the condition, are known to suffer from some form of disability. ^[1]

Types and Symptoms of Aneurysm

Aneurysm can be classified into three major types, depending on their location in the body.

1. Aortic Aneurysm:

Aorta is the largest artery in the human body. It starts from left ventricle of the heart and reaches all the way down to abdominal cavities via chest. Normally, aorta has a radius of about 1-1.5 centimeters, but with aneurysm it can have a bulge of around 2.5 centimeters. This further, can be of two types:

Abdominal Aortic Aneurysm (AAA): Mostly, aortic aneurysm develops near the abdominal cavity, which is known as abdominal aortic aneurysm (AAA). An AAA of over 3 centimeters in radius has around 20% annual survival rate.

Thoracic Aortic Aneurysm (TAA): Sometimes, aortic aneurysm may develop near the chest area, known as thoracic aortic aneurysm (TAA). Without any treatment, patient suffering from TAA has a survival rate of around 56%. However, TAA is a rare condition and affects only around 25% of the people with aneurysm.

Usually, aortic aneurysm does not show any symptom; especially, thoracic aortic aneurysm. But, symptoms may occur if the bulge gets bigger enough to put pressure on the surrounding organs.

Symptoms of unruptured abdominal aortic aneurysm:

• Abdominal pain
• Pain in lower back, chest or flank
• Pulsating sensation in abdomen
• Cold foot
• Fever
• Weight loss

Symptoms of ruptured abdominal aortic aneurysm:

• Sudden, severe pain in abdomen and lower back
• Nausea
• Vomiting
• Signs of shock
• light-headedness
• Bluish lips
• Passing out

Symptoms of Unruptured Thoracic aortic aneurysm:

• Deep, aching chest pain
• Shortness of breath
• Hoarseness
• Pain while swallowing food
• Pain in jaw

Symptoms of ruptured thoracic aortic aneurysm:

• Severe pain in back, abdomen, arms and chest
• Signs of shock
• Vomiting
• Nausea

2. Cerebral Aneurysm:

When the arteries, supplying blood to the brain, develop aneurysm, it is called intracranial aneurysm. They appear like a berry and, hence given the name “berry aneurysms.”

A ruptured intracranial aneurysm can lead to death within 24 hours. Nearly 40% of intracranial aneurysms leads to death, and if patients survive, around 66% of them are known to suffer from some sort of disability or neurological impairment.

Symptoms of unruptured cerebral aneurysm:

• Loss of balance
• Dangling speeches
• Blurred vision
• Numbness on face
• Dilated pupil

Symptoms of ruptured cerebral aneurysm:

• Severe headache
• Neck pain and stiffness around neck
• Facial paralysis
• Signs of shock

3. Peripheral Aneurysm:

Aneurysm that occurs in peripheral arteries are called peripheral aneurysm. It can be further divided into six types:

• Popliteal Aneurysm: It develops at popliteal fossa (hough or knee pit) and is the most common type of peripheral aneurysm.
• Splenic Artery Aneurysm: Not so common, it develops near the spleen.
• Mesenteric Artery Aneurysm: It affects the arteries that transport blood to intestinal area.
• Femoral Artery Aneurysm: The aneurysm develops particularly in femoral artery – a large artery in thigh. It is found in groin.
• Carotid Artery Aneurysm: Carotid artery is found in neck. When aneurysm develops in the neck area, then it is called carotid aneurysm.
• Visceral Aneurysm: When aneurysm develops in the arteries that supply blood to bowel and kidney, then it is called visceral aneurysm.

Aortic aneurysms are more likely to rupture than peripheral aneurysms. In peripheral aneurysm, severe pain can be experienced in a particular area, where aneurysm has developed.

