Understanding Aneurysms

 

Understanding Aneurysms

I. Introduction to Aneurysms

An aneurysm is defined as "a bulge or a ballooning of the wall of a blood vessel," typically occurring in arteries which carry oxygenated blood from the heart. When a section of an artery's wall weakens, the pressure of blood pumping through it causes it to expand or bulge. Aneurysms are generally "not usually painful, and you may not even know you have one." However, their rupture is extremely dangerous and "can cause bleeding inside the body, which can be extremely dangerous and may even be life-threatening."

II. Locations and Types of Aneurysms

Aneurysms can form in any artery throughout the body, including the heart, brain, abdomen, chest, legs, and neck. Specific types are named based on their location:

·         Aortic Aneurysm: The most common type, occurring in the aorta, the body's main and largest artery.

·         Abdominal Aortic Aneurysm: Forms in the part of the aorta passing through the abdomen.

·         Thoracic Aortic Aneurysm: Forms in the upper part of the aorta running through the chest.

·         Cerebral Aneurysm: Develops in the blood vessels of the brain.

·         Peripheral Aneurysms: Occur in arteries other than the aorta and brain, such as those in the leg, neck, or groin.

·         Aneurysms can also form in arteries supplying blood to the intestine and spleen.

III. Causes and Risk Factors

The exact causes of aneurysm formation are not fully understood. Some may be "congenital (present at birth)," while others may result from "injury or disease." Several risk factors have been identified:

·         Demographics: Being male, being over the age of 60.

·         Family History: A family history of aneurysms increases risk.

·         Health Conditions: High blood pressure, diabetes, obesity.

·         Lifestyle Factors: Tobacco use, elevated fats and cholesterol in the blood.

IV. Prevalence and Mortality Data

Data on aneurysm prevalence, particularly in India, is limited. However, global trends indicate a significant increase in aneurysm-related deaths:

·         A 2024 study in the Journal of Vascular Surgery found that global "aortic aneurysm-related deaths 'increased from 94,968 in 1990 to 172,427 in 2019, signifying an 81.6% increase,' which greatly exceeds the 18.2% increase in all-cause mortality observed over the same time interval." This increase "markedly correlated with advancing age."

·         Globally, "hypertension surpassed smoking as the leading risk factor" for aortic aneurysm deaths.

·         The Brain Aneurysm Foundation reports approximately "5,00,000 deaths worldwide each year caused by brain aneurysms, and half the victims are younger than 50."

·         Gender Disparity in Brain Aneurysms: "Women are more likely than men to have a brain aneurysm (3:2 ratio)." Furthermore, "Women, particularly those over the age of 55, have a higher risk of brain aneurysm rupture than men (about 1.5 times the risk)."

V. Signs and Symptoms

Many aneurysms are asymptomatic and "may only be found during check-ups for other issues." Not all aneurysms rupture. However, a ruptured aneurysm constitutes a "medical emergency and requires immediate attention." Symptoms of a ruptured aneurysm vary depending on its location and may include:

·         Headache: Severe headache.

·         Neurological: Nausea, vomiting, vision changes, dizziness, light-headedness, fatigue, loss of consciousness.

·         Pain: Pain in the abdomen, chest, or back.

·         Other: Difficulty swallowing, a pulsating abdominal mass, rapid heartbeat.

It is crucial to note that "some of the symptoms of a ruptured aneurysm may resemble symptoms of other medical conditions," necessitating a doctor's consultation for accurate diagnosis.

VI. Treatment and Management

A ruptured aneurysm can lead to "internal bleeding" or the formation of a blood clot that can travel and cause a stroke. Immediate medical attention is essential in these cases. Treatment options are tailored based on age, overall health, and the aneurysm's location and size:

·         Unruptured Aneurysms: For smaller, unruptured aneurysms, doctors may opt for close monitoring to prevent rupture.

·         Medication: Prescriptions may include medication to "improve blood flow, lower cholesterol and lower blood pressure."

·         Lifestyle Modifications: Recommendations for lifestyle changes are often given.

·         Larger Aneurysms at Risk of Bursting: These may require surgery. Procedures include:

·         Open repairs

·         Endovascular repairs

·         Other surgical procedures