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14-September-2008 12:50:20 - Aneurysm Redirected from Aneurysms November 2007 For other uses, see Aneurysm disambiguation. Aneurysm Classification and external resources ICD-10 I72. ICD-9 442 DiseasesDB 15088 MedlinePlus 001122 MeSH D000783 An aneurysm or aneurism is a localized, blood-filled dilation balloon-like bulge of a blood vessel caused by disease or weakening of the vessel wall. Aneurysms most commonly occur in arteries at the base of the brain the circle of Willis and in the aorta the main artery coming out of the heart, a so-called aortic aneurysm. The bulge in a blood vessel can burst and lead to death at any time. The larger an aneurysm becomes, the more likely it is to burst and since aneurysms naturally grow, given enough time they will inevitably reach the bursting point if undetected. Look up Aneurysm in Wiktionary, the free dictionary. Contents 1 Diagnosis of Brain Aneurysms 2 Structure 2.1 Location 3 Risks 4 Formation 5 Treatment 5.1 Treatment of aneurysms 5.2 Treatment of aortic and peripheral aneurysms 6 See also 7 References 8 External links Diagnosis of Brain Aneurysms Diagnosis of a ruptured cerebral aneurysm is commonly made by finding signs of subarachnoid hemorrhage on a CT scan Computerized Tomography, sometimes called a CAT scan. The CT scan is a computerized test that rapidly X-rays the body in cross-sections, or slices, as the body is moved through a large, circular machine. If the CT scan is negative but a ruptured aneurysm is still suspected, a lumbar puncture is performed to detect blood in the cerebrospinal fluid CSF that surrounds the brain and spinal cord. To determine the exact location, size and shape of an aneurysm ruptured or unruptured, neuroradiologists will use either cerebral angiography or tomographic angiography. Cerebral angiography, the traditional method, involves introducing a catheter small plastic tube into an artery usually in the leg and steering it through the blood vessels of the body to the artery involved by the aneurysm. A special dye, called a contrast agent, is injected into the patient's artery and its distribution is shown on X-ray projections. This method may not detect some aneurysms due to overlapping structures or spasm. Computed Tomographic Angiography CTA is an alternative to the traditional method and can be performed without the need for arterial catheterization. This test combines a regular CT scan with a contrast dye injected into a vein. Once the dye is injected into a vein, it travels to the brain arteries, and images are created using a CT scan. These images show exactly how blood flows into the brain arteries. It also cures itself with time. Structure In a true aneurysm the inner layers of a vessel have bulged outside the outer layer that normally confines them. The aneurysm is surrounded by these inner layers. A false- or pseudoaneurysm does not primarily involve such distortion of the vessel. It is a collection of blood leaking completely out of an artery or vein, but confined next to the vessel by the surrounding tissue. This blood-filled cavity will eventually either thrombose clot enough to seal the leak or it will rupture out of the tougher tissue enclosing it and flow freely between layers of other tissues or into looser tissues. Pseudoaneurysms can be caused by trauma that punctures the artery and are a known complication of percutaneous arterial procedures such as arteriography or of arterial grafting or of use of an artery for injection, such as by drug abusers unable to find a usable vein. Like true aneurysms they may be felt as an abnormal pulsatile mass on palpation. Location Most non-intracranial aneurysms 94% arise distal to the origin of the renal arteries at the infrarenal abdominal aorta, a condition mostly caused by atherosclerosis. The thoracic aorta can also be involved. One common form of thoracic aortic aneurysm involves widening of the proximal aorta and the aortic root, which leads to aortic insufficiency. Aneurysms occur in the legs also, particularly in the deep vessels e.g., the popliteal vessels in the knee. Arterial aneurysms are much more common, but venous aneurysms do happen for example, the popliteal venous aneurysm. 