An aneurysm is a localized bulge in the arterial blood vessels, usually found in the main artery (aorta), cerebral arteries, or leg arteries. It results from vascular calcification (arteriosclerosis), which causes a weakness in the medial layer of the artery wall. An ultrasound examination or computer tomography are both used to make the diagnosis. Treatment depends on the size, diameter, and location of the aneurysm.
What causes an aneurysm?
An aneurysm can develop when a disease or injury weakens the arterial wall. Wall damage of this kind frequently results from arteriosclerosis, also known as “hardening of the arteries” in everyday language. A calcification of an arterial vessel, such as the leg arteries in peripheral arterial occlusive disease (PAD) or the coronary arteries in coronary heart disease (CHD), also denotes a calcification of other arteries. As a result, pre-existing arteriosclerosis-related illnesses (like CHD) are also taken into account as risk factors for aneurysms.
Other risk factors for abdominal aortic aneurysms include advanced age, male gender, smoking, high blood pressure, and a favorable family history. You are more likely to develop an abdominal aortic aneurysm if it affects your family members frequently.
Congenital blood vessel malformations, connective tissue diseases (such as Marfan syndrome or Ehlers-Danlos syndrome), wounds to the vessel wall, and, less frequently, bacterial infections like syphilis or tuberculosis can also cause aneurysms. Kawasaki syndrome is characterized by smaller aneurysms on the coronary arteries. A previous heart attack is the main factor in the development of a heart wall aneurysm.
Which symptoms are brought on by an aneurysm?
Typically, an aneurysm has no symptoms. They frequently come to light by accident during a routine exam, such as an abdominal ultrasound or a chest x-ray. However, regular examinations should be performed as soon as they are found in order to catch an increase in aneurysm size early. The likelihood that an aneurysm will burst and cause potentially fatal bleeding increases with its size. The size (diameter) and rate of growth per year are used to determine the need for surgery.
An aneurysm can cause symptoms such as difficulty swallowing, coughing, hoarseness, breathing difficulties, ECG changes, abdominal or back pain, and bleeding from an aneurysm in the cerebral arteries. Blood clots can form in aneurysms, leading to vascular occlusions.
How is an aneurysm treated?
An aneurysm rupture can have life-threatening consequences, so it must be treated immediately with a surgical intervention. Risk factors such as high blood pressure and dyslipidemia should be treated, and anyone who smokes should try to give up their vice.
When is surgery required?
Doctors recommend that an aneurysm of a certain size be removed by surgery. For an abdominal aortic aneurysm of four to five centimeters in diameter, the risk of it rupturing is about one percent per year. From a size of five centimeters, the risk increases to more than ten to 20 percent per year. Women are more at risk of tearing, so they should be treated when they are 4.5 to 5 centimeters in size.
An increase in size of more than 10 millimeters per year can also lead to an operation recommendation. If the aneurysm affects the ascending section of the aorta (aorta ascendens) or the aortic arch, surgical treatment is usually carried out. In the case of an aneurysm in the descending section of the aorta (aorta descendens), endoluminal prostheses are increasingly being used (TEVAR). The timing of the operation must always be determined individually based on personal risk factors.