Symptoms
Many types of aneurysms are asymptomatic, in the sense that they do not cause obvious symptoms, at least until breakage or other complications occur:
- If the aneurysm is superficial it can be evidenced by the presence of a localized "pulsating" swelling. Often, the pain associated with the injury is described by the patient as a "tear or tear".
- Deep aneurysms, inside the body or at the brain level, on the other hand, as a rule are not associated with symptoms that are easily defined by the patient. The subject can suspect the presence of an aneurysm only when some complication arises: thrombosis, presence of emboli, tachycardia, sudden lowering of the pressure, sense of confusion, etc.
Symptoms depend on the location of the aneurysm, hence the affected district, and the extent of damage affecting the blood vessel wall:
- Loss of appetite, intense abdominal pain or lower back, which extends to the groin or legs: may indicate an abdominal aortic aneurysm .
- Sudden chest pain, hoarseness, persistent cough and difficulty swallowing: may indicate a thoracic aneurysm .
- A feeling of pulsation or swelling directly behind the knee: it may indicate a popliteal aneurysm .
- A violent headache, associated with pain radiated to the neck: it may indicate a cerebral aaneurysm, which is usually characterized by the co-presence of other signs: visual disturbances, nausea and / or vomiting, unconsciousness, etc. The cerebral aneurysm is always to be considered a condition of extreme emergency.
Complications
Clinical evolution: what are the dangers of an aneurysm?
The aneurysm formation mechanism is connected to the pressure inside the blood vessel that, by pressing on the weak point of the wall, determines its bulging. In general, aneurysms progressively increase their size, by 0.2-0.3 cm per year (with an increasing risk of rupture).
Potentially, the clinical course of the aneurysm may evolve under the following conditions:
- Rupture (fearsome complication, causes death): the vessel wall, in the affected area, is thinned, loose, and can break very easily, causing - depending on the location - hemorrhage in the retroperitoneal tissues, in the abdominal cavity or subarachnoid hemorrhage (aneurysms brain). In particular, in the case of abdominal aortic aneurysms the blood can perforate the peritoneum, causing hypovolemic shock, while in the brain it can cause stroke, disability and death.
The risk of death after aneurysm rupture is high. Surgical treatment of the rupture reduces mortality by 50%. The risk of rupture is directly correlated with the diameter of the aneurysm:
- <4 cm: no risk;
- 4-5 cm: Increases by 1% a year;
- 5-6 cm: increases by 11% a year;
- > 6 cm: 25% increase per year.
- Retrosternal stabbing pain (can simulate a heart attack);
- Ischemic lesions, if affected cerebral vessels or coronaries;
- Formation of an embolus, due to rupture of a plaque or resulting from the detachment of thrombotic material;
- Thrombosis: aneurysms are sites where the blood flow is altered, therefore the turbulence that is created favors the formation of thrombi, which can be thin (frequent) or coarse;
- Compression of adjacent anatomical structures (eg, ureters and vertebrae). The compression of nerves can lead, for example, to weakness and numbness in the popliteal artery (knee);
- Presence of a palpable and "pulsating" abdominal mass ;
- Infections, which occur due to the altered blood flow .
Diagnosis and Treatment
Early diagnosis and treatment of an aneurysm are critical.
The discovery of an aneurysm can occur in a fortuitous way, since the initial event can be ignored and, for this reason, routine examinations are strongly encouraged (especially in those at risk and if there is a family predisposition).
The risk of rupture can be evaluated based on their size, calculated using ultrasound imaging techniques ( ultrasound ). For example, an aortic aneurysm larger than 6 cm has a 50% chance of rupturing for 10 years after diagnosis. In any case, there are very useful diagnostic tests in the various phases of the clinical course:
- Physical examination and medical history .
- Transesophageal or abdominal ultrasound : it allows to visualize the aneurysm and identify the possible presence of a thrombosis. It also allows to verify the evolution of the aneurysm and to verify if this can determine complications (example: to prevent the circulation or to contribute to the formation of blood clots).
- X-ray of the abdomen and thorax ( aneurysm on the aorta ): it shows a wide shadow at the level of the lesion and the possible compression of the adjacent structures.
- Electrocardiogram (if symptoms are due to coronary involvement).
- Angio magnetic resonance imaging ( angio-MRI ): highlights the vascular district in certain points of the body.
- Angiography axial-computed tomography ( angio-TAC, with contrast medium): it provides information regarding the extension of the aneurysm, the possibility that a rupture may occur and the possible presence of thrombi that hinder or prevent the normal circulation of blood. In the case of a cerebral aneurysm, the CT and angiography of the cerebral vessels allow to face emergency conditions such as haemorrhages, the presence of edema or hydrocephalus, as well as providing detailed diagnosis for the correct therapeutic planning.
Treatment depends mainly on the type, size and position of the aneurysm. Pharmacological therapy initially involves the reduction of blood pressure values, through the administration of vasodilators or beta-blockers . If the aneurysm is small and there are no symptoms, the doctor may recommend that you have regular check-ups to see how the aneurysm evolves and to evaluate a timely surgical approach. The goal is to perform an operation before serious complications develop: if the aneurysm is small (<5 cm approximately) or if it is not at risk of rupture (so if the aneurysm does not tend to grow in little time), the patient is rarely treated.
When recommended, surgery mainly involves the following approaches:
- Traditional repair ( open ): an aneurysm in an accessible area, like in the abdomen, can be surgically removed and the vessel can be repaired or replaced with an artificial material graft.
- Extravascular surgical approach ( clipping ): it allows surgical intervention on the aneurysmal sac to exclude it from circulation. The clipping approach consists of a scratch on the aneurysm collar, with the application of a metal clip that respects the patency of the supporting blood vessel.