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 with autosomal dominant polycystic kidney disease ADPKD. The third stage of syphilis also manifests as aneurysm of the aorta, which is due to loss of the vasa vasorum in the this isnt real tunica adventitia. Risks Rupture and blood clotting are the risks involved with aneurysms. Rupture leads to drop in blood pressure, rapid heart rate, and lightheadedness. The risk of death is high except for rupture in the extremities. Blood clots from popliteal arterial aneurysms can travel downstream and suffocate tissue. Only if the resulting pain and/or numbness are ignored over a significant period of time will such extreme results as amputation be needed. As long as treatment is sought quickly, a doctor should be able to provide non-invasive treatment. Aneurysms should be treated with care as over pressure when trying to get rid of them can cause them to shift. Clotting in popliteal venous aneurysms are much more serious as the clot can embolise and travel to the heart, or through the heart to the lungs a pulmonary embolism. Risk factors for an aneurysm are diabetes, obesity, hypertension, tobacco use, alcoholism, and Copper deficiency. A minority of aneurysms are caused by a copper deficiency. Numerous animal experiments have shown that a copper deficiency can cause diseases affected by elastin 1 tissue strength Harris. The lysyl oxidase that cross links connective tissue is secreted normally, but its activity is reduced 2, due, no doubt, to some of the initial enzyme molecules apo-enzyme or enzyme without the copper failing to contain copper 3 4. Aneurysms of the aorta are the chief cause of death of copper deficient chickens, and also depleting copper produces aneurysms in turkeys 5. Men who die of aneurysms have a liver content which can be as little as 26% of normal 6. The median layer of the blood vessel where the elastin is is thinner but its elastin copper content is the same as normal men. The overall thickness is not different 7. The body must therefore have some way of preventing elastin tissue from growing if there is not enough activated lysyl oxidase for it. Men are more susceptible to aneurysms than young women, probably because estrogen increases the efficiency of absorption of copper. However, women can be affected by some of these problems after pregnancy, probably because women must give the liver of their babies large copper stores in order for them to survive the low levels of copper in milk. A baby's liver has up to ten times as much copper as adult livers 8. Elastin is about as flexible as a rubber band and can stretch to two times its length 9. Collagen is about 1000 times stiffer. A healthy artery can resist blood pressure of up to about 1,000 mm Hg before rupturing 10. Therefore keeping strength of arteries up would seem to be even more important than keeping blood pressure down. Formation Most frequent site of occurrence is in the anterior cerebral artery from the circle of Willis. The occurrence and expansion of an aneurysm in a given segment of the arterial tree involves local hemodynamic factors and factors intrinsic to the arterial segment itself. The human aorta is a relatively low-resistance circuit for circulating blood. The lower extremities have higher arterial resistance, and the repeated trauma of a reflected arterial wave on the distal aorta may injure a weakened aortic wall and contribute to aneurysmal degeneration. Systemic hypertension compounds the injury, accelerates the expansion of known aneurysms, and may contribute to their formation. Aneurysm formation is probably the result of multiple factors affecting that arterial segment and its local environment. Hemodynamically, the coupling of aneurysmal dilation and increased wall stress is approximated by the law of Laplace. Specifically, the Laplace law states that the arterial wall tension is proportional to the pressure times the radius of the arterial conduit T = P X R. As diameter increases, wall tension increases, which contributes to increasing diameter. As tension increases, risk of rupture increases. Increased pressure systemic hypertension and increased aneurysm size aggravate wall tension and therefore increase the risk of rupture. In addition, the vessel wall is supplied by the blood within its lumen in humans. Therefore in a developing aneurysm, the most ischemic portion of the