Risk Factors of Aneurysm

Several risk factors associated with this condition are discussed below:

• Age: Aneurysms mostly occurs in the mid-60s of a person.
• Tobacco Use: People, who use tobacco are at a higher risk of developing aneurysm.
• High Blood Pressure: Increased blood pressure can damage blood vessels, increasing the chances of aneurysm.
• Plaque in Arteries (Atherosclerosis): Fat and other substances can deposit along the walls of the vessels and might increase the risk of aneurysm.
• Marfan Syndrome and Related Disorders: If someone is suffering from Marfan syndrome (a genetic disorder involving connective tissue) or other disorders like Ehlers-Danlos Syndrome or Loeys-Dietz syndrome, he/she is at a higher risk of developing aneurysm.
• Bicuspid Aortic Valve: People, who have two cusps instead of three in their aortic valve have 50% higher risk of developing aneurysm.
• Atherosclerosis: It is a condition in which the walls of artery gets hardened. This also increases the risk of aneurysm.
• High Cholesterol: Cholesterol deposits inside the vein increases the chances of blockage; thereby, increasing the risk of aneurysm.

Do I have Aneurysm?

If you are experiencing symptoms of aneurysm, it is advised not to immediately jump to any conclusion as it can be something other than aortic aneurysm.

• If you are experiencing mild to severe abdominal pain, it could also be because of peptic ulcer, gallstone, pancreatitis, gastroesophageal reflex (GERD) or pyelonephritis (kidney infection).
• A cold or black foot can be an indication of peripheral arterial disease or atrial fibrillation.

If you are experiencing one or more of the afore-mentioned symptoms, consulting a doctor is highly recommended.

Causes and Prevention of Aneurysm

Causes of Aneurysm:

The underlying cause of aneurysm is weakening of arterial walls. Repeated pounding of blood on the walls of arteries can cause the weak spot to bulge out, which may eventually burst after some time. The risk of aneurysm is directly proportional to the blood pressure of a person.

Some factors that can lead to the development of aneurysm are as follows:

Atherosclerosis (Hardening of Arteries): Deposits of plaque on the walls of arteries make them hard, less flexible and weak. This mostly occurs after the age of 60 years.

Genetic Conditions: People born with Marfan syndrome are at a higher risk of aneurysm. Marfan syndrome weakens the artery wall, making it more susceptible to aneurysm.

Untreated Infection: Although rare, it is still possible to develop aneurysm because of infections like salmonellosis or syphilis.

Injury: This too is rare, but severe accidents may weaken arterial walls and can cause aneurysm.

Prevention of Aneurysm:

Some measures that can be taken to improve the health of blood vessels and prevent incidence of aneurysm are listed below:

• Abstain from smoking
• Avoid illicit drugs
• Have a balanced diet
• Intake of trans fats, saturated fats, sodium salt and sugar should be minimal.
• Exercise daily
• Keep blood pressure in check

Diagnosis and Tests of Aneurysm

When someone is suspected to have aneurysm, specialized diagnosis and tests may be recommended. These are discussed below:

• Physical Exam: In this, a doctor checks the blood pressure and listens to the sound of blood flow.
• Imaging Tests: Imaging tests are used to confirm the location, size and shape of the aneurysm. computed tomography (CT) is the most common imaging test, which uses X-rays to visualize the structure of aneurysm in two-dimensional slices. Other imaging tests used to detect aneurysm are echocardiography, ultrasound and magnetic reasoning imaging (MRI).
• Lumber Puncture: It is used to detect a ruptured brain aneurysm. In lumber puncture, samples of cerebrospinal fluid (CSF) is taken by inserting a needle into the hollow space around the spinal cord. If there are traces of blood in the fluid, then it is an indication of cerebral aneurysm.
• Angiography: In this, a tube (catheter) is inserted inside the body via an artery in groin and pushed towards the site of possible aneurysm. X-Rays are used for better guidance. Some contrast coloring agents may be injected to have a better X-ray view.

Treatment and Care for Aneurysm

Treatment of Aneurysm:

Most cases of unruptured aneurysm doesn’t require a treatment at all until it grows large enough to exert pressure on the surrounding organs. However, a ruptured aneurysm requires an immediate surgery. Delayed access to medical facilities can be fatal in such a case.

