Aneurysms are localized, pathological dilations of blood vessels that often go unnoticed for a long time. If an aneurysm ruptures, there is a risk to life. Read more about symptoms, warning signs, origin and treatment in the clinical picture aneurysm.

Synonyms

Arterial dilation, Arterial sacking

Definition

stomach pain

An aneurysm is what physicians refer to as localized, pathological widening of blood vessels due to congenital or acquired changes in the blood vessel wall. This differentiates aneurysms from ectasias, which appear as permanent blood vessel dilations with an intact vessel wall.

In most cases, different sections of the main artery (aorta) are affected by aneurysms. The ancient Greek word for bagging gave the disease its name. The plural of aneurysm is aneurysm or aneurysm. In colloquial language, there is often talk of arterial dilation or arterial sacking.

The term bagging can be taken literally: in the case of an aneurysm, the artery in the affected area forms an extension that looks like a more or less filled bag. But sometimes aneurysms are shaped like a spindle. In almost 80 percent of cases, aneurysms are a result of advanced arteriosclerosis. The malformation of the aortic vessel wall can also be congenital or genetic. Important risk factors for arterial sacs are high blood pressure (hypertension) and peripheral arterial disease (paVK).

Depending on the symptoms and location, medical professionals distinguish between 3 types of aneurysm.

  •  Aneurysm verum: The real aneurysm is the classic and most common form of arterial sac. With this aneurysm, the different layers of the arterial wall are still intact and the vascular cross-section as a whole is enlarged.
  • Medical doctors call an aneurysm dissecans an artery sagging that forms when blood gets between the layers of the vessel wall through a tear in the inner skin of the artery (doctors say: it dissects). The dissecans aneurysm is often referred to as aortic dissection.
  • Wrong aneurysm: The aneurysm spurium / falsum or pseudoaneurysma is a special form in which the inner and middle wall of the vessel is damaged by definition. However, there is no sagging of the vascular tissue here as in the other forms. Rather, there is a bruise around the damaged vascular wall section, which covers the vascular wall defect. Often, bleeding to death is only delayed for a short time. If the bruise persists longer, it is encapsulated by the surrounding tissue and appears like an aneurysm. The risk of a vascular tear continues to exist.

Danger to life due to aneurysms

Aneurysms pose a life-threatening risk. If the walls of the damaged artery tear (ruptured artery), severe internal bleeding occurs. These ruptures are most dangerous when the main artery is affected (aortic aneurysm) or a large artery in the brain (cerebral aneurysm). Abdominal aortic aneurysms (abdominal aortic aneurysm) are also extremely dangerous.

Although aneurysms can be so life-threatening, there are hardly any noticeable symptoms. In most cases, they are discovered accidentally or recognized by risk patients during a check-up. Aneurysms requiring treatment are surgically removed as far as possible and the affected arteries are stabilized or replaced.

Frequency

In hereditarily unaffected people, the risk of developing an aneurysm increases, especially with age. With family history, aneurysms occur in all age groups. Overall, men are affected up to 7 times more often than women.

Aneurysms are common. It is believed that more than one million Germans have pathological artery dilation. These numbers are estimates based on research. An average of 1 to 2 percent of all vascular representations (angiographies) result in a positive aneurysm result. This rate increases significantly with age. Autopsies of people over the age of 70 show up to 7 percent of the cases in which vasodilation is potentially in need of treatment.

The frequency of an aortic aneurysm in men between the ages of 70 and 75 is given in the literature as 8.5 percent. Then it rises to more than 10 percent.
Exact numbers on the frequency of brain aneurysms are not available. Experts estimate a new incidence rate of 15 people per 100,000 people. For Germany that would be more than 1,200 cases a year.

Symptoms

In most cases, aneurysms cause no noticeable symptoms for years. When the vascular sacks have reached a critical size, they can sometimes be felt. The symptoms depend on the size and location of the aneurysm.

Symptoms of thoracic aneurysms

If there is extensive aortic bagging (thoracic aneurysm) in the chest area, this is particularly noticeable with chest pain and breathing difficulties. Characteristically, these symptoms worsen on inhalation. Sometimes the narrowing leads to cough, hoarseness, and difficulty swallowing. When listening to the breathing sounds, a pathological breathing sound is perceptible (stridor). Recurring infections such as pneumonia are not uncommon for the diagnosis of thoracic aneurysms.

