What is an aneurysm?

An aneurysm is an abnormal swelling of a weakened part of an artery or blood vessel. If left untreated, the aneurysm may enlarge and stretch the walls of the artery or blood vessel to the point of rupture. This, in turn can cause internal bleeding and sudden death.

“Aneurysms tend to affect more men than women. People over the age of 65 and those with a heart condition or high blood pressure (hypertension) should also watch out for pains in the chest, head or abdomen, as these could indicate an aneurysm,” says Dr Soon Jia Lin, Consultant, Department of Cardiothoracic Surgery, National Heart Centre Singapore (NHCS), a member of the SingHealth group.

Aneurysms affect arteries in the chest, abdomen and brain

Although aneurysms can affect any weakened blood vessel, they are particularly deadly in the blood vessels within the brain (brain aneurysm) or in the aorta (aortic aneurysm).

The aorta is the body’s largest and longest artery. It carries oxygenated blood from the heart to the rest of the body. Aortic aneurysms are most common in the abdomen (abdominal aortic aneurysm) or chest (thoracic aortic aneurysm).

Symptoms of aneurysm

“An aneurysm can show no symptoms until it has grown so large that it bursts, or tears within its wall. Early detection and treatment enhances survival,” says Dr Soon.

Detecting an aneurysm early may be difficult due to the initial lack of symptoms. At a later stage, symptoms usually depend on the location of the aneurysm.

Type of AneurysmSymptoms​
Brain Aneurysm
  • Severe headache
  • Blurred vision
  • Numbness on one side of the face
  • Nausea and vomiting
Abdominal aortic aneurysm
  • Deep, constant abdominal pain
  • Pulsations in the abdomen
  • Throbbing lump in the groin or legs
  • Lower back pain
Thoracic aortic aneurysm (chest)
  • Deep, throbbing chest pain
  • Difficulty swallowing
  • Shortness of breath
  • Cough and hoarseness

Causes of aneurysm

The most common causes are untreated, chronic high blood pressure (hypertension) and atherosclerosis (hardening of arteries due to cholesterol plaque buildup). They cause the artery walls to become so stretched and weakened that they bulge outward, creating a ballooned area called aneurysm.

Congenital conditions such as Marfan’s syndrome and bicuspid aortic valves may also weaken aortic walls, diminishing their ability to withstand the sheer forces of blood flowing through them.

Diagnosis of aneurysms

Doctors will conduct a thorough physical examination, checking for high blood pressure, heart murmurs, or any pulsating lumps in the abdomen, groin or legs.

A variety of tests including an ultrasound, computed tomography scan (CT scan), magnetic resonance imaging scan (MRI scan) and angiogram can help to confirm the diagnosis.

Treatment for aneurysm

The larger an aneurysm becomes, the more likely it will burst. Doctors will prescribe oral medications such as beta blockers to reduce the force of blood pressure against the weakened artery wall. Generally high blood pressures will be aggressively treated.

Doctors may surgically remove the aneurysm and replace the weakened portion of the aorta with a synthetic graft if the aneurysm is at risk of rupturing - usually when the aneurysm grows beyond a threshold size. This threshold varies depending on the location of the aneurysm. But such open surgery is not suitable for everyone.

Endovascular aneurysm repair is a less invasive surgery involving threading a stent through an artery in the groin. The stent can relieve excessive pressure on the vessel walls and reduce the risk of rupture.

How to prevent aneurysm?

“The best way to prevent or to slow the growth of aneurysms is to keep your blood pressure and cholesterol levels under control. Exercise regularly and kick the cigarette habit if you’re a smoker,” says Dr Soon.

Ref: R14