Aneurysm: What is a vascular bulge, how does it manifest and what are its risks?

An aneurysm, also known as vascular edema, is a disease of the blood vessels. It is caused by a change in the structure of the vessel wall. It most often affects the aorta and other arteries. These are mainly the arteries in the thigh or gill area and the cerebral vessels. The aorta mainly affects the abdominal part. And it is less common in the liver, kidney, or carotid artery.

Aneurysms can occur anywhere in the body. However, they mostly affect the aorta, namely its abdominal part, followed by the cerebral arteries.

The bowl of the vessel is described as an extension, in the 1.5 times normal original transversediameter (diameter). It is caused by a pathological change in the structure of the vascular wall. The exact cause of this change is not fully understood.

It is described as a multifactorial action of risk factors, which include genetic predisposition, family occurrence,  male gender, or old age. This also because of atherosclerosis, inflammation of the vessel, infectious disease (syphilis), injury, tumor damaging the vessel from the outside, or congenital inferiority of the vessel wall.

A person can live with an unrecognized aneurysm for many years, or it may be detected accidentally during another examination or preventive examination. A serious complication is a rupture of a weakened concave vascular wall, which is followed by a sudden deterioration in health. Therefore, an aneurysm is also called a silent killer.

In most cases, it mainly affects older men over the age of 50. The bulging of the cerebral vessels, though happens also in young people, and conversely, mostly women.

In men aged 65-75 years, the approximate incidence is 3-10% and a higher risk of aneurysm is for those over 80 years old.

The bulge of the vessel can have various shapes. The most common is the vesicular enlargement of the aorta . Other forms of aneurysm  include, for instance, arthropod, spindle-shaped, diffuse or serpentine. Of course, size is also crucial . The size of the aneurysm itself can cause the oppression of the surrounding structures. Which is a major problem, especially with cerebral aneurysms.

In abdominal aortic aneurysm , the size of the aortic diameter is determined to be more than 3 cm . The normal width of the abdominal aorta is approximately 2 cm and the differences depend on age and gender. With an outer transverse diameter width of more than 5.5 cm , the abdominal bulge is classified as large . The small aneurysm is in the range of up to 4.5 cm .

The higher risk of rupture of the abdominal aortic aneurysm is when ranging above 5 cm.

In the case of a cerebral aneurysm, the bulge is differentiated in size into:

• baby aneurysm up to 3 mm
• small bulge 4 - 6 mm
• middle bulge 7 - 10 mm
• large bulge 11 - 25 mm
• gigantic bulge over 25 mm

The distribution of the aneurysm by type is given in the table

The cause of the aneurysm is not precisely elucidated. The multifactorial action of several risk factors is assumed. These include atherosclerosis, genetic predisposition, and familial occurrence. The formation is also influenced by biochemical and enzymatic factors or the hemodynamic influence at the site of the division of the aorta into smaller arteries.

Aneurysms usually occur in places where the blood vessels bend and branch, that is, where they diverge. In the area, the vessel is under the greatest hemodynamic load. In the case of cerebral edema, lower elasticity, a smaller layer of muscle and the presumption of congenital predispositions of the vascular wall also contribute.

One is not born with an aneurysm, it develops during life.

The main causes of vascular bulges and risk factors include:

• atherosclerosis
• inflammation of the vessel
• infectious diseases such as syphilis, salmonella arteritis, TB, fungal infection
• damage to the vessel from the outside, its erosion by tumor, TB, peptic ulcer
• injury and injury to a vessel, for example during surgery, after needle insertion, during catheterization
• congenital inferiority of the vascular wall
• genetic and hereditary influences
  • 12 times higher risk in first-degree blood offspring 
  • connective tissue disorders
  • Marfan syndrome
  • Ehler - Danlos syndrome
• biochemical and enzymatic factors
  • reduced amount of collagen, elastin
  • alpha 1 antitrypsin deficiency
  • higher proteolytic activity of enzymes, matrix metalloproteinases (MPPs)
• hemodynamic effects
• hypertension as a cause of complication, ie rupture of the edema
• smoking
• alcohol
• age over 50 years
• male 
• overall bad lifestyle

The symptoms of an aneurysm depend on several circumstances . However, the bulging of the vessel may not manifest at all . And often its first manifestation is a rupture  , followed by a sudden and dramatic development of difficulties . A complication in the form of a rupture often has a difficult course ending in death or with serious permanent consequences. Therefore, the aneurysm is also called the Silent Killer .