Symptoms of abdominal aortic aneurysm

A typical symptom of abdominal aortic aneurysms is persistent pain in the lower abdomen, which sometimes radiates into the legs or back. The pain is typically sharp. In rare cases, the abdominal artery in the abdomen is sagged to such an extent that it interferes with intestinal function and causes constipation.

Symptoms of brain aneurysm

Brain aneurysms do not appear until the time of the rupture. Accordingly, there are no symptoms that could be perceived as warning signs.  

Causes

The most common cause of aneurysms are age-related changes in the vascular wall, such as arteriosclerosis. “Vascular calcification” makes the layers of tissue on the arterial wall increasingly brittle. The arteries, which have to stretch with every heartbeat, lose elasticity. They wear out and favor real aneurysms. The arteriosclerotic form of the aneurysm occurs in 80 percent of all cases without hereditary previous stress.

The second largest group of patients are people in whom first-degree relatives have already developed an aneurysm. This suggests that hereditary factors can play a role in the development.

Rare causes of aneurysms

Rare causes of aneurysms are infections of the inner walls of blood vessels (for example mycotic aneurysm or as a result of rheumatic fever, Kawasaki syndrome and borreliosis) and rare congenital weaknesses in the connective tissue such as Marfan syndrome or Ehlers-Danlos syndrome. There is also evidence that headbanging is associated with an increased risk of brain aneurysms.

Incorrect aneurysms are a rare consequence of injuries to the inner wall of the vessel, such as those that can result from a cardiac catheter examination.

Risk factors

In addition to the hereditary pre-stress, high blood pressure (hypertension) and peripheral arterial disease (paVK) are the most important risk factors for aneurysms. Both high blood pressure and paVK are favored primarily by a lack of exercise, a diet high in fat and smoking.

Complications

The greatest danger is that the aneurysm tears (ruptures). Such a rupture is often associated with acute pain that is almost unbearable. A rupture in the brain is accompanied by unbearable headaches, often combined with nervous failures in the form of paralysis or visual disturbances.

Broken abdominal and thoracic aneurysms cause severe pain in the abdomen and / or chest area. These annihilation pains are often accompanied by nausea, vomiting and circulatory collapse. If an aneurysm tear is suspected, the emergency doctor must be called immediately.

Examination

The investigation of aneurysms is mainly based on imaging methods. In very many cases, a simple ultrasound examination provides the decisive information. This is especially the case with abdominal aortic aneurysms or thoracic aneurysms. In the latter, the ultrasound probe can also be passed through the esophagus (transesophageal sonography).

A brain aneurysm, on the other hand, can only be discovered using computed tomography (CT) or magnetic resonance imaging (MRI).  

Treatment

Depending on the location, aneurysms require treatment from a certain size. Up to this threshold, therapy can be limited to merely observing the sags. Depending on the size, the check-ups are carried out every 6 or 12 months.

Treat underlying diseases

The most common cause of aneurysms is the combination of high blood pressure and arteriosclerosis. Therefore, an essential part of treating aneurysms is to lower high blood pressure.

Operation of aneurysms

The surgical methods for the surgical treatment of aneurysms depend on the location and size of the vascular changes. A brain aneurysm understandably requires a different approach than a relatively easily accessible abdominal aortic aneurysm.

The principle of the operation, however, is the same in most cases: the damaged artery is either replaced by a natural or artificial implant and then stabilized with a stent. With a brain aneurysm, the bagging is usually pinched off.

Forecast

The likelihood of survival in an aneurysm depends largely on whether the enlarged artery is noticed in good time before the tearing. The prognosis for these patients is very good. The number of complications and deaths in these cases is in the range of a few percent.

However, if a large artery is already torn, the chances of survival decrease significantly. If the main artery ruptures in the chest (thoracic aortic aneurysm), 3 out of 4 sufferers die within a few hours. Only half of the patients survive a rupture of an abdominal aortic aneurysm or a brain aneurysm. Especially in the case of the brain aneurysm, the survivors also have to reckon with permanent impairments of brain function.

Prevention

Safe prevention of aneurysms is not possible. This is especially true for people with inherited disorders. However, the risk can be significantly reduced. A fresh, low-fat and varied diet and regular exercise reduce the risk of obesity and typical complications such as arteriosclerosis, high blood pressure, diabetes or other vascular disorders such as paVK. Refraining from smoking and, at best, moderate alcohol consumption improve the chances of preventing an aneurysm.

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