The term “aneurysm” is derived from the ancient Greek word “aneúrysma,” which literally means “dilatation.” Any blood vessel can be affected by an aneurysm.
In most cases, however, this dilation occurs along the arteries. Arteries are blood vessels that carry oxygen-rich blood from the heart to organs, muscles, and tissues. An aneurysm is therefore also referred to as an arterial dilation or arterial bulge.
Aneurysms rarely occur in veins—the blood vessels that carry oxygen-poor blood back to the heart.
A cardiac aneurysm usually develops after a heart attack, when the damaged heart wall loses stability and bulges under the pressure of the blood. Such a ventricular aneurysm is a typical weak spot that can cause various symptoms depending on its location in the heart. While small bulges often cause no symptoms, a large aneurysm can impair the heart’s pumping function and lead to circulatory problems. Aneurysms can form not only in the heart but also in the aorta—both in the chest and in the abdomen. An aortic aneurysm often goes unnoticed but is frequently detected during routine examinations. The condition becomes critical when the vessel wall loses strength due to advancing age or when an aortic dissection occurs, in which blood enters the space between the layers of the wall. Depending on the location of the aneurysm, pain may occur in the chest, abdomen, or back. If the aneurysm grows larger or there is a significant dilation of the aorta, open-heart surgery may be necessary, during which the vessel is repaired using a heart-lung machine. Alternatively, stent grafts are inserted through the femoral artery if a less invasive method is possible.
Aneurysms most commonly occur in the main artery, also known as the aorta. This type of aneurysm is also referred to as an aortic aneurysm.
An aneurysm in the lower part of the aorta in the abdomen, known as the abdominal aorta, is called an abdominal aortic aneurysm. Accounting for over 90 percent of all aneurysms, this is the most common type.
An aortic aneurysm in the upper part of the aorta, which runs through the chest and is therefore called the thoracic aorta, is referred to as a thoracic aneurysm. Such a dilation of the upper aorta in the chest is much less common; it accounts for only about 3 percent of all aortic aneurysms.
In addition to the upper and lower aorta, other blood vessels may also be affected by pathological dilation in rare cases:
- Brain vessels (intracranial or cerebral aneurysm)
- Blood vessels near the heart
- Arteries of the arms, legs, and internal organs
A cardiac aneurysm, or aneurysm of the heart wall, can develop in the left ventricle following a heart attack.
Depending on the type of vascular dilation, we distinguish three different types of aneurysms:
- "true" aneurysm (aneurysma verum)
- dissecting aneurysm (aneurysma dissecans)
- "false" aneurysm (aneurysma spurium or falsum)
Aneurysma verum is the aneurysm in the true sense of the word. All three layers of the blood vessel wall remain intact throughout. They bulge outward like a sac, forming a sac-like dilation of the vessel.
In a dissecting aneurysm, one layer of the blood vessel wall has torn. As a result, blood flows between the different layers of the vessel wall, forming an expanded cavity there.
An aneurysma spurium, or aneurysma falsum, is also known as a false aneurysm. It is not an arterial bulge in the true sense. It develops when, following an injury to the vessel wall, a bruise (hematoma) forms around the blood vessel. Over time, this hematoma becomes encased in a connective tissue capsule and filled with blood.
Causes and Risk Factors for Cardiac and Aortic Aneurysms
Aneurysms usually develop in areas where the vessel wall is weakened. These weaknesses can be either congenital or acquired.
Congenital causes:
- Connective tissue disorders (e.g., Marfan syndrome or Ehlers-Danlos syndrome)
- Malformations of the blood vessels
Acquired weaknesses and changes in the blood vessel wall can result from vascular injuries, such as those caused by a cardiac catheterization procedure.
Certain risk factors increase the likelihood of an aneurysm forming. These include, in particular,
An aneurysm often causes no symptoms for a long time. Symptoms usually do not appear until the diameter of the dilated blood vessel becomes large enough to put pressure on surrounding structures. The exact symptoms caused by an aneurysm depend on its location.
For example, an abdominal aortic aneurysm usually causes symptoms such as
.
If an abdominal aortic aneurysm ruptures, it can, in the worst-case scenario, lead to life-threatening internal bleeding. This manifests as sudden, very severe, stabbing, and persistent pain in the