The etymology of aneurysm comes from the Greek aneurysma, which means dilatation. It consists of the increase in size of a blood vessel, reaching between 2.5 to 3 times its normal or usual size.
Aneurysms can be classified into several types:
- True: arteriosclerosis and congenital aneurysms.
- False: aneurysms secondary to trauma or previous surgeries.
- Latrogenic.
- Fungal or infectious.
- Depending on their location they can be: cerebral, aortic, mesenteric and renal vessels, or extremities.
Causes of aneurysms
The causes of this dilatation may be several:
- Genetic: increasingly, there are theories about the genetic component of this alteration: it has been observed families with a coincidence of several of its members who have this alteration.
- Infectious: an infection in the vessel wall can trigger an aneurysm, in these cases it is specifically a mycotic aneurysm.
- Most of the aneurysms treated and studied by the vascular surgeon is the arteriosclerotic origin, its etiology is in an alteration of the muscular layer of the vessel, which is responsible for this alteration. They usually appear in the abdominal and thoracic aorta, iliac, popliteal, and to a much lesser extent in the carotid vessels, among other locations.
Risk factors for the appearance of aneurysms
The main risk factors for aneurysms are:
- Obesity
- Arterial hypertension
- Tobacco
- Hyperlipemia
- Age
- Hereditary factor
Aneurysm diagnosis
These vascular dilatations have a very uneven evolution if left untreated, the evolution is thrombosis or rupture of the aneurysm depending on its location, which is why early diagnosis is very important.
Clinically a pulsatile mass can be found in the clinical examination, under the instrumental point of view, ultrasonic means such as ultrasound and CT are the most common techniques,
Aneurysms generally have no symptoms, so their diagnosis today is by ultrasound, as in the study of renal and prostatic pathology the alteration is detected although it is always advisable to perform an abdominal CT scan to determine its extent.
Treatment of aneurysm
Treatment is one of the most important points, we must not forget that famous people have died from ruptured aortic aneurysm.
The first treatments date back to Rudolf Matas in the first half of the 20th century, who, together with Alexis Carrel, initiated the first treatments, consisting of wrapping the abdominal mass with cellophane to cause fibrosis that stopped its growth or to perform various ligatures, or the introduction of wires to cause thrombosis. It was not until 1949 that the replacement of the aneurysmal area with a prosthesis, which is the basis of subsequent treatments, was considered.
The treatment recommended by experts in Angiology and Vascular Surgery is the replacement of the dilated area, either with the interposition of a new vessel, ie performing a Bypass with synthetic material, or with the patient’s own material in most cases with saphenous vein, or in peripheral aneurysms is the interposition of a prosthesis in the area of the aneurysm, this prosthesis goes from healthy artery to healthy artery, excluding the diseased area.
The treatment of abdominal aortic aneurysms involves opening the abdomen to make this substitution, with consequent blood loss, and significant morbidity, so different approaches are proposed to reduce the various complications.
Due to the significant morbidity of this type of treatment in the 1990s began the endovascular treatment of aneurysm, being one of the promoters the Argentine Parodi, who initiated the treatment of aneurysms with endovascular techniques. This technique involves the introduction of prosthetic material inside the vessel, with the help of a catheter. This prosthesis thus placed performs the same functions, with a minimally invasive approach.
The endovascular technique in aneurysm plays an increasingly important role, since it allows solving the problem with low morbidity, although it is true that not all cases can be solved in this way, but it can treat the vast majority of aneurysmal dilatations.