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Description:
Abnormal dilatation of a part of the arterial system is known as Aneurysm.
Generally it is limited locally.
Alternative nomenclature-
Aneurusma, Berry’s Aneurysm
Subtypes
1) True Aneurysm: This type of aneurysm has all the three layers of the wall of the artery.
This type can be further classified into on basis of shape into:
a) Fusiform aneurysm: In this type the entire arterial wall dilates uniformly.
b) Saccular aneurysm: This type is usually traumatic and in it a part of the circumference of the wall of the artery dilates.
c) Dissecting aneurysm: In this type the innermost layer of the artery that is the Tunica Intima tears off usually under a plaque (atheromatous plaque). The blood then enters the inner and outer parts of the next layer o f the arterial wall i.e. Tunica Media. This leads to dilatation of that part and hence the aneurysm.
2) False Aneurysm:This type of aneurysm has only the fibrous layer of the wall of artery. | |
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Epidemiology:
Aneurysm can occur at any artery of the body. The common sites however are:
1) Aorta: Abdominal Aorta is common. Can occur in thoracic aorta also.
2) Brain: Cerebral Artery Aneurysm
3) Intestine: Mesenteric Artery Aneurysm
4) Spleen: Splenic Artery Aneurysm
5) Lower Limb: Popliteal and Femoral Artery Aneurysm
Aneurysms show strong familial relationship.
Arterial Aneurysm are very common than the Venous Aneurysm. However the cases of venous aneurysm have also been reported. Common site for venous aneurysm is Popliteal Artery.
Show association with conditions like autosomal dominant polycystic kidney disease, copper deficiency. | |
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Complications of Surgery
• Damage to the surrounding structures in surgery
• Rupture of aneurysm
• Re rupture of aneurysm after preventive surgery
• Mortality is high even if the patient is in good hands
• Massive bleeding | |
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Causes and Risk Factors:
Aneurysm occurs due to weakening in the arterial wall.
It can be:
1) Congenital:
• Congenital deficiency of the elastic lamina in blood vessels of circle of Willis in the brain can cause aneurysm commonly known as Berry’s Aneurysm.
• Congenital aneurysm is also seen in the conditions like MarfanSyndrome or Ehler-Danlos Syndrome.
• Congenital arteriovenous fistula is also associated with aneurysm.
• Cirsoid aneurysm
2) Acquired:
a) Trauma:
• Direct trauma like penetrating wounds to artery.
• Radiation aneurysm.
• Trauma causing aterio venous aneurysm
• Indirect trauma can also cause aneurysm
b) Degenerative: Common group
• Atherosclerosis- common cause
• IntimomedialMucoid Degeneration causing aneurysm in abdominal aorta
c) Infective:
• Syphilis
• Acute infections can also cause aneurysm
• Infected emboli can also cause aneurysm
• Peptic Ulcer can be a cause for Aneurysm at its base
• Polyarteritis | |
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Risk Factors:
1) Smoking
2) Drinking
3) High Blood Pressure
4) Obesity
5) Diabetes
6) Previous history of Intracranial Bleed
7) Atherosclerotic diseases | |
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Complications of disease
A) Pressure Effects:
Pressure of aneurysm on veins leads to edema
Pressure of aneurysm on nerves leads to tingling sensation, paraesthesia, numbness and pain.
Pressure on adjacent organs 1) Dysphagia in case of aneurysm of aorta
2) Hematemesis in case the aortic aneurysm ruptures
Pressure on skin leads to inflammation
Pressure on bones leads to erosion and degeneration
Effects of Thrombosis:
Decrease in the blood flow to the distal parts.
Effects of Emboli formation:
Decrease in the blood flow to distal parts. Can cause claudication, severe pain even gangrene.
Effects of infection:
Septicemia can occur.
Rupture of the aneurysm:
Most grave complication of aneurysm. Can lead to death due to bleeding.
Differential Diagnosis:
1) Swelling above the artery can give pulsation
2) Swelling below the artery
3) Abscess
4) Pulsating tumors like telengiectatic osteosarcoma | |
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Treatment options/ Indications:
Mainly surgical.
Medical treatment is adjuvant. | |
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Investigations:
1) Arteriography
2) Angiography
3) X Rays
4) CT Scans
5) MRI
6) Transcranial Ultrasound
7) Echocardiography | |
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Latest Articles or references/ internet links
http://www.webmd.com/heart-disease/tc/aortic-aneurysm-surgery
Treating specialty
General Surgery
Neuro Surgery
Pediatric Surgery
Pediatric Neurosurgery
Neurology | |
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Signs and Symptoms:
Can be asymptomatic and get detected accidently. Other common symptoms include
• Dull aching pain is normally the presenting symptom
• Acute pain
• Bursting sever pain
• Referred pain
• Pulsatile mass
• Ischemia of lower limb
• Painful swollen limb due to venous obstruction and thrombosis
• Visual problems
• Fatigue
• Speech articulation problems
• Balancing problems
• Headache
Signs:
• Pulsatile mass in arterial path expanding with arterial beats
• Compressible swelling
• Pulsation decreases with pressure applied before the swelling
• Thrill
• Systolic bruit on auscultation
• Peripheral arterial insufficiency | |
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Diagnosis:
Proper history and clinical examination helps in the diagnosis.
Arteriography is the main diagnostic tool. | |
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Medical Treatment:
It includes monitoring the patient called as Watchful waiting.
• Life style modifications.
• Weight lose management.
• Regular examinations.
• Medication for the control of Blood Pressure.
• Nimodipine (Nimotop) is a calcium channel blocker and is usually used. It controls the spasm of ruptured blood vessel.
• Medications to control seizures.
• Glucocorticoids
• Anti inflammatory drugs
• Steroids | |
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Limitations of medical treatment
• Not the definitive treatment for the condition.
• The condition is a Surgical Emergency. | |
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Surgical Treatment
It includes:
• Preventive Surgery: to prevent the aneurysm from rupturing.
• Emergency Surgery: after the rupture of the aneurysm.
Aortic Aneurysm:
Preventive Surgery
1) When size is from 5 to 5.5 cms with risk factors.
2) When size is more than 5.5 cms even without the risk factors.
Surgerical Treatment is Grafting.
In here the affected part is removed surgically and is replaced by synthetic material termed as graft.
Open Surgery or Endovascular Surgery can be done.
In open Surgery an open large surgical cut is taken and the affected part is replaced by the graft.
In endovascular Surgery a Catheter is guided to the aorta and the graft is put at the affected part to reinforce it.
Intracranial Aneurysm:
Preventive Surgery
1) When the size is less than 3mm and with risk factors.
2) When the size is more than 7mm with or without risk factors.
Surgical Treatment can be
1) Clipping
2) Coiling
1) In surgical or Neurosurgical Clipping a part of the skull bone is excised by taking a cut under general anesthesia. The aneurysm is located and then it is surgically clipped. The bone part is placed again and the scalp is sutured.
2) In Coiling or Endovascular Coiling a small catheter is guided to the arteries of the brain and into the aneurysm. The catheter is inserted from the arteries of the lower limbs or groin. Next, small coils of platinum are inserted from the catheter into the aneurysm. These coils then block the blood flow in the aneurysm. | |