An aneurysm is considered a silent danger because it often goes unnoticed for a long time. If the bulge in the vessel grows and tears, there is a risk to life due to internal bleeding. What symptoms indicate an aneurysm.
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Quick overview: aneurysm
Definition: If a blood vessel expands, it is an aneurysm. A main artery is usually affected (aortic aneurysm).
Symptoms: Depending on the location of the deformity, different signs such as back pain or heart problems can indicate the danger. However, an aneurysm often does not cause any symptoms.
Causes: In many cases, atherosclerosis weakens the artery wall. High blood pressure and smoking are also risk factors.
Therapy: In the case of small vascular dilatations, it is sometimes necessary to wait. Otherwise, endovascular surgery is used in which the weak point is repaired with a stent or bypass.
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What is an aneurysm?
A blood vessel can not only become too narrow and close (thrombosis), but also become dilated. Such a bulging of the vessel, the aneurysm, often forms on the arteries, the body’s large arteries. They transport oxygen-rich blood from the heart to the organs.
This bulge most often forms along the main artery (aortic aneurysm). It very often affects the abdominal aorta (abdominal aortic aneurysm). In addition, the arteries can
- in the chest (thoracic aneurysm),
- in the brain (intracranial or cerebral aneurysm),
- in the pool or
- be expanded in the legs.
Risk increases with age
Most people acquire the sac-shaped artery bulge during their lifetime. Deposits (plaques) weaken the vessel walls as we age. This is why older people over 60 years old in particular develop aneurysms. Less commonly, the vascular anomaly is congenital. In these cases, those affected become ill at a young age.
Brain aneurysms in particular often exist from birth. However, there are usually further malformations of blood vessels.
Aneurysm symptoms: Vascular weakness goes unnoticed for a long time
The symptoms depend on where in the artery the enlargement is and how large it is. Sometimes doctors find the aneurysm by chance during a routine examination, for example during an X-ray or ultrasound. Most people only feel the aneurysm when it is more advanced, presses on the internal organs or, in the worst case, ruptures.
Abdomen (abdominal aortic aneurysm):
- Pain in the back, chest or lower abdomen
- Flank pain that radiates to the back or legs
- In the event of a rupture: sudden back pain that radiates to the side or groin, high internal blood loss with dizziness, loss of consciousness and circulatory collapse
Chest cavity (thoracic aneurysm):
Near the heart wall:
Brain (brain aneurysm, cerebral aneurysm):
- Headache
- Losses of nerve function
- If cracked: Sudden, extremely severe headache, stiff neck, paralysis and dizziness
Causes of an aneurysm
The most common cause is arteriosclerosis, in which deposits called plaques form in the blood vessels. They weaken the artery wall, meaning the blood vessels are no longer as elastic as healthy ones. A dilation slowly develops, increasing in size and causing the diameter of the vessel to increase.
Certain factors increase the risk of arteriosclerosis – and therefore an aneurysm. These include:
- high blood pressure
- increased blood lipids
- Diabetes mellitus
- Smoke
- excessive alcohol consumption
Many patients not only have one aneurysm, but also several dilated or malformed vessels.
Hereditary aneurysm
Genetic factors also play a role. The vascular disease occurs more frequently in some families.
Inflammation due to a bacterial infection and injuries to the vessel walls (false aneurysm) also promote weak points in the vessel, for example during a cardiac catheter examination.
Diagnosis when an aneurysm is suspected
The bulging of the vessel usually does not cause any symptoms for a long time. At the beginning of the diagnosis, the doctor asks a few questions about the symptoms and the medical history. This is followed by a physical examination in which certain areas of the body are palpated. A large abdominal aortic aneurysm can sometimes even be felt with your hands.
Imaging procedures are also used:
Ultrasonic: Ultrasonography of the abdomen or pelvis shows the location and size of the aneurysm and the danger posed by the bulge. Ultrasound can also be used to check abnormal aneurysms that do not yet require treatment.
