Aneurysm designates the abnormal dilation of a portion of artery (aorta, artery of the brain, abdominal…). You usually feel nothing (or almost nothing) when you have an aneurysm. The main risk is breakage.
The aneurysm corresponds to the abnormal widening of part of an arterywhose weakened wall risks breaking (this is called a aneurysm rupture). And the larger the aneurysm, the higher the risk of rupture, which is why regular monitoring of its size is important. “The aneurysm affects 80% men and 20% women. But for 15 years, the incidence of aneurysms increased by 25% in women“, underlines Pr Paul Menu, heart surgeon and spokesperson for the French Federation of Cardiology (FFC) What is the cause an aneurysm? The risk factors? Are there any warning signs ? How to cure ?
What is the definition of an aneurysm?
“An aneurysm is the dilation of a portion of an artery. THE arteries (aorta, carotid artery, femoral artery, abdominal artery, cerebral artery…) are vessels whose wall is formed of three layers, when the middle layer, the media, weakens, the vessel expands and threatens to rupture”, explains Professor Paul Menu. This progressive dilation thus weakens the wall of the artery which, above a certain size, can crack or break, causing sudden internal bleeding: this is called a ruptured aneurysm. “Since the arteries are everywhere in the body, the risks and consequences are very different depending on the location of the aneurysm. It’s not not the same as having an aneurysm in the brain than having an aneurysm in the big toe“, wishes to clarify our expert.
What causes an aneurysm? The risk factors?
The most common cause of aneurysm is atherosclerosis that corresponds to fatty deposits in the arteries, which weakens their walls. This is how all of the risk factors for atherosclerosis increase the chances of developing an aneurysm. These are mainly:
- hypertensionparticularly hypertensive flare-ups
- The tobacco
- Diabetes
- Overweight
- Cholesterol
- Stress (shock, strong emotion, etc.)
Prevention involves controlling these risk factors. “The risk factors multiply among themselves. Hypertension multiplies the risk of aneurysm by 7 and tobacco multiplies the risk of aneurysm by 6. A hypertensive person who smokes therefore has a risk of aneurysm multiplied by 42 (6×7). There is also congenital aneurysms (present from birth) in people who have more fragile vessels than normal“, explains our interlocutor.
Does an aneurysm cause symptoms?
“Since the arteries are not innervated, you generally feel nothing (or almost nothing) when you have an aneurysm. An aneurysm does not give no clinical signs until it ruptures and can be present throughout an individual’s lifetime without manifesting itself. “The absence of symptoms is therefore one of the main difficulties in detecting this pathology. In about 80% of cases, it is during the complication that one can have symptoms“, explains our interlocutor. The occurrence of acute abdominal painblurred vision, facial pain, or severe headache may be warning signs of a large aneurysm or a ruptured aneurysm.
What are the complications of an aneurysm?
Aneurysm is a dangerous pathology that can be fatal. “The main complication of an aneurysm is ruptured aneurysm : a wall that expands becomes thinner and thinner and can rupture, which has consequences for the territory vascularized by the ruptured artery. Again, the severity of the aneurysm rupture depends on the site. We understand that the rupture is much more serious if it is a cerebral aneurysm than if it is a radial or femoral aneurysm for example.“, he indicates.
What is a cerebral aneurysm?
Brain aneurysms represent more than 20% of aneurysms. These are the most common aneurysms. The brain aneurysm is (almost) asymptomatic. “We don’t have a headache. There are practically no clinical signs before the rupture. A ruptured brain aneurysm is one of the causes of stroke (stroke)“, warns our doctor. Survivors can suffer from significant sequelae such as paralysis and speech, vision, memory disorders…
What is a thoracic aneurysm?
Thoracic aortic aneurysm is the second most common type of aneurysm. It corresponds to the dilation of the thoracic aorta, the body’s main artery, which brings blood from the heart to all parts of the body “Normally, a thoracic aorta should be less than 30 millimeters in diameter. If it increases in diameter, it must be monitored with ultrasounds. From 60 millimeters in diameter the risk of rupture is very high. The French Society of Thoracic and Cardiovascular Surgery recommends operating when the aorta reaches 50 to 52 mm in diameter (to be defined according to age, patient profile and rate of evolution of the aneurysm)“, reports our interlocutor.
What is an abdominal aneurysm?
The abdominal aortic aneurysm (AAA) corresponds to a localized dilation of a more or less long segment of the aorta in its abdominal portion. AAA is mostly located in the infrarenal aorta (the infrarenal abdominal aorta is the distal segment of the abdominal aorta). It relates to men in 85% of cases. “Rupture of an abdominal aortic aneurysm in men over 75 has a high case fatality rate“, emphasizes our speaker.
What is a mycotic aneurysm?
Mycotic aneurysm is one of the (rare and serious) complications of infective endocarditis.
Most often, an aneurysm is discovered by chance, during a medical examination by palpation of an abdominal mass, ultrasound or other imaging test. “When there are known risk factors, the doctor must look for an aneurysm and consider carrying out appropriate examinations (X-ray, MRI, angiography, ultrasound) to check that the arteries are not dilated.“, insists Professor Menu.
What is the treatment for an aneurysm?
Once the problem has been identified, the management differs depending on the severity of the aneurysm: either we do nothing, but rigorously monitor its development, or we perform surgery to correct the problem. “There are several operating techniques: operation by video surgery or endovascular operation (installation of a prosthesis inside the artery)“, lists Professor Menu. The rupture of an aneurysm is considered an absolute medical emergencybecause of its risk of rapid death and the sequelae it can cause.
There is no preventive treatment to avoid the formation of an aneurysm. However, it is possible to limit its aggravation by avoiding tobacco, a sedentary lifestyle and being overweight and by properly treating high blood pressure and high blood cholesterol.
Thanks to Pr Paul Menu, heart surgeon and spokesperson for the French Federation of Cardiology (FFC).