Recognizing the danger

An aneurysm (ancient Greek for »widening«) is a widening of a vessel in an artery in the abdomen, chest or brain. Theoretically, such aneurysms can develop anywhere in the body. However, it most frequently manifests itself in the three places mentioned and in the arteries, because the pressure on the blood vessels is higher here than in the veins. This is followed by an aneurysm of the knee joint artery, writes the University Hospital Zurich (USZ).

People with a congenital weakness of the arterial vessel walls have a higher risk of developing an aneurysm. This usually only becomes apparent in adulthood. The cause is not arteriosclerosis. This is not the case with so-called acquired causes, the main cause of which is arteriosclerosis and which develop in the aorta (aortic aneurysm) or the leg arteries. The increasing calcification of the vessel walls weakens them so that they can react less flexibly to the pressure of the blood and leak more easily. Doctors can differentiate between congenital and acquired aneurysms based on certain different characteristics of both forms.

Obesity, diabetes, high blood pressure, high blood lipid levels and smoking promote arteriosclerosis and aneurysms. There is also evidence that aneurysms sometimes occur more frequently in families. Inflammatory processes in the blood vessels as well as infections and injuries also promote the lability of vessel walls and therefore aneurysms. Age itself is another risk factor, but aneurysms do not only occur in older people, but also at a younger age.

An aneurysm (unfortunately) usually does not cause any symptoms. On the one hand, this is good for those who live with it unharmed until their natural death, but on the other hand it is bad for those whose lives are abruptly ended by the rupture of an undetected aneurysm. Depending on its size and location, such aneurysms can also cause symptoms: A larger abdominal aortic aneurysm, for example, can bring with it a pulsating sensation near the navel, describes the USZ, and those affected often also suffer from abdominal, back and flank pain.

An aneurysm in the chest area sometimes causes chest and back pain, difficulty swallowing, coughing, hoarseness and breathing problems, according to the hospital. If the aneurysm is located in the brain, it can cause headaches, visual disturbances, “eye pain”, or paresthesia or paralysis in the face. If it is located in the knee joint artery, an associated blood clot may block the knee artery. Those affected experience severe pain and their lower leg and foot become cold.

If an aneurysm ruptures, the affected person is at risk of bleeding to death. Even if there are other people on site who can call for help when this happens, it is not certain that patients will survive. In the case of an aneurysm in the head, around 30 percent of those affected die and 20 percent are left with damage. If such a vessel bursts in the abdomen, 90 percent of patients die before they can be taken to hospital. Of those who reach hospital alive and are operated on there, only one in two survives.

A devastating headache that has never been experienced is the main symptom of a brain aneurysm. The blood spreads in the cerebrospinal fluid space, also known as the subarachnoid space (SAB), which lies between the brain and the base of the skull. This directly causes a massive increase in pressure in the brain. Those affected suffer profound unconsciousness. Smaller ruptures can also manifest themselves in the symptoms of a stroke. Those affected by a burst abdominal aortic aneurysm also experience devastating pain, in this case in the abdominal and chest area. The circulation usually collapses here too.

In the case of a brain aneurysm, microsurgical clipping or endovascular coiling can be considered. In coiling, the doctor pushes a catheter through the groin to the aneurysm. This catheter is filled with platinum coils that fill the bulge. This prevents the blood flow from continuing to enter. The aneurysm thromboses and can no longer bleed. During clipping, the surgeon closes the aneurysm with a vascular clip. Once cut off from the blood flow in this way, it also thromboses.

A stent prosthesis is used in the endovascular treatment of an abdominal aortic aneurysm. It consists of a wire frame encased in a special material. The procedure is often performed under local anesthesia, which saves patients from having to undergo general anesthesia. In open surgery, the aneurysm is replaced with a plastic vessel via an abdominal or flank incision after it has been removed.