Aneurysm

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For other uses, see Aneurysm (disambiguation).

Aneurysm
Classification and external resources

Angiography of an aneurysm in a cerebral artery

ICD-10

I72

ICD-9

442

DiseasesDB

15088

MedlinePlus

001122

MeSH

D000783

An aneurysm or aneurism (from Greek: , aneurysma, "dilation", from

, aneurynein, "to dilate") is a localized, blood-filled balloon-like bulge in the wall of
a blood vessel.[1]
Aneurysms can occur in any blood vessel, with examples including aneurysms of the circle of
Willis in the brain, aortic aneurysmsaffecting the thoracic aorta, and abdominal aortic
aneurysms. Aneurysms can also occur within the heart itself.
As an aneurysm increases in size, the risk of rupture increases. [2] A ruptured aneurysm can
lead to bleeding and subsequenthypovolemic shock, leading to death. Aneurysms are a result

of a weakened blood vessel wall, and can be a result of a hereditary condition or an acquired
disease. Aneurysms can also be a nidus for clot formation (thrombosis) and embolization.
Contents
[hide]

1 Classification
1.1 True and false aneurysms

1.2 Morphology

1.3 Location

2 Signs and symptoms

o

2.1 Cerebral aneurysm

2.2 Abdominal aneurysm

2.3 Renal (kidney) aneurysm

3 Risk factors

4 Pathophysiology

5 Diagnosis

6 Treatment
o

6.1 Intracranial aneurysms

6.2 Aortic and peripheral aneurysms

6.3 Renal aneurysms

7 Epidemiology
o

7.1 Pediatric aneurysms

7.2 Risk factors

8 Notable cases

9 See also

10 References

11 External links

Classification[edit]
Aneurysms may be classified by type, morphology, or location.

True and false aneurysms[edit]

A true aneurysm is one that involves all three layers of the wall of an artery
(intima, media and adventitia). True aneurysms include atherosclerotic, syphilitic, and
congenital aneurysms, as well as ventricular aneurysms that follow transmural myocardial

infarctions (aneurysms that involve all layers of the attenuated wall of the heart are also
considered true aneurysms).[3]
A false aneurysm, or pseudo-aneurysm, is a collection of blood leaking completely out of an
artery or vein, but confined next to the vessel by the surrounding tissue. This blood-filled cavity
will eventually either thrombose (clot) enough to seal the leak, or rupture out of the surrounding
tissue.[3]
Pseudoaneurysms can be caused by trauma that punctures the artery, such as knife and bullet
wounds,[4] as a result of percutaneous surgical procedures such as coronary angiography or
arterial grafting,[5] or use of an artery for injection. [6]

Morphology[edit]
Aneurysms can also be classified by their macroscopic shape and size, and are described as
either saccular or fusiform. The shape of an aneurysm is not specific for a specific disease. [3]
Saccular aneurysms are spherical in shape and involve only a portion of the vessel wall; they
vary in size from 5 to 20 cm (8 in) in diameter, and are often filled, either partially or fully, by
a thrombus.[3]
Fusiform aneurysms ("spindle-shaped" aneurysms) are variable in both their diameter and
length; their diameters can extend up to 20 cm (8 in). They often involve large portions of the
ascending and transverse aortic arch, the abdominal aorta, or less frequently the iliac arteries.[3]

Location[edit]
Aneurysms can also be classified by their location:

Arterial and venous, with arterial being more common.[citation needed]

The heart, including coronary artery aneurysms, ventricular aneurysms, aneurysm of
sinus of Valsalva, and aneurysms following cardiac surgery.

The aorta, namely aortic aneurysms including thoracic aortic

aneurysms and abdominal aortic aneurysms.

The brain, including cerebral aneurysms, berry aneurysms, and CharcotBouchard

aneurysms.

The legs, including the popliteal arteries.[citation needed]

The kidney, including renal artery aneurysm and intraparechymal aneurysms. [7]

Capillaries, specifically capillary aneurysms.

