Why do aneurysms occur?
There are many reasons for aneurysms. The most common are associated with severe atherosclerosis and high blood pressure. For many of these patients, there is also a family or genetic tendency to have aneurysms, so that a history of aneurysm is present in several generations. The most common aneurysm of this type occurs in the lower portion of the aorta in the back of the abdomen, and others can occur in the chest, the pelvis, the groin, or behind the knees.
Some aneurysms are congenital: People are born with them or have a genetic tendency to form them. Sometimes these are in the brain; others are in different parts of the body and are due to abnormalities in the connective tissue that joins muscle, tendon, bone and skin together. Some of these patients are remarkably "double jointed" or have histories of many hernias.
Other aneurysms occur because of weakening of an artery wall after previous vascular surgery, because of local infection involving an artery, or because of ongoing hemorrhage through a punctured artery. These are called false aneurysms.
Finally, there are medical problems, such as inflammatory disorders or infections, associated with special aneurysms.
How do I know whether I have an aneurysm?
There are no "screening programs" for aneurysms that should be done regularly. Most large aneurysms can be felt by a doctor during a regular physical examination. If you are obese, it may be hard to feel an aneurysm in your body.
Today, it is common to find an aneurysm as an incidental abnormality during an X-ray, ultrasound study, or computed tomography scan (CT).
People with several risk factors can have special studies to see if an aneurysm is present. Risk factors include high blood pressure, a strong family history for aneurysm (as in several close relatives), atherosclerosis in other parts of the body, and a history of hernia repair. You may need to discuss these issues with your doctor.
What is done about aneurysms?
Treatment is individualized, based on the type of aneurysm and its location. Some aneurysms are easily repaired, with minimal risk. Others may be so dangerous that surgery is too risky, and you are told to live with the aneurysm. In general rupture of an aneurysm is so often life-threatening, that we prefer to repair them if possible with elective surgery.
The general principle behind aneurysm repair is to bridge around the diseased aneurysmal artery with a bypass. For aneurysms in large arteries, such as the aorta, we use various plastic based grafts. These operations have been performed since the early 1950's, and are currently very safe, although there are surgical risks that your doctor will discuss with you.
There are new experimental techniques for repairing some aortic aneurysms that have received recent publicity. These involve the use of catheters and expandable grafts and stents to repair an aneurysm without a major operation. At present, there are very few centers in the world where these devices are being studied. Even when these grafts and methods receive approval from the U.S. government, they will not be the most appropriate method for all patients.
For aneurysms elsewhere in the body, plastic tubes are sometimes used, as well as bypasses using your own vein. For some types of aneurysms, the artery is primarily repaired and closed with strong sutures.
Ruptured aneurysms are life-threatening and usually require emergency surgery. People who survive a ruptured aneurysm usually have serious complications and a prolonged hospital course.
After repair of large aneurysms in the chest or abdomen, there is usually a prolonged convalescence when you feel tired and have a poor appetite, but these feelings pass. This is a major operation, but it is worth the stress because the person who successfully undergoes repair has as good an outlook for survival as the population of similar age without an aneurysm.