Aneurysms

An aneurysm (AN-u-rism) is caused by progressive weakening of the aortic wall that causes a "ballooning" of the vessel. The bulge or "ballooning" of the vessel will grow larger and eventually rupture if it is not diagnosed and treated. The most common place to have an aneurysm is in the aorta (the artery that goes from your heart down to the arteries which supply blood to your legs). Other common locations where aneurysms can occur are the arteries of the abdomen (iliac), groin (femoral), leg (popliteal) and, less frequently, in the arteries of the intestines, spleen, and brain. A ruptured aneurysm is an emergency and procedures must take place immediately to save one's life and avoid serious complications.

It is not known what causes an aneurysm. Atherosclerosis (build-up of plaque) is associated with having an aneurysm, and other risk factors include smoking, high blood pressure, high cholesterol, obesity, and family history of aneurysms or cardiovascular disease. Your risk will increase as you grow older, although some aneurysms are present at birth. Rarely, aneurysms are caused by infection or injury.

Symptoms depend on where the aneurysm is found and sometimes there may be no symptoms at all. Aneurysms near the surface of the body may appear as a pulsating swelling. Those deep in the body may not be felt. With abdominal aortic aneurysms (AAA), lower abdominal or lower back pain may be present. With iliac, femoral, or popliteal aneurysms, a person may experience severe pain, coldness or splotchiness of the leg. If an aneurysm breaks (ruptures), you may have a fall in your blood pressure, pass out, have a high pulse rate, or eventually die if not promptly diagnosed, and attended to.

In order to find out if you have an aneurysm, your health-care provider will ask for your personal medical history and will perform a physical examination and ask about any symptoms. If an aneurysm is suspected, an ultrasound, CT scan, or MRI may be performed. In some cases, an angiogram (dye test) may be necessary, particularly if surgery is planned.

If an aneurysm is found, treatment depends upon the size, location, symptoms, your general state of health, and whether or not, the aneurysm is completely blocked with clots or plaque. If the aneurysm is small, it may be followed closely by your health-care provider and you will be given instructions to watch your blood pressure. An AAA is seldom repaired until it is about the size of a lemon. If you have a popliteal aneurysm, you will be told not to squat.

Treatment in some cases may include surgery or endovascular stenting. With surgery, an artificial tube is inserted and sutured or sewn into place. In endovascular surgery, the graft is delivered through a catheter or tube inserted into an artery. X-ray guidance is then used to accurately position the graft within the aneurysm. The graft is then expanded inside the aneurysm and held in place with metallic hooks rather than sutures. Hospital stays for endovascular surgery are shorter than those for open surgery, but patients undergoing endovascular stenting need more frequent follow-up tests. The decision regarding whether surgery or endovascular stenting is performed depends on a number of factors.

It is important to talk to your health-care provider if you have a family history of aneurysms of any kind. If you are found to have an aneurysm, you should contact your provider if you discover a new lump. You should always maintain a normal blood pressure and stop smoking (if you do).