Docyard : Keep your heart healthy

Aneurysm is a swelling that occurs in the blood vessels due to the weakening of its walls that causes a bulgy appearance. Aneurysm can appear in any part of the body including arteries and veins and can have serious consequences. Usually, the most common occurrence of aneurysm has been seen in the aorta (main artery), back of the knees, brain or intestines.

If the aneurysm gets ruptured, it can even cause internal bleeding and stroke leading to casualty. The symptoms are only prevalent when it ruptures and intervention is possible depending upon the location, size and the condition of the aneurysm.

Who is at riskIJ

Men are more likely to develop aneurysms than women. People more than 60 years are at higher risk. It is caused by combination of potential risk factors like smoking, high cholesterol, hypertension, tissue disorders and family history of heart disease and heart attack. Pregnancy can also increase the risk of aneurysm of the spleen in women. Most of the cases being congenital, it isn’t always possible to prevent aneurysm. Certain lifestyle changes can help prevent the risk like no smoking, maintaining blood pressure, and BMI with a balanced diet, no high cholesterol diet, regular exercises and medication.

 Types

Classification of aneurysm is done depending on its location in the body. Blood vessels of the brain and the heart are the most common locations to get seriously affected. The swelling can be of two types— either the complete blood vessel is swollen or a specific side of the blood vessel can bulge out from sides. The following are the most common types of aneurysm:

• Aortic Aneurysm: When the swelling is seen in the aorta starting from the left ventricle to the chest and abdominal cavity. It can cause the aorta to swell from its normal diameter of 2.5 cm up to or even beyond 5 cm.
• Abdominal Aortic Aneurysm: It is the most common aneurysm that occurs in aorta. This aneurysm bulges in the part of the aorta that runs through the abdomen. Timely intervention can not only prevent casualties but also treat the condition.
• Thoracic Aortic Aneurysm: It is a lesser known aneurysm that can affect aorta running through the chest. There is only 25 per cent chance of its occurrence in the chest.
• Cerebral Aneurysm: Intracranial aneurysms occurs in the arteries that supply blood to the brain. They are also called Berry Aneurysms due to their appearance and can also frequently rupture and bleed. The ruptured aneurysm can be fatal within 24 hours.
• Peripheral Aneurysm: It develops in the popliteal artery which runs in the lower part of thigh and knee. It can also develop in the artery located in groin, neck, arms and arteries supplying blood to the kidneys or bowel.

Diagnosis

Usually aneurysm remains undetected and screening may be required for patients needing monitoring or treatment. Women being at lower risk of developing aneurysm, men must undergo ultrasound screening over the age of 55 or who is a regular smoker.

MRI scans are useful for identifying aneurysms that don’t rupture but the symptoms are prevalent. In case when the aneurysm gets ruptured and leads to the risk of bleeding in the brain, CT scans are preferred. An Angiogram may be performed in extreme cases with severe rupture and bleeding in the brain to identify the exact area for treatment.

Surgical intervention 

Flow diversion stent is the new innovative intervention for the treatment of aneurysm in the initial stages. It is a pipeline method that includes placing a device inside the sac of the parent blood vessel to divert the blood flow from aneurysm. This intervention is  endovascular in which a cylindrical, metallic mesh stent is placed inside the blood vessel containing aneurysm. These stents prevent the coils from exiting the aneurysm and maintaining the pressure on the coil to keep aneurysm under control.

The writer is Dr Vipul Gupta Director, Neurointervention, Agrim institute neuro sciences at Artemis Hospital, Gurugram