Cerebral aneurysms, also known as intracranial or brain aneurysms, occur most commonly in
the anterior cerebral artery, which is part of the circle of Willis. This can cause severe strokes
leading to death. The next most common sites of cerebral aneurysm occurrence are in
the internal carotid artery.[8]

Signs and symptoms[edit]

Aneurysm presentation may range from life-threatening complications of hypovolemic shock to
being found incidentally on X-ray.[9] Symptoms will differ by the site of the aneurysm and can
include:

Cerebral aneurysm[edit]
Main article: Cerebral aneurysm

Symptoms can occur when the aneurysm pushes on a structure in the brain. Symptoms will
differ if an aneurysm has ruptured or not. For an aneurysm that has not ruptured:

Fatigue
Loss of perception

Loss of balance

Speech problems

Double vision

For a ruptured aneurysm, symptoms of a subarachnoid hemorrhage may present:

Severe headaches
Loss of vision

Double vision

Neck pain and/or stiffness

Pain above and/or behind the eyes

Abdominal aneurysm[edit]

Illustration depicting location of abdominal aneurysm

Main article: Abdominal aneurysm Signs and symptoms

Abdominal aneurysms can cause central back pain, oedema and deep vein
thrombosis, vomiting, and lower limb ischaemia[9]

Renal (kidney) aneurysm[edit]

Flank pain and tenderness

Hypertension

Haematuria

Signs of hypovolemic shock

Risk factors[edit]
Risk factors for an aneurysm include diabetes, obesity, hypertension, tobacco use, alcoholism,
high cholesterol, copper deficiency, increasing age, and tertiary syphilis infection.[9]
Specific infective causes associated with aneurysm include:

Advanced Syphilis infection resulting in syphilitic aortitis and an aortic aneurysm

Tuberculosis, causing Rasmussen's aneurysms

Brain infections, causing infectious intracranial aneurysms

A minority of aneurysms are associated with genetic factors. Examples include:

Berry aneurysms of the anterior communicating artery of the circle of Willis, associated
with autosomal dominant polycystic kidney disease.[10]
Familial thoracic aortic aneurysms
Cirsoid aneurysms, secondary to congenital arteriovenous malformations.

Pathophysiology[edit]
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Aneurysms form for a variety of interacting reasons. Multiple factors, including factors affecting
a blood vessel wall and the blood through the vessel, contribute.
Atherosclerosis. A variety of different factors, including atherosclerosis, may contribute to
weakening of a blood vessel wall. The repeated trauma of blood flowing through the vessel
may contribute to degeneration [clarification needed] of the vessel wall. Hypertensive injury may
compound this degeneration and accelerate the expansion of the aneurysm. As the aneurysm
expands, the wall tension increases.[11][citation needed]
The pressure of blood within the expanding aneurysm may also injure the blood vessels
supplying the artery itself, further weakening the vessel wall. Without treatment, these
aneurysms will ultimately progress and rupture. [12]
Infection. A mycotic aneurysm is an aneurysm that results from an infectious process that
involves the arterial wall.[13] A person with a mycotic aneurysm has a bacterial infection in the
wall of an artery, resulting in the formation of an aneurysm. The most common locations
include arteries in the abdomen, thigh, neck, and arm. A mycotic aneurysm can result in
sepsis, or life-threatening bleeding if the aneurysm ruptures. Less than 3% of abdominal aortic
aneurysms are mycotic aneurysms.[14]
Syphilis. The third stage of syphilis also manifests as aneurysm of the aorta, which is due to
loss of the vasa vasorum in the tunica adventitia.[15]
Copper Deficiency. A minority of aneurysms are caused by copper deficiency, which results in
a decreased activity of the lysyl oxidase enzyme, affecting elastin, a key component in vessel
walls[16][17][18] Copper deficiency results in vessel wall thinning, [19] and thus has been noted as a
cause of death in copper-deficient humans,[20] chickens and turkeys [21]

Diagnosis[edit]
Diagnosis of a ruptured cerebral aneurysm is commonly made by finding signs of
subarachnoid hemorrhage on a computed tomography (CT) scan. If the CT scan is negative
but a ruptured aneurysm is still suspected based on clinical findings, a lumbar puncture can be
performed to detect blood in the cerebrospinal fluid. Computed tomography angiography (CTA)
is an alternative to traditional angiography and can be performed without the need for arterial
catheterization. This test combines a regular CT scan with a contrast dye injected into a vein.
Once the dye is injected into a vein, it travels to the cerebral arteries, and images are created
using a CT scan. These images show exactly how blood flows into the brain arteries. [citation needed]

