Aneurysm Disease

What is an aneurysm?

An artery is a blood vessel that carries oxygen-rich blood from your heart to all the parts of the body. An aneurysm is a condition where the walls of the artery weaken causing swelling of the artery. This ballooning may increase in size and finally burst leading to haemorrhage (bleeding). Aneurysms can be of different types depending on its location:

• Thoracic aortic aneurysm: Aneurysm in the aorta (major artery arising from the heart) that runs down your chest
• Abdominal aortic aneurysm: Aneurysm in the aorta that extends to your abdominal region
• Peripheral aortic aneurysm: Aneurysm in arteries found in the peripheral regions such as popliteal artery (which runs down the back of your lower knee and thigh), femoral artery (groin area), cerebral artery (brain) and carotid artery (neck region).

What causes an aneurysm?

Aneurysms can be caused by inflammation, leading to the weakening or breakdown of the artery walls. This inflammation can result from atherosclerosis, which is characterized by the deposition of plaque (calcium, cholesterol and minerals). The plaque deposits weaken the inner wall of the artery, making it more susceptible to swelling and rupture.

Diseases like Marfan's syndrome (genetic disorder that affects the tissues holding the body’s cells, tissues and organs together), syphilis (sexually transmitted infection) and tuberculosis (bacterial infection that affects the lungs) can weaken the layers of the aortic wall. There are certain factors that increase the risk of developing an aneurysm such as smoking, high blood pressure, family history, obesity and high cholesterol levels. The risk generally increases with age and occurs more commonly in men than in women.

What are the symptoms of an aneurysm?

An aneurysm may not show any symptoms. However, when symptoms do appear, they generally depend on the region of the aneurysm.

Symptoms for an abdominal aortic aneurysm may include:

• Pulsating feeling in your abdomen, like a heartbeat
• Sudden, extreme pain in your lower back or abdomen (may indicate that the aneurysm is about to burst)
• Rarely, your feet may develop painful sores and discoloration

In cases of thoracic aortic aneurysm, you may experience:

• Breathing difficulty or coughing
• Pain in the region of the jaw, upper back, chest and neck
• Congestive heart failure if the aneurysm is closest to the heart

Symptoms of a peripheral aneurysm include:

• Leg and arm pain during exercise (claudication) or rest
• Pulsating lump
• Ulceration in fingers and toes
• Numbness and radiating pain
• Gangrene (tissue death)

It is critical to inform your doctor as soon as you experience these symptoms to avoid further complications and even death.

How is an aneurysm diagnosed?

Your doctor may conduct a physical examination and analyse details of your medical history. Imaging tests like CT scan, MRI, chest X-ray and abdominal ultrasound are commonly ordered to determine the presence of an aneurysm. Your doctor may also recommend an echocardiography (ultrasound imaging of the heart), stress test or angiography (viewing blood vessels by injecting a contrast dye) to detect an aneurysm.

How is an aneurysm treated?

The treatment depends on the location and size of the aneurysm and whether symptoms are present. Some of the treatment options include:

• Watchful waiting: Initial stages of an aneurysm may not require surgery. Your doctor may regularly monitor you every 6-12 months for changes in the size of the aneurysm. This approach is suggested for aneurysms that are smaller than 2 inches in diameter. Your doctor may prescribe medication to lower your blood pressure, and thrombolytic agents to dissolve blood clots. You may also be advised to quit smoking.

• Open surgical repair: During an open surgical repair, your surgeon makes an incision on the chest, for a thoracic aortic aneurysm, and in the abdomen, for an abdominal aortic aneurysm. Your doctor replaces the weakened section of the aorta with an artificial tube called a graft which facilitates blood to flow through it. You may have to stay in the hospital for about 7 days and may need 3 months to completely recover.

• Endovascular stent graft repair: In this procedure, your surgeon makes a small incision in the groin region and guides a catheter (thin tube) through the blood vessel. The doctor uses live X-ray images to guide a stent-graft to the site of the aneurysm. The graft makes your artery stronger and prevents it from rupturing. The stent-graft eases the blood flow without putting pressure on the region of the aneurysm. You may be required to stay in hospital for 2-3 days until recovery. In time, the aneurysm may even shrink because of the stent-graft.

• Surgical bypass: Your doctor may recommend this treatment for peripheral aneurysm. During the procedure, your doctor creates a graft using your own veins or an artificial tube. This is sutured above and below the aneurysm to create a detour or a new pathway through which blood can easily flow through. The procedure is performed under general anaesthesia. You may have to stay in the hospital for 2-3 days after the surgery.

How can I prevent an aneurysm?

The best way to prevent an aneurysm is to:

• Quit smoking
• Keep cholesterol levels under control
• Keep blood pressure levels under control
• Adapt a healthy diet
• Exercise regularly