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Aneurysm And Dissection

What is a dissection or an aneurysm?

A vessel segment will enlarge when the vessel wall weakens, which is known as an aneurysm. An aneurysm may balloon as blood continues to flow through it due to strain on the compromised wall. Any vessel can develop an aneurysm, but the brain, heart, thoracic aorta, and abdominal aorta are the most common.

Blood can flow through the layers that make up the blood vessel wall and separate them when the inner layer of the blood vessel wall is torn, which is known as a dissection.  Critical organs may lose blood supply as a result of this impairment to blood flow in the vessel's major section. Dissections can happen in any arterial, although the thoracic or abdominal aorta are the most common places.

Blood clots, also known as thrombi, can form in areas of turbulent blood flow caused by aneurysms and dissections. Blood clot fragments, or emboli, can harm the brain, heart, or other organs if they become lodged there and induce ischemia (lower blood flow to the organ). Additionally, a swollen vessel that results from an aneurysm or dissection might compress nearby nerves and hurt. The danger of blood vessel rupture rises as an aneurysm or dissection gets bigger. If a rupture is left untreated, it can cause rapid bleeding and death.

Blood clots, also known as thrombi, can form in areas of turbulent blood flow caused by aneurysms and dissections. Blood clot fragments, or emboli, can harm the brain, heart, or other organs if they become lodged there and induce ischemia (lower blood flow to the organ). Additionally, a swollen vessel that results from an aneurysm or dissection might compress nearby nerves and hurt. The danger of blood vessel rupture rises as an aneurysm or dissection gets bigger. If a rupture is left untreated, it can cause rapid bleeding and death.

Risk Factors

  • History of aneurysm
  • Increasing age
  • Family history
  • Genetic conditions such as Marfan Syndrome and Turner Syndrome
  • Connective tissue disorders such as Ehler-Danlos Syndrome and Autosomal Dominant Polycystic Kidney Disease
  • Certain infections such as syphilis
  • Obesity
  • Hypertension
  • Atherosclerosis
  • Alcoholism
  • Smoking

Symptoms

The following is a list of typical aneurysm and dissection symptoms. The topic of intracranial (brain) aneurysms is not covered here.

Unruptured aneurysms

Unruptured aneurysms may have symptoms depending on where they are located or their size, or they may not have any symptoms at all. Below is a list of frequent variations.

  • Thoracic aortic aneurysm
  • Ache in the jaw, neck, chest, or upper back
  • Breathing issues Swallowing issues
  • Hoarseness

Abdominal aortic aneurysm

  • lower back or abdominal ache
  • abdominal pulsation sensation

Visceral aneurysms

Visceral aneurysms are aneurysms in arteries that supply internal organs, such as the spleen, liver, intestines, and kidneys. Symptoms will vary depending on the organ the affected artery supplies.

Ruptured aneurysms

Because there is insufficient blood pressure to carry blood to the organs, a ruptured aneurysm of a blood vessel like the aorta can result in a fast loss of huge volumes of blood. This condition is known as hypovolemic shock. Similar symptoms can also be caused by ruptured visceral aneurysms. If not treated right away, death can happen.

  • Sudden, severe pain upon rupture
  • Abdominal swelling
  • Pale skin
  • Excessive thirst
  • Nausea and vomiting
  • Dizziness
  • Rapid heart rate
  • Hypovolemic shock

Dissection

  • Sharp tearing or stabbing pain
  • Aortic dissection usually includes severe chest pain that radiates to the back
  • Difficulty swallowing
  • Nausea and vomiting
  • Shortness of breath
  • Pale, clammy skin
  • Dizziness
  • Abdominal pain

Diagnosis

Your healthcare professional may be able to identify some aneurysm cases through a physical examination. Usually, the following tests are run to see if an aneurysm or dissection is present:

  • CT or MRI with contrast
  • Angiography (X-ray with contrast agent to visualize blood vessels)
  • Doppler ultrasound

Treatments

Endovascular stent grafting (EVAR, or endovascular aneurysm repair)

A treatment called endovascular stent grafting is used to treat aneurysms and dissections. A stent graft is an expandable vascular conduit that is inserted into the affected artery segment to strengthen the vessel wall and lessen the risk of rupture or disease progression.

The treatment involves inserting wire into a vascular that can be accessed in the arm or leg.  The wire is inserted into the dissected or aneurysmal vessel using an x-ray device called a fluroscope to guide the navigation.

After the wire is properly positioned, the type of aneurysm or dissection being treated, the size of the vessel, the sorts of branches that emerge from the diseased arterial, and other parameters are taken into consideration before choosing the proper stent graft.  The wire and fluoroscope are used as guides while the collapsed stent graft is inserted into the target vessel.

A balloon is inserted over the wire and into the center of the collapsed stent after the stent graft has been implanted in the proper location. The balloon expands the stent, seating it against the vascular wall.

To check the fit and seating of the stent graft, contrast may be injected into the vessel.  The wire and balloon are withdrawn from the body after a successful implantation, and the arm or leg puncture is then sealed.  After that, the patient is transferred to the recovery section for follow-up care.

Embolization of an aneurysm

Embolization is a different treatment that might be taken into consideration if the aneurysm has particular dimensions and is located in a suitable area of the body.

A needle puncture in the arm or leg can also be used to access the affected blood artery for aneurysm embolization.  Using an x-ray machine known as a fluroscope, a wire is inserted into an aneurysmal vessel.

A catheter is then positioned over the wire and used to navigate to the aneurysm after the vascular tree has been accessible.  Following the placement of the catheter into the aneurysm sac, embolization coils are inserted to fill the sac and slow blood flow into it.  Once the sac's blood flow slows down enough, the body's built-in clotting cascade promotes clot formation there and the sac's blood flow stops.

To check that the coil pack is positioned correctly and that blood flow into the aneurysm sac is slow enough, contrast may be injected into the vessel.  The wire and catheter are removed from the body after a successful implantation, and the arm or leg puncture is then sealed.  After that, the patient is transferred to the recovery section for follow-up care.

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