Treatment Options for Aortic Aneurysm:

Doctor may prescribe certain medicines to reduces the blood pressure and blood cholesterol and sugar levels. Patients can be asked to take these medicines before a surgery or in place of a surgery.

Beta Blockers: They slow down the heart rate, which helps decrease blood pressure.

Angiotensin II Receptor Blockers: These medications are prescribed when beta blockers fail to control the blood pressure.

Calcium Channel Blockers: These lessen vasospasm (drastic narrowing of blood vessels) and restricts the entry of calcium into the cells.

Interventions to Prevent Stroke: Intervenous injections can be prescribed to reduce the chances of stroke from insufficient blood flow.

Rehabilitative Therapy: Cerebral aneurysm may result in brain damage, and so, various rehabilitative therapies like speech, physical and occupational therapy may be required to reset the skills back to normal.

Surgery: If the aneurysm is large and is growing rapidly, then a surgery is must. There are mainly two types of surgery:

• Open Surgery: In an open AAA surgery, a cut is made in the abdominal area to expose aorta. A graft (piece of living tissue) can be attached to the weaker section of aorta to repair aneurysm.
• Endovascular Stent-Graft Surgery: In this procedure, a small incision is made near the hip area and a catheter is used to insert an endovascular graft. This graft is then positioned to seal aneurysm.

Treatment Options for Cerebral Aneurysm:

In this case, a surgery is required only if there is a high risk of rupture. The risk of brain damage from surgical complications are very high in cerebral aneurysm. Like AAA, the potential risk of rupture depends on the size, shape and location of aneurysm.

In some cases of ruptured cerebral aneurysm, patients may be given general set of guidelines on how to manage the associated risk factors. In cases, where ruptured cerebral aneurysm results in subarachnoid hemorrhage, surgery is inevitable.

Types of surgeries to treat cerebral aneurysm:

• Coiling: In this a tube (catheter) is inserted through a vein and is pushed to the affected area. Thereafter, the area is coiled using latex or platinum wire.
• Clipping: In this procedure, the skull is cut open and a clip is put across the affected area. This checks the blood flow through the affected area.

Care for People with Aneurysm:

A lot depends on the post-surgical care provided to the patient-
Some of the measures that should be taken are:

• Make sure to feed the patient with low-cholesterol, low-salt diets
• Keep regular check on his blood pressure
• Prepare detox water for the patient
• Make sure that he/she should not engage in any strenuous activity

OTC Medications and Self-Management Methods for Aneurysm

Over-the-Counter (OTC) Medications for Aneurysm:

There is no OTC drug available for aneurysm, because unruptured aneurysm is hard to detect and a ruptured aneurysm is a case of medical emergency and requires immediate surgery.

Self-Management Methods for Aneurysm:

Some of the life style changes that can help reduce the risk of developing aneurysm are as follows:

• Don’t Smoke
• Stop the use of illicit drugs
• Avoid fat-rich food
• Have balanced diet
• Exercise regularly

Natural Ways to Cure Aneurysm

Several life style changes can help prevent or check the growth of aneurysm:

• Eat a healthy diet
• Avoid smoking
• Exercise daily
• Avoid caffeine
• Reduce fat intake
• Be cautious about aspirin
• Incorporate garlic in food
• Go out in sun to bring vitamin-D level back to normal
• Have citrus fruits; they are rich in Vitamin-C, which helps strengthen aortic walls
• Incorporate foods rich in omega-3 fatty acids in one’s diet as they help reduce plaque deposits on arterial walls

Health tip by Expert

Aneurysm is hard to detect until it grows too big to rupture the arterial walls or start exerting pressure on the surrounding organs. However, precautionary measures should be taken, and one should refrain him/herself from smoking and use of recreational drugs.

Exercising daily not only reduces chances of developing aneurysm, but is also good for overall wellbeing. However, upon experiencing the symptoms of aneurysm, one should immediately contact a doctor.