Transesophageal ultrasound (TEE): If a vascular bulge in the chest is suspected. The transducer is inserted through the esophagus.
Computed tomography (CT) and magnetic resonance imaging (MRI): If a vascular change in the abdomen, chest or brain is suspected. This allows the size and risk of cracks to be determined.
Angiography: X-ray examination of the vessels shows how large the aneurysm is.
Treat aneurysm with surgery
The treatment of choice is endovascular surgery. With this method, the blood vessel is treated from the inside. Surgeons do not operate on a smaller aneurysm immediately. They initially observe how it develops with regular ultrasound examinations.
However, if the vessel dilates more than five centimeters in diameter and there is an impending risk of rupture, an operation is usually carried out. If the vessel bursts, those affected end up in a life-threatening condition because internal bleeding occurs. Experts try to stop the life-threatening bleeding as quickly as possible in an emergency operation.
Treatment options:
Aortic aneurysm in the abdomen: In an open operation, an abdominal incision is made, the vessel is opened and an artificial piece of vessel (plastic prosthesis) is inserted. Alternatively, the aneurysm in the abdomen can be operated on through a small incision in the groin. A catheter and a small tube (stent) are inserted through the inguinal artery to the weak point. There the stent is deployed using a balloon and fixed in the abdominal aorta.
Aneurysm in the chest and leg: An aneurysm in the legs is often located in the popliteal artery. A bypass is usually placed to bypass the affected vessel and continue to ensure blood circulation.
Brain aneurysm: During open brain surgery, clipping involves closing the aneurysm with a clip. Alternatively, the closure is done with coiling using a platinum spiral (coil). The coil is advanced into the area of the aneurysm via a catheter in the groin.
Possible risks of surgery
For people with chronic illnesses, such as cardiovascular, respiratory or kidney diseases, open surgery is usually too risky and therefore not suitable. Surgery to repair an aneurysm in the chest also carries an increased risk. For example, it can lead to heart and breathing problems. A surgical procedure in which the weakened section of the vessel is replaced should therefore only be carried out in specialized centers.
Prognosis for aneurysm
The prognosis depends on the location, rate of growth and size of the vascular bulge. At first it usually doesn’t cause any problems and often goes unnoticed. The larger the vascular bulge, the higher the risk that the vessel will rupture and cause internal bleeding. A vascular rupture is associated with a high risk of mortality. If the aneurysm is discovered in time, it can be easily treated and the chances of recovery are favorable in many cases.
Prevent aneurysms
Certain measures can prevent vascular bulges and reduce the important risk factor arteriosclerosis. The following tips can promote vascular health and prevent or at least delay the growth of an aneurysm:
Quit smoking: Not only the lungs and respiratory tract benefit from this, but also the vessels. An existing aneurysm usually stops growing if you stop smoking. The best way to stop smoking is with nicotine replacement products (nicotine chewing gum, nicotine patches) and behavioral therapy.
High blood pressure: Increased blood pressure should be adequately treated with medication. Medicines that lower blood pressure include ACE inhibitors and beta blockers.
increased blood fats: If you have high blood fat levels (triglycerides, cholesterol), you should try to lower them. This can be achieved with a healthy diet and physical activity. Medication can support the process.
Lose excess weight: Excess kilos can also put a strain on the vessels and should therefore be reduced if possible.
healthy (low-salt) diet:Lots of fruit and vegetables, whole grain products and fats from plant sources (rapeseed oil, linseed oil, sunflower oil) should be on the menu. However, limit the consumption of animal fats (meat, sausage, butter) and salt.
Follow-up examinations:Those affected should have the condition of the vascular replacement and the sutures checked regularly.
Check-ups:They are important for diagnosing aneurysms in a timely manner and taking timely action if aneurysms increase in size. The German Society for Vascular Surgery and Vascular Medicine (DGG) recommends that legally insured men aged 65 and over undergo ultrasound screening of the abdominal aorta. This also applies to women over 65 who smoke or have smoked in the past.
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