Types of Aneurysms
An aneurysm occurs when the wall of an artery is weakened and bulges due to the blood pressure on the weakened wall artery. This weakened area can rupture and cause internal bleeding.
AAA Abdominal Aortic Aneurysm
In many cases there are no symptoms of an aneurysm and it is found as a result of medical evaluation for a non-associative medical condition. Some symptoms can include: sudden or severe abdominal or back pain.
There are many factors that contribute to the formation of Abdominal Aortic Aneurysms. Some of these factors include: Tobacco use, atherosclerosis, high blood pressure, heredity, Trauma, Blood vessel disease, infection in the aorta.
Due to the lack of symptoms many AAA are found incidentally. Diagnosis and confirmation of a AAA is confirmed via imaging tests including: an abdominal ultrasound that can measure the size of the aneurysm. Additional testing includes Computed tomographic angiography or CTA to assess the size, location, and extent of aneurysm.
1. Small AAA (Less than 5cm Diameter)
Patients will be watched by their vascular surgeon and will have an ultrasound every 6-12 month to monitor for aneurysm growth and rupture risk.
2. Smoking cessation – your vascular surgeon will ask you to find a smoking cessation program as smoking only increases likelihood of aneurysmal growth.
3. Larger AAA, your doctor will probably recommend that the aneurysm is corrected surgically.(More than 5cm Diameter)
a. EVAR – Endovascular aneurysm repair with a endovascular stent graft placed via a catheter much like a typical stent. The graft allows for the bypass of blood through the new prosthesis and maintaining a consistent diameter of the vessel.
b. Open vascular graft surgery – where the affected portion of the aorta is removed and replaced with a prosthesis graft and stitched into place.
A peripheral aneurysm occurs when the wall of the blood vessels in the peripheral part of your body weaken and the vessel balloons outward or becomes abnormally widened.
Many times, aneurysms have no symptoms, and develop slowly and un-noticeable to the individual. Aneurysms are generally discovered during a physical examination, many times this discover occurs during examination for an unrelated illness.
Causes of peripheral aneurysms include a family history of aneurysms, past history of a peripheral aneurysm, as well as smoking. In Women, Splenic aneurysms tend to grow during pregnancy especially for those mothers who have had multiple children.
When a peripheral aneurysm is suspected it is prudent to make an appointment with a vascular surgeon. Your surgeon will recommend the following tests: Duplex ultrasound, CT scan and ultrasound testing, or angiography to confirm size and location of aneurysm.
Treatment of a peripheral aneurysm will depend on the size and location as well as the condition of surrounding blood vessels.
The following are common treatments for peripheral aneurysms:
Bypass Surgery: Blood flow is re-directed around the aneurysm via a synthetic graft material or preferably by using the patients own vein, or the vein of another person. The graft is sown above and below the aneurysm, redirecting the flow of blood to the new graft and the aneurysm piece is removed.
Stent Graft: A stent graft is also used in many cases. In this procedure a catheter is placed in the femoral artery (Groin area) and a stent graft is threaded into the aneurysmal area and deployed. This redirects the flow of blood through the new graft and creates a new vessel area so that the vessel wall is no longer exposed to the pressure of blood flow.
Thoracic Aortic Aneurysm
A thoracic aneurysm is an expansion or ballooning of the bodys’ main blood vessel, the aorta, within the chest. Thoracic aneurysms are rare, but are at a high risk of rupture due to the pressure of the blood flow through the aorta as it leaves the heart.
Like other aneurysms thoracic aneurysms develop and expand slowly over time and are in most cases not discovered until physical examination generally for an unrelated issue.
Family history and genetic syndromes most commonly; Marfan, Ehler-Danlos, Loeys-Dietz and Turner syndromes. Smoking is also a cause, and continued smoking will worsen the overall disease.
Most commonly identified during physical examination for an unrelated issue or illness. Some aneurysms can be detected by routine x-ray and ultrasound testing; however, your vascular surgeon may suggest a CT or MRI scan in order to provide more detailed information about the aneurysm.
Monitoring- Most smaller aneurysms do not require immediate surgery and are monitored at regular intervals. Generally, your vascular surgeon will have you visit every 6 months to a year depending on the size of the aneurysm and to inspect for growth.
Conventional Open Surgery – A open thoracic aortic aneurysm repair or (TAA) is done replacing the aneurysmal section of the vessel with a synthetic or one of your own veins allowing the flow of blood to be redirected through the new vessel section.
Endovascular Surgery – Thoracic aortic endograft repair (TEVAR) a less invasive approach is performed via a catheter placed in the femoral artery (Groin area) where a graft is threaded via a small wire to the affected area and deployed allowing the blood flow to pass through the new section while leaving the aneurysm vessel in place.
Visceral Artery Aneurysm
Patients suffering from a visceral artery aneurysm may have no symptoms and the aneurysm may be found during imaging tests for unrelated issues. Some patients may feel pain in their side or abdomen due to the aneurysm growing and creating pressure and compressing other structures.
Aneurysms can be caused by the weakening of the vessel walls due to atherosclerosis and or connective tissue problems from birth. Additionally, aneurysms can be caused following certain medical procedures or caused by infection.
Most commonly found during examination for unrelated medical concern. Visceral artery aneurysms can be identified by CT, MRI, and ultrasound testing. Aneurysms can also be identified during an angiogram.
Endovascular stenting – performed via a catheter placed in the femoral artery (Groin area) where a graft is threaded via a small wire to the affected area and deploy a metal-mesh scaffold providing permanent support to the vessel and allowing the blood flow to pass through the new section while leaving the aneurysm vessel in place above it. The aneurysmal section will shrink over time as the blood is not passing through it.
Bypass Surgery – Aneurysmal section of the vessel is removed and replaced with a synthetic or patients vein section allowing the blood to once again flow through the area without the likelihood of rupture.