Like a Balloon That Bursts
Aneurysms often show no symptoms, but a rupture can be deadly
By Jeffrey Westhoff
Above image: Sapan Desai, MD, PhD, MBA, a vascular surgeon at Northwest Community Hospital in Arlington Heights, repairs an abdominal aortic aneurysm. Computer-assisted imaging and intraoperative visualization systems are increasingly used to train the next generation of surgeons on uncommon or especially complex procedures. Photo by Jason Johnson
An aneurysm is an enlargement in a blood vessel, usually an artery, caused by a weakness in the vessel’s wall. It can grow as it fills with blood. Think of it like a balloon.
“As you stretch a balloon, it gets larger and larger and thinner and thinner. Then it might burst and that could be a life-threatening condition,” says Ross Milner, MD, director of the Center for Aortic Diseases at University of Chicago Medicine.
Aneurysms don’t usually show symptoms until they rupture. But when they do rupture, it can result in internal bleeding, stroke or death.
While aneurysms can occur anywhere in the body, they are most likely to be found in the aorta (the large artery that exits the heart and travels through the chest and abdomen), in the brain or in the legs. The risks and treatment can be different, depending on where the aneurysm is located.
As an aneurysm fills with blood, either the vessel’s circumference bulges like a worn bicycle inner tube (a fusiform aneurysm, more common in the body) or the blood pushes into a blister that forms on the vessel’s exterior (a saccular aneurysm, more common in the brain).
A ruptured aneurysm leads to internal bleeding. In a large vessel, such as the aorta or iliac artery, the results can be catastrophic, says Sapan Desai, MD, PhD, MBA, a vascular surgeon with NCH Medical Group in Arlington Heights. “You’re bleeding uncontrollably,” he says. About 9 out of 10 people with a ruptured abdominal aortic aneurysm die, he says.
Ruptured brain aneurysms carry serious risks as well. “They produce probably the worst kind of stroke there is,” says Camilo Gomez, MD, professor of neurology and neurosurgery at Loyola University Medical Center.
Early detection, then, is critical. Yet diagnosing aneurysms is difficult because they seldom exhibit symptoms until they rupture.
“Before they rupture, we usually discover them by accident,” says Fady Charbel, MD, professor and head of the Department of Neurosurgery at the University of Illinois Hospital & Health Sciences System.
Often, aneurysms are found during tests for other medical conditions. Aneurysms can be detected by simple, noninvasive imaging: for the body, an ultrasound scan; for the head, a test similar to an MRI called an MR angiogram.
Kevin Bottum, 69, of Buffalo Grove, a patient of Desai’s, went in for a CAT scan of his kidney when a large aneurysm was discovered in his iliac artery. “I had no symptoms whatsoever,” he says.
Physicians may decide to monitor an aneurysm if it is small when initially detected, but the only true treatment is to repair it. Twenty years ago, this required open surgery that meant up to a week in the hospital, but today aneurysms can be repaired with minimally invasive endovascular surgery that usually requires just an overnight stay. Milner says that 88 percent of aortic aneurysms are now fixed by endovascular surgery.
Technological advances in endovascular repair are constant. “There’s not a year when more devices don’t come to the market,” Charbel says.
Desai repaired Bottum’s aneurysm with an endograft—a small tube that diverts blood past the damaged portion of the vessel. The FDA approved it for use in the iliac artery in February 2016. “We’re able to do these really complex, minimally invasive procedures on patients who were historically not candidates for a minimally invasive approach,” Desai says.
Despite the rapid development of new treatments, aneurysms remain mysterious. “Most of the time we don’t have a definite cause,” Charbel says.
With no known cause, there is no certain prevention, though being aware of and limiting risk factors is a good idea.
Chief among risk factors are a family history of aneurysms and a history of smoking. “For the average person out there, not smoking will help to prevent an aneurysm,” Milner says. Other risk factors include hypertension and high cholesterol.
People with a family history of aortic aneurysm should be checked by age 50, Milner says. Those with a family history of brain aneurysm should be screened after age 21, Gomez says. Desai recommends that all smokers be checked for aneurysm by age 65.
For those unsure if they are at risk, Gomez has simple advice: “Go see your regular doctor and ask if you need to be checked out.” An aneurysm caught early is a patient’s best defense against serious or fatal issues.
Originally published in the Spring 2017 print edition
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