Thoracic aortic aneurysm causes a number of problems, such as aortic valve involvement with consequent inadequate aortic function. The blood is insufficiently emptied into the aorta, ie towards the body. As a result, hypertrophy and dilatation of the left ventricle of the heart, ie enlargement of the heart, occur.

It can cause narrowing of the coronary arteries . Which causes problems such as heart ischemia , ie angina pectoris  to heart muscle infarction . An aneurysm also suppresses the surrounding structures located in the chest, namely the larynx, vocal cords, trachea, bronchi or esophagus.

Interesting information: read also the articles at the Medical Center about angina pectoris , ischemic disease and heart attack .

When the abdominal aorta is affected , the highest incidence is reported in the area under the retreat of the renal arteries and in up to 1/3 of cases it continues to the lumbar arteries. A substantial amount of these abdominal bulges are asymptomatic. Subsequently, abdominal pain begins to increase and there is a risk of it breaking.

The basis of the difficulties is again the oppression of the surrounding tissues and structures, such as the intestines, kidneys or vertebrae. An aneurysm also disrupts blood flow through the vessel. This in turn predisposes the formation of thrombi - blood clots. Blood clots can cause tissue ischemia in the affected area.

A complication is also the tearing off of the clot and the transfer of this embolus, ie embolization. This is the case, for example, with an aneurysm of the popliteal artery, which is the coronary artery. Embolism in the limb causes ischemia with consequent difficulties. Non-bleeding of the limb is manifested by pain, discoloration (purple, pale, marble to gray), or a decrease in the temperature of the foot to the touch.

Swelling can also be the cause of blood loss from the body's circulation. Anemia, that is, deficiency in blood occurs. With the rupture of the aneurysm, the state of health changes suddenly. The start of intense, unbearable to severe pain, large blood loss with shock. The complication is serious, endangers the health and life of the affected person, and despite urgent surgery, 40-60% of patients die.

In the case of a cerebral aneurysm, the first manifestation of its existence is usually a rupture. This is in most cases due to an increase in blood pressure with a weakened blood vessel wall. There is a bleeding stroke that is very dangerous to human health and life and in the form of SAH / SAK (subarachnoid haemorrhage / bleeding).

Rupture is reported to occur in approximately 45% of cases of cerebral (intracranial) aneurysms.
Mortality is reported in up to 44% of these bleeds.
And about 10% of those affected die before medical care arrives.

In addition to hypertension, smoking, alcohol, and even pregnancy are also at risk. It is characterized by difficulties such as intense headache , meningeal symptoms, such as  meningism  , the opposition of the neck, inability to tilt the head and touch the chest with the chin, but also increased sensitivity to noise and light, such as photophobia . Furthermore, vomiting or impaired consciousness is associated , and thus collapse or unconsciousness.

A cerebral aneurysm causes the compression of brain tissue , as the brain is within the skull and it is inflexible. Thus, even an unbroken cerebral edema results in various non-specific difficulties . Such as:

• imbalance, gait and coordination
• speech disorder
• vision problem, visual field loss
• memory disorders
• impairment of thinking, cognition and processing of information
• reduction of concentration - concentration
• behavioral changes
• fatigue, increased sleepiness

The table lists the different symptoms of an aneurysm and its rupture according to the area of ​​occurrence

Diagnosis is based on history and clinical picture . Because a minor aneurysm may have an asymptomatic, asymptomatic course , it is detected accidentally . For example, during a preventive examination or as a by-product of another disease.

Imaging methods such as X-rays, USG (SONO), but also CT and MRI are used to diagnose the aneurysm . Angiography has its limitations in determining the overall extent and is used less frequently. Hemoculture, ie blood collection, is also added to the fungal type.

Some imaging forms have a limit to determine a cerebral aneurysm . However, the basis consists of CT and MRI examinations . Subsequently, CT angiography and DSA , which is digital subtraction angiography , are also selected . What is an invasive method based on CT imaging before and after injection of a contrast agent into the carotid artery. Subsequently, the cerebral circulation is drawn - a cerebral angiogram.

The course is fully dependent on the type of aneurysm, and thus its location and size . Of course, on whether the bulge persists without rupture , or leads to its rupture . When the form is not cracked, it often takes place hidden and asymptomatic. Or, you experience these symptoms.

The subsequent rupture manifests itself in most cases suddenly and with intense difficulties . The same is true of the dissecting form. Early diagnosis and early treatment are therefore often life-saving . In the case of these diseases, preventive examinations and targeted aneurysm screening are of great preventive importance.