Aneurysms

(Abdominal, aortic, and dissecting aneurysms)

An aneurysm is a bulging in the wall of a weakened segment of a blood vessel. The aorta, the body's largest artery, is most often affected, although aneurysms develop also in arteries at the base of the brain and in some of the smaller vessels within the brain.

Aneurysms usually do not produce symptoms until they are large enough to press on nearby organs. For example, an aortic aneurysm that occurs near the heart can cause chest pain and other symptoms that mimic angina or a heart attack. In this type of aneurysm, the artery's inner and outer walls may divide, allowing blood to seep between the layers and reducing blood flow to other pans of the body. This is called a dissecting aortic aneurysm and it is especially dangerous.

An abdominal aortic aneurysm can sometimes be felt as a throbbing, tender mass just under the skin, below the ribcage in the center of the abdomen. If it leaks blood, it can cause pain that radiates to the back and groin. In a carotid aneurysm, the throbbing is felt in the neck, and there may also be a visible bulging under the skin.

Arteriosclerosis, a hardening of the arteries, promotes aneurysms, as does high blood pressure. Other causes are congenital defects and inherited disorders. For instance, coarctation of the aorta, a congenital defect in which a segment of the artery is stiff and narrowed, can lead to an aortic aneurysm in the normal portion. Anyone with Marian's syndrome, a hereditary disorder characterized by eye, skeletal, and cardiovascular abnormalities, is also prone to aneurysms.

As an aneurysm enlarges, the danger increases that it might suddenly rupture. A burst aneurysm is usually fatal within minutes, especially if the aorta or carotid arteries are involved, although immediate surgery to halt bleeding and repair the break is sometimes life-saving.

Diagnostic Tests and Procedures

During a physical examination, a doctor can often feel and hear the abnormal throbbing of an aneurysm. As blood flows through the weakened segment of the vessel, it may also make a distinctive sound that can be heard through a stethoscope. A doctor may suspect coarctation of the aorta if blood pressure is elevated in the arms and upper body, and normal or low in the trunk and legs. This is confirmed by measuring blood pressure separately in the arms and the legs.

Imaging studies, ranging from ordinary X-rays to a CT scan or MRI and ultrasound, confirm the presence of an aneurysm. Asymptomatic aneurysms sometimes show up on X-rays or scans taken for some other purpose.

Medical Treatments

A small aneurysm that is neither enlarging nor producing symptoms usually requires only regular monitoring with X-rays or other tests to detect any enlargement.

Surgery, sometimes on an emergency basis, is required if the aneurysm is growing or in danger of rupture. A promising experimental treatment for an expanding aneurysm entails lining the weakened artery with a thin tube.

Coarctation of the aorta also requires surgical repair, although some cases can be resolved by balloon angioplasty. In this procedure, a balloon-tipped catheter is inserted into the aorta, and the balloon is inflated at the narrowed site to stretch the artery, thereby allowing normal blood flow.

Alternative Therapies

There are no safe alternative approaches for an aneurysm, although meditation and other relaxation techniques are useful adjunctive therapies if high blood pressure is a contributing factor. In such cases, salt restriction, weight loss, and other nutritional therapies may also be beneficial.

Self-Treatment

An aneurysm does not lend itself to self-treatment. However, preventive a measures may be recommended in certain situations. For example, patients with Marfan's syndrome are advised to avoid competitive or endurance sports. Some athletes with undiagnosed Marfan's syndrome have died suddenly during a strenuous competitive event. Flo Hyman, a member of the U.S. Olympic volleyball team in 1984, is a 7 notable example of sudden death due to Marfan's syndrome.

Because atherosclerosis increases the risk of an aneurysm, a diet low in saturated fat and high in fiber, which will help reduce blood cholesterol levels, is advisable. Smoking and excess weight can also contribute to conditions that provoke aneurysms, so stopping smoking and controlling weight are important aspects of preventive self-care. Moderate exercise, approved by a physician, may also be beneficial.

Other Causes of Aneurysm Symptoms

The pain of an abdominal aneurysm, which may be felt in the back or sides, a sometimes leads a doctor to suspect a ruptured spinal disk, kidney disease, or intestinal disorder.