Everything you need to know about aneurysms

Blood circulates around the human body through different blood vessels. Arteries are one type of blood vessel. They are responsible for transporting oxygenated blood from the heart to the rest of the body.

Arteries consist of three layers: the external layer or tunica adventitia (made of connective tissue), the middle layer or tunica media (with muscular fibres), and the internal layer or tunica intima (composed of endothelium and a subendothelial layer).          

An aneurysmcan form when the internal and external layers are compromised. An aneurysm is defined as the permanent and irreversible dilatation of an artery by over 50% of its diameter .

Based on their morphology, aneurysms can be classified as fusiform , if they affect the entire morphology of the vessel, or saccular if they only affect a portion of the vessel’s circumference.

Types of aortic aneurysms

There are two types of aortic aneurysms:

• Abdominal aortic aneurysm: this is the most common type which occurs in the part of the aorta located in the lower half of the abdomen (descending aorta). Most abdominal aneurysms originate in the infrarenal aorta and extend to the aortic bifurcation. They can also affect the iliac arteries.
  
• Thoracic aortic aneurysm: this affects the areas of the aorta between the ascending aorta (where the aorta starts), the aortic arch, and the upper half of the descending aorta.

Causes 

There are many situations that can cause aweakening of the aortic wall, which leads to dilatation and the appearance of an aneurysm. In most cases, the cause is unknown. However, there are certain situations in which aortic dilatation is more common.

• Genetic problems,such as Marfan syndrome
• Arteriosclerosis or the hardening of arteries
• Infections
• Smoking
• High blood pressure
• Abdominal trauma or chest pain

Prevention

The first important step in preventing an aneurysm is to change your lifestyle and to adopt healthy habits that include a balanced diet and moderate exercise. Specialists also recommend monitoring high blood pressure and quitting smoking to reduce the risks of having an aneurysm.

Diagnosis

Aneurysms are said to be silent killers as they do not present specific symptoms. They are usually detected by chance when a patient undergoes an imaging study for some other reason.

In some cases, they can produce symptoms depending on the size and location of the dilatation of the aorta. For example, an aneurysm of the ascending aorta or the aortic root can distort the aortic valve (the “exit” valve of the heart), which can sometimes produce symptoms of heart failure (e.g., shortness of breath upon exertion or when lying down, chest pain, palpitations, fatigue, etc.).

On the other hand, aortic arch aneurysms sometimes compress the adjacent structures which can causehoarsenessordifficulty swallowing, and evenback pain. Likewise, aneurysms of the descending aorta and abdominal aorta can also causeback and lower back pain. When an aneurysm ruptures or "dissects" (the aortic wall tears and lets blood pass through from top to bottom, producing a "shotgun barrel-shaped” aorta), there are usually clear symptoms, such asintense pain between the shoulder blades or in the abdomen, shortness of breath, dizziness, or blackouts, etc.

To diagnose an aortic aneurysm, you can perform an ultrasound, which lets you measure the size of the aneurysm. In addition, you can use computed tomography (CT) or magnetic resonance imaging (MRI), the latter of which may be more helpful as it can measure the size and extent of the aneurysm.

Treatment

Treating an aortic aneurysm is different for each patient according to the type of aneurysm and the degree of severity. The best course of action is to seek advice from a specialist.

The three most common treatments are:

• Careful and continuous observation: not all aneurysms require surgery. If the aneurysm is small and slow-growing, your doctors may decide to wait and observe it carefully to see if any changes occur.
•  Open surgery: this is performed under general anaesthesia. The doctor makes an incision in the chest or abdomen, and replaces the affected part with a synthetic graft (usually a Dacron stent-graft). For this type of treatment, patients are normally admitted to hospital for 5 to 7 days.
•  Vascular stent: an alternative to open surgery is a stent or endovascular repair of the aneurysm. This is a minimally invasive procedure in which one or two small incisions are made in the groin area before inserting a stent (a synthetic graft supported by a metal structure). The blood flow is redirected from a healthy section of an artery to another healthy section, thereby isolating the affected area.

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