aneurysm is at the farthest end, resulting in weakening of the vessel wall there and aiding further expansion of the aneurysm. Thus eventually all aneurysms will, if left to complete their evolution, rupture without intervention. In dogs, collateral vessels supply the vessel and aneurysms are rare. Treatment Historically, the treatment of arterial aneurysms has been surgical intervention, or watchful waiting in combination with control of blood pressure. Recently, endovascular or minimally invasive techniques have been developed for many types of aneurysms. Treatment of aneurysms Currently there are two treatment options for brain aneurysms: surgical clipping or endovascular coiling. Surgical clipping was introduced by Walter Dandy of the Johns Hopkins Hospital in 1937. It consists of performing a craniotomy, exposing the aneurysm, and closing the base of the aneurysm with a clip. The surgical technique has been modified and improved over the years. Surgical clipping remains the best method to permanently eliminate aneurysms. Endovascular coiling was introduced by Guido Guglielmi at UCLA in 1991. It 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. Once the catheter is in the aneurysm, platinum coils are pushed into the aneurysm and released. These coils initiate a clotting or thrombotic reaction within the aneurysm that, if successful, will eliminate the aneurysm. In the case of broad-based aneurysms, a stent is passed first into the parent artery to serve as a scaffold for the coils stent-assisted coiling. At this point it appears that the risks associated with surgical clipping and endovascular coiling, in terms of stroke or death from the procedure, are the same. The major problem associated with endovascular coiling, however, is the high recurrence rate and subsequent bleeding of the aneurysms. For instance, the most recent study by Jacques Moret and colleagues from Paris, France, a group with one of the largest experiences in endovascular coiling indicates that 28.6% of aneurysms recurred within one year of coiling, and that the recurrence rate increased with time. Piotin M et al., Radiology 2432:500-508, May 2007 These results are similar to those previously reported by other endovascular groups. For instance Jean Raymond and colleagues from Montreal, Canada, another group with a large experience in endovascular coiling reported that 33.6% of aneurysms recurred within one year of coiling. Raymond J et al., Stroke 346:1398-1403, June 2003 The long-term coiling results of one of the two prospective, randomized studies comparing surgical clipping versus endovascular coiling, namely the International Subarachnoid Aneurysm Trial ISAT are turning out to be similarly worrisome. In ISAT, the need for late retreatment of aneurysms was 6.9 times more likely for endovascular coiling as compared to surgical clipping. Campi A et al., Stroke 385:1538-1544, May 2007 Therefore it appears that although endovascular coiling is associated with a shorter recovery period as compared to surgical clipping, it is also associated with a significantly higher recurrence and bleeding rate after treatment. Patients who undergo endovascular coiling need to have annual studies such as MRI/MRA, CTA, or angiography indefinitely to detect early recurrences. If a recurrence is identified, the aneurysm needs to be retreated with either surgery or further coiling. The risks associated with surgical clipping of previously-coiled aneurysms are very high. Ultimately, the decision to treat with surgical clipping versus endovascular coiling should be made by a cerebrovascular team with extensive experience in both modalities. At present it appears that only older patients with aneurysms that are difficult to reach surgically are more likely to benefit from endovascular coiling. These generalizations, however, are difficult to apply to every case, which is reflected in the wide variability internationally in the use of surgical clipping versus endovascular coiling. Treatment of aortic and peripheral aneurysms For aortic aneurysms or aneurysms that happen in the vessels that supply blood to the arms, legs, and head the peripheral vessels, surgery involves replacing the weakened section of the vessel with an artificial tube, called a graft that is sutured at vascular stumps. Instead of