Why Are Aneurysms Called “Silent Killers”?
Aneurysms are sometimes called “silent killers” because they may go
undetected for years until they break open. A segment of an artery*, or
vein* (although venous aneurysms are not common), or other blood
vessel may weaken and begin to bulge, like an underinflated balloon
whose air is squeezed from the ends to the middle. The bulge may grow
slowly for years until one day the blood vessel wall gives way (ruptures).
This rupture is a medical emergency that may lead to death. There are
two major classes of aneurysms: aortic aneurysms, which occur in the
major artery that carries blood away from the heart, and cerebral aneurysms,
which occur in an artery in the brain. Aneurysms of the aorta
are virtually always caused by atherosclerosis (the build-up of plaque in
arteries, which causes the arteries to lose elasticity and to harden). In
the case of aortic aneurysms, a tiny tear develops within the inner layer
of the aorta (the largest artery that carries blood away from the heart).
Blood leaks through this tear into the middle layer of aortic tissue, causing
the inner and middle layers to separate (dissect). Over time, this socalled
dissecting aneurysm results in an elongated, blood-filled channel
running up and down the aorta, which can break open, causing fatal
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Aortic aneurysms may arise in the abdominal portion of the aorta
(abdominal aortic aneurysms) or the thoracic portion of the aorta (thoracic
aortic aneurysms). In the United States more than 15,000 people die
annually due to abdominal aortic aneurysm rupture. The most common
aneurysm is the cerebral aneurysm, which is a stroke.
How Do Aneurysms Happen?
Aneurysms result when the normal structure of a blood vessel becomes
weak in an area. Such deterioration can be a result of atherosclerosis,
where fatty deposits of lipoproteins, including cholesterol, accumulate on
the walls of the blood vessels, but this kind of weakness in a blood vessel
may also come about as a result of infection or trauma, or the aneurysm may be congenital*. An increased incidence of aneurysm may be seen with certain conditions, such as syphilis or Marfan syndrome. Many
times, however, an aneurysm develops without any known cause.
Abdominal aortic aneurysm affects many more men than women.
It also occurs more often in people who are older than age 55, who are
smokers, or who have high blood pressure. People with other family members
who have had these types of aneurysms are more likely to develop the
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There usually are no signs of a growing aneurysm. In the case of
abdominal aortic aneurysms, the affected person will sometimes feel pain
in his or her abdomen*. A large aneurysm in the abdomen may press
against the spine and cause back pain. The rupture of an aneurysm in an
artery can kill a person quickly. The rupture of a brain aneurysm constitutes
a kind of hemorrhagic stroke. It is a medical emergency. Symptoms
may include numbness, paralysis, stiff neck, vision loss, confusion, and
loss of consciousness.
What Are the Signs and Symptoms of Aneurysms?
The signs and symptoms of an aneurysm depend on the location of the
aneurysm and how large it is. Initially, for example, there may be no symptoms
at all. As the aneurysm grows, however, symptoms may develop.
For example, an expanding abdominal aortic aneurysm may cause severe,
deep pain in the individual’s back and/or abdomen. The feet and legs may
become cold and numb, due to interference with blood flow to the lower
limbs. The physician may feel a pulsing mass in the individual’s abdomen
and may hear a characteristic sound as he or she listens to the area with
a stethoscope. If the abdominal aortic aneurysm should rupture, severe,
life-threatening symptoms will occur, including dizziness, fainting, rapid
heart rate, nausea and vomiting, intensely severe abdominal and back
pain, and eventually shock from blood loss. If the expanding aneurysm is
located in the chest (thoracic aortic aneurysm), the individual may develop
pain in the jaw, neck, upper back, or chest, as well as coughing, hoarse
voice, and difficulty breathing and shortness of breath. The symptoms
of an expanding brain aneurysm depend on where it is located. Possible
symptoms of a growing brain aneurysm include the drooping of an eyelid,
double vision, other vision impairment, pain in or behind the eye, an
abnormally dilated pupil, a numb or weak feeling on one side of the body
or the face. If the brain aneurysm ruptures, then the signs and symptoms
may include an intensely unbearable headache, nausea and vomiting, stiff
neck, unconsciousness, and other signs of stroke (difficulty swallowing,
difficulty talking and understanding speech, confusion, dizziness, loss of
balance, difficulty walking, weakness, or paralysis of limbs). If the patient
has a peripheral aneurysm, then the person might notice a pulsing bump in
his or her neck, arm, or leg, as well as limb pain or muscle cramping with
exercise, unhealing sores on the toes or fingers, or even gangrene due to loss
of blood flow.
How Do Doctors Diagnose and Treat Aneurysms?
Fortunately, many aneurysms can be detected before they rupture. Doctors
often are able to feel the pulsating sensation of abdominal aneurysms
through the skin. Also, aneurysms often cause subtle changes in how the
heart sounds, and doctors might notice these changes when listening to
the heart. The most reliable methods of checking for aneurysms are x-rays,
ultrasound* exams, and other imaging techniques that can provide more
detailed images of the body.
Wait and see If an aneurysm is discovered, sometimes a doctor may
adopt a wait-and-see strategy, but often this approach depends on the
aneurysm’s location, size, and the person’s overall health. Small aneurysms
might be checked every six months or so to confirm that they are not
growing. Aneurysms usually grow slowly.
Surgery Sometimes surgery is required. One method involves removing
the section that is bulging and replacing it with an artificial blood vessel.
Another technique for repairing aortic aneurysms involves snaking a thin,
flexible wire up from an artery in the leg to the aneurysm, where a tube or
coils are attached to the artery’s walls on either side of the aneurysm.
How Are Aneurysm Prevented?
It is most important to detect aneurysms before they break open. More
than 60 percent of people whose aneurysms rupture die before they reach
the hospital, and a large percentage may die during or after emergency surgery.
However, regular medical care and surgery allows the vast majority
of people whose aneurysms are discovered before they rupture to recover.
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