Treatment[edit]
Historically, the treatment of arterial aneurysms has been limited to either surgical intervention,
or watchful waiting in combination with control of blood pressure. In recent years, endovascular
or minimally invasive techniques have been developed for many types of aneurysms. [citation needed]

Intracranial aneurysms[edit]
Main article: Cerebral aneurysm treatment
There are currently two treatment options for brain aneurysms: surgical clipping or
endovascular coiling. There is currently debate in the medical literature about which treatment
is most appropriate given particular situations. [citation needed]
Surgical clipping was introduced by Walter Dandy of the Johns Hopkins Hospital in 1937. It
consists of a craniotomy to expose the aneurysm and closing the base or neck of the
aneurysm with a clip. The surgical technique has been modified and improved over the years.
Endovascular coiling was introduced by Guido Guglielmi at UCLA in 1991. It consists of
passing a catheter into the femoral artery in the groin, through the aorta, into the brain arteries,
and finally into the aneurysm itself. Platinum coils initiate a clotting reaction within the
aneurysm that, if successful fill the aneurysm dome and prevent its rupture. [citation needed]

Aortic and peripheral aneurysms [edit]

For aneurysms in the aorta, arms, legs, or head, the weakened section of the vessel may be
replaced by a bypass graft that is sutured at the vascular stumps. Instead of sewing, the graft
tube ends, made rigid and expandable by nitinol wireframe, can be easily inserted in its
reduced diameter into the vascular stumps and then expanded up to the most appropriate
diameter and permanently fixed there by external ligature. [22][23] New devices were recently
developed to substitute the external ligature by expandable ring allowing use in acute
ascending aorta dissection, providing airtight (i.e. not dependent on the coagulation integrity),
easy and quick anastomosis extended to the arch concavity [24][25][26]Less invasive endovascular
techniques allow covered metallic stent grafts to be inserted through the arteries of the leg and
deployed across the aneurysm.

Renal aneurysms[edit]
Renal aneurysms are very rare consisting of only 0.10.09% [27] while rupture is even more rare.
[27][28]
Conservative treatment with control of concomittant hypertension being the primary option
with aneurysms smaller than 3 cm. If symptoms occur, or enlargement of the aneurysm, then
endovascular or open repair should be consider.[29] Pregnant women due to high rupture risk of
up to 80% should be treated surgically.[30]

Epidemiology[edit]

Incidence rates of cranial aneurysms are estimated at between 0.4% and 3.6%. Those without
risk factors have expected prevalence of 23%.[8]:181 In adults, females are more likely to have
aneurysms. They are most prevalent in people ages 35 60, but can occur in children as well.
Aneurysms are rare in children with a reported prevalence of .5% to 4.6%. The most common
incidence are among 50-year-olds, and there are typically no warning signs. Most aneurysms
develop after the age of 40.[citation needed]

Pediatric aneurysms[edit]
Pediatric aneurysms have different incidences and features than adult aneurysms.
[31]
Intracranial aneurysms are rare in childhood, with over 95% of all aneurysms occurring in
adults.[8]:235

Risk factors[edit]
Incidence rates are two to three times higher in males, while there are more large and giant
aneurysms and fewer multiple aneurysms.[8]:235 Intracranial hemorrhages are 1.6 times more
likely to be due to aneurysms than cerebral arteriovenous malformations in whites, but four
times less in certain Asian populations. [8]:235[32]
Most patients, particularly infants, present with subarachnoid hemorrhage and corresponding
headaches or neurological deficits. The mortality rate for pediatric aneurysms is lower than in
adults.[8]:235

Notable cases[edit]

Albert Einstein, who died from a repaired aortic aneurysm

Richard Holbrooke, who died from a thoracic aortic aneurysm
John Olerud, a baseball player who had an aneurysm while in college at Washington
State University, and went on to have a seventeen year career in Major League Baseball[33]
Tasos Mitsopoulos, Cypriot politician who died from a brain aneurysm.
Richard Batum, a professional basketball player in France. Richard died during a game
in 1991 after suffering an aneurysm.