sewing, the graft tube ends, made rigid and expandable by nitinol wireframe, can be much more simply and quickly inserted into the vascular stumps and there permanently fixed by external ligature1 11. Less invasive endovascular techniques allow covered metallic stent grafts to be inserted through the arteries of the leg and deployed across the aneurysm. Abdominal aortic aneurysm See also Aortic aneurysm Aortic dissection Cerebral aneurysm Charcot-Bouchard aneurysms Rasmussen aneurysm Aneurysm of sinus of Valsalva References ^ http://herkules.oulu.fi/isbn9514267397/isbn9514267397.pdf elastin review. ^ Kosonen T Uriu-Hare JY Clegg MS Keen CL Rucker RB 1996 Copper incorporation into lysyl oxidase. FASEB Journal; 10; A293, ^ Rucker RB, Kosonen T, Clegg MS, Mitchell AE, Rucker BR, Uriu-Hare JY, Keen CL 1998 Copper, lysyl oxidase, and extracellular matrix protein cross-linking.; Am J Clin Nutr. May;675 Suppl:996S-1002S. ^ Smith-Mungo LI, Kagan HM.: Lysyl oxidase 1998 properties, regulation and multiple functions in biology; Matrix Biol. Feb;167; 387-98. ^ Guenther E Carlson CW Emerick RJ 1978 Copper salts for growth stimulation and alleviation of aortic rupture losses in turkeys., Poult. Sci. Sep;575:1313-24. ^ Tilson MD 1983 Decreased hepatic copper levels. Arch. Surgery 117; 1212.-1213 ^ Senapati A Carlsson LK Fletcher CDM Browse NL Thompson RPH 1995 Is tissue copper deficiency associated with aortic aneuryzms? British Journal of Surgery 72; 352-353. ^ Dorea JG, Brito M, Araujo MO. 1987 Concentration of copper and zinc in liver of fetuses and infants. J Am Coll Nutr. Dec;66:491-5. ^ Carnes 1971 WH Role of copper connective tissue metabolism. Fed. Proc. 30; 995. ^ Shadwick RE 1998 Elasticity in arteries. American Scientist 86; 535-551. ^ Tex Heart Inst J. 2002;291:56-9 External links Diagram showing what an aneurysm looks like Addressing the Challenges Faced as a Result of Brain Haemorrhage Brain Blood Vessel Disorder Help Info Site @neurIST - Integrated Biomedical Informatics for the Management of Cerebral Aneurysms Story of Aneurysm Survival v d e Cardiovascular disease: vascular disease - Circulatory system pathology I70-I99, 440-459 Arteries, arterioles and capillaries Arterial occlusive disease/ peripheral vascular disease Arteriosclerosis: Atherosclerosis - Intermittent claudication - Atheroma - Monckeberg's arteriosclerosis Stenosis Renal artery stenosis, Carotid artery stenosis - Fibromuscular dysplasia - Degos disease - Aortoiliac occlusive disease Raynaud's phenomenon/Raynaud's disease - Erythromelalgia Aneurysm Aortic aneurysm/Abdominal aortic aneurysm - Cerebral aneurysm - Coronary artery aneurysm - Intracranial berry aneurysm - Dissection Aortic, Carotid, Vertebral - Pseudoaneurysm Other Arteritis Aortitis - Buerger's disease Arteriovenous fistula - Herary hemorrhagic telangiectasia Nevus Spider angioma, Halo nevus, Cherry angioma Veins Venous thrombosis/ Phlebitis/ Thrombophlebitis primarily lower limb Deep vein thrombosis abdomen May-Thurner syndrome, Portal vein thrombosis, Budd-Chiari syndrome, Renal vein thrombosis upper limb/torso Paget-Schroetter disease, Mondor's disease head Cerebral venous sinus thrombosis Post-thrombotic syndrome Varicose veins Varicocele - Gastric varices - Portacaval anastomosis Hemorrhoid, Esophageal varices, Caput medusae Other Superior vena cava syndrome - Inferior vena cava syndrome - Venous ulcer Arteries or veins Vasculitis - Thrombosis - Embolism Pulmonary embolism, Cholesterol embolism - Angiopathy Macroangiopathy, Microangiopathy Lymphatic disease Lymphadenitis - Lymphedema - Lymphangitis Blood pressure Hypertension Hypertensive heart disease - Hypertensive nephropathy - Secondary hypertension Renovascular hypertension - Pulmonary hypertension Hypotension Orthostatic hypotension See also congenital, neoplasia Retrieved from http://en..org/wiki/Aneurysm Categories: Gross pathologyHidden category: Articles needing additional references from November 2007 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages العربية Asturianu БългарÑ?ки Deutsch Español Français Italiano Kapampangan Nederlands ‪Norsk bokmÃ¥l‬ ‪Norsk nynorsk‬ Polski Português РуÑ?Ñ?кий Simple English Suomi Svenska Türkçe УкраїнÑ?ька This page was last modified on 13 September 2008, at 01:07
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