Aneurysm

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Aneurysm
Classification and external resources

Angiography of an aneurysm in a cerebral artery ICD-10 #$% ICD-9 &&% DiseasesDB '()** MedlinePlus ))''%% MeSH +)))$*, An aneurysm or aneurism (from -reek: ./012345 6 aneurusma 7dilation7, from ./210./8. 6 aneurunein 7to dilate7) is a locali9ed, blood6filled balloon6like bulge in the :all of a blood vessel.;'< Aneurysms can commonly occur in arteries at the base of the brain (the circle of Willis) and an aortic aneurysm occurs in the main artery carrying blood from the left ventricle of the heart. When the si9e of an aneurysm increases, there is a significant risk of rupture, resulting in severe hemorrhage, other complications or death. Aneurysms can be hereditary or caused by disease, both of :hich cause the :all of the blood vessel to :eaken.

Classification
Aneurysms may be classified by type, location, and the affected vessel. =ther factors may also influence the pathology and diagnosis of aneurysms. True and false aneurysms A true aneurysm is one that involves all three layers of the :all of an artery (intima, media and adventitia). rue aneurysms include atherosclerotic, syphilitic, and congenital aneurysms, as :ell as ventricular aneurysms that follo: transmural myocardial infarctions (aneurysms that involve all layers of the attenuated :all of the heart are also considered true aneurysms).;%< A false aneurysm or pseudo6aneurysm does not primarily involve such distortion of the vessel. #t is a collection of blood leaking completely out of an artery or vein, but confined ne>t to the vessel by the surrounding tissue. his blood6 filled cavity :ill eventually either thrombose (clot) enough to seal the leak or rupture out of the tougher tissue enclosing it and flo: freely bet:een layers of other tissues or into looser tissues. !seudoaneurysms can be caused by trauma that punctures the artery and are a kno:n complication of percutaneous arterial procedures, such as arteriography, arterial grafting, or use of an artery for in?ection. @ike true aneurysms, they may be felt as an abnormal pulsatile mass on palpation.

Mor !olo"y Aneurysms are classified by their macroscopic shape and si9e and are described as either saccular or fusiform. Aaccular aneurysms are spherical in shape and involve only a portion of the vessel :allB they vary in si9e from ( to %) cm (* in) in diameter, and are often filled, either partially or fully, by thrombus. Fusiform (7spindle6shaped7) aneurysms are variable in both their diameter and lengthB their diameters can e>tend up to %) cm (* in). hey often involve large portions of the ascending and transverse aortic arch, the abdominal aorta, or less freCuently the iliac arteries. he shape of an aneurysm is not pathognomonic for a specific disease.;,< #ocation Derebral aneurysms, also kno:n as intracranial or brain aneurysms, occur most commonly in the anterior cerebral artery, :hich is part of the circle of Willis. his can cause severe strokes leading to death. he ne>t most common sites of cerebral aneurysm occurrence are in the internal carotid artery.;&<:'*' Eany non6intracranial aneurysms arise distal to the origin of the renal arteries at the infrarenal abdominal aorta, a condition some have postulated to be related to atherosclerosis. Fo:ever, increasing evidence suggests abdominal aortic aneurysms are a :holly separate pathology. he thoracic aorta can also be involved. =ne common form of thoracic aortic aneurysm involves :idening of the pro>imal aorta and the aortic root, :hich leads to aortic insufficiency. Aneurysms can also occur in the legs, particularly in the deep vessels (e.g., the popliteal vessels in the knee). Arterial and venous Arterial aneurysms are much more common, but venous aneurysms do happen (for e>ample, the popliteal venous aneurysm).

$ idemiolo"y
Incidence #ncidence rates of cranial aneurysms are estimated at bet:een ).&G and ,.HG. hose :ithout risk factors have e>pected prevalence of %6,G.;&<:'*' #n adults, females are more likely to have aneurysms, are most prevalent in people ages ,( I H), but can occur in children as :ell. Aneurysms are rare in children :ith a reported prevalence of .(G to &.HG. he most common incidence are among () year old and there are typically no :arning signs. Eost aneurysms develop after the age of &). Pediatric aneurysms !ediatric aneurysms have different incidences and features than adult aneurysms. ;(< #ntracranial aneurysms are rare in childhood, :ith over J(G of all aneurysms occurring in adults.;&<:%,( #ncidence rates are t:o to three times higher in males, :hile there are more large and giant aneurysms and fe:er multiple aneurysms. ;&<:%,( #ntracranial hemorrhages are '.H times more likely to be due to aneurysms than cerebral arteriovenous malformations in :hites, but four times less in certain Asian populations.;&<:%,(;H< Eost patients, particularly infants, present :ith subarachnoid hemorrhage and corresponding headaches or neurological deficits. he mortality rate for pediatric aneurysms is lo:er than in adults.;&<:%,( %is& factors Kisk factors for an aneurysm include diabetes, obesity, hypertension, tobacco use, alcoholism, high cholesterol, copper deficiency, and increasing age.;citation needed< Aome types are the result of congenital, or inherited, :eakness in artery :alls.
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Copper deficiency An editor has e>pressed a concern that this article lends undue 'ei"!t to certain ideas( incidents( controversies or matters relative to the article sub?ect as a :hole. !lease help to create a more balanced presentation. +iscuss and resolve this issue before removing this message. (November 2011) A minority of aneurysms are caused by a copper deficiency. Lumerous animal e>periments have sho:n that a copper deficiency can cause diseases affected by elastin;*< tissue strength ;Farris<. he lysyl o>idase that cross links connective tissue is secreted normally, but its activity is reduced,;J< due to some of the initial en9yme moleculesM (apo6en9yme or en9yme :ithout the copper) lack of copper.;')<;''<

Aneurysms of the aorta are the chief cause of death of copper deficient chickensB depleting copper produces aneurysms in turkeys.;'%< Een :ho die of aneurysms have a liver content (of copper) that can be as little as %HG of normal.;',< #n such men the median layer of the blood vessel (:here the elastin is) is thinner but its elastin copper content is the same as in the elastin of normal men.;'&< he body must therefore have some :ay of preventing elastin tissue from gro:ing if there is not enough activated lysyl o>idase for it. A babyNs liver has up to ten times as much copper as an adult liver.;'(< O>cess intake of 9inc can lead to deficiency of copper (hypocupremia). his deficiency happens because e>cess 9inc in the body triggers reduced absorption of copper in the -# tract, resulting in increased fecal loss of copper.;'H<

Pat!o !ysiolo"y
his section may re)uire cleanu to meet *i&i edia+s )uality standards.
(November 2011)

Aneurysm formation is probably the result of multiple factors affecting that arterial segment and its local environment.Eany aneurysms are atherosclerotic in nature. he occurrence and e>pansion of an aneurysm in a given segment of the arterial tree involves local hemodynamic factors and factors intrinsic to the arterial segment itself. he aorta is a relatively lo:6resistance circuit for circulating blood. he lo:er e>tremities have higher arterial resistance, and the repeated trauma of a reflected arterial :ave on the distal aorta may in?ure a :eakened aortic :all and contribute to aneurysmal degeneration. Aystemic hypertension compounds the in?ury, accelerates the e>pansion of kno:n aneurysms, and may contribute to their formation. #ncreasing aneurysmal dilatation leads to increasing arterial :all tension or stress. #n hemodynamic terms, the coupling of aneurysmal dilatation and increased :all stress is appro>imated by the @a: of @aplace. he @a: of @aplace applied to a cylinder states that the (arterial) :all tension is eCual to the pressure times the radius of the arterial conduit divided by :all thickness ( P ;! > K<Qt). As diameter increases, :all tension increases, :hich contributes to more increase in diameter and risk of rupture. #ncreased blood pressure (systemic hypertension) and increased aneurysm si9e increase arterial :all tension and therefore increase the risk of rupture. Wall thickness is decreased in aneurysms and further adds to the increase in :all tension. #n addition, the vessel :all is supplied by the blood :ithin its lumen in humans in a developing aneurysm, the most ischemic portion of the aneurysm is at the farthest end, resulting in :eakening of the vessel :all there and aiding further e>pansion of the aneurysm. hus eventually all aneurysms :ill, if left to complete their evolution, rupture :ithout intervention. A mycotic aneurysm is an aneurysm that results from an infectious process that involves the arterial :all. ;'$< A person :ith a mycotic aneurysm has a bacterial infection in the :all of an artery, resulting in the formation of an aneurysm. he most common locations include arteries in the abdomen, thigh, neck, and arm. A mycotic aneurysm can result in sepsis, or life threatening bleeding if the aneurysm ruptures. @ess than ,G of abdominal aortic aneurysms are mycotic aneurysms.;'*< While most aneurysms occur in an isolated form, the occurrence of berry aneurysms of the anterior communicating artery of the circle of Willis is associated :ith autosomal dominant polycystic kidney disease (A+!R+). his type of aneurysm places pressure on the surrounding brain tissue, causing it to malfunction. A rupture of this cerebral brain tissue, :ould cause e>cessive bleeding around the brain, called a subarachnoid hemorrhage. Aevere bleeding can cause brain damage and lead to permanent disability.;'J< he third stage of syphilis also manifests as aneurysm of the aorta, :hich is due to loss of the vasa vasorum in the tunica adventitia.

Sym toms and dia"nosis

his section does not cite any references or sources. !lease help improve this section by adding citations to reliable sources. "nsourced material may be challenged and removed. (April 2013) +iagnosis of a ruptured cerebral aneurysm is commonly made by finding signs of subarachnoid hemorrhage on a computed tomography (D ) scan. #f the D scan is negative but a ruptured aneurysm is still suspected based on clinical findings, a lumbar puncture can be performed to detect blood in the cerebrospinal fluid. Domputed tomography angiography (D A) is an alternative to traditional angiography and can be performed :ithout the need for arterial catheteri9ation. his test combines a regular D scan :ith a contrast dye in?ected into a vein. =nce the dye is in?ected into a vein, it travels to the cerebral arteries, and images are created using a D scan. hese images sho: e>actly ho: blood flo:s into the brain arteries.

Cere,ral aneurysm Aymptoms for a cerebral aneurysm occur :hen the aneurysm pushes on a structure in the brain. #n the case of a cerebral aneurysm, the symptoms for an aneurysm that has ruptured and one that has not ruptured are different. Aymptoms for an aneurysm that has not ruptured: Fatigue @oss of perception @oss of balance Apeech problems +ouble vision Aymptoms for a ruptured aneurysm: Aevere headaches @oss of vision +ouble vision Leck pain andQor stiffness !ain above andQor behind the eyes

Treatment
Fistorically, the treatment of arterial aneurysms has been limited to either surgical intervention, or :atchful :aiting in combination :ith control of blood pressure. #n recent years, endovascular or minimally invasive techniCues have been developed for many types of aneurysms. Intracranial aneurysms Eain article: Derebral aneurysm treatment here are currently t:o treatment options for brain aneurysms: surgical clipping or endovascular coiling. here is currently debate in the medical literature about :hich treatment is most appropriate given particular situations. Aurgical clipping :as introduced by Walter +andy of the Johns Fopkins Fospital in 'J,$. #t consists of a craniotomy to e>pose the aneurysm and closing the base of the aneurysm :ith a clip. he surgical techniCue has been modified and improved over the years. Ondovascular coiling :as introduced by -uido -uglielmi at "D@A in 'JJ'. #t consists of passing a catheter into the femoral artery in the groin, through the aorta, into the brain arteries, and finally into the aneurysm itself. !latinum coils initiate a clotting reaction :ithin the aneurysm that, if successful, :ill eliminate the aneurysm. Aortic and eri !eral aneurysms For aneurysms in the aorta, arms, legs, or head, the :eakened section of the vessel may be replaced by a bypass graft that is sutured at the vascular stumps. #nstead of se:ing, the graft tube ends, made rigid and e>pandable by nitinol :ireframe, can be easily inserted in its reduced diameter into the vascular stumps and then e>panded up to the most appropriate diameter and permanently fi>ed there by e>ternal ligature.;%)<;%'< Le: devices :ere recently developed to substitute the e>ternal ligature by e>pandable ring allo:ing use in acute ascending aorta dissection, providing airtight (i.e. not dependent on the coagulation integrity), easy and Cuick anastomosis e>tended to the arch concavity ;%%<;%,<;%&< @ess invasive endovascular techniCues allo: covered metallic stent grafts to be inserted through the arteries of the leg and deployed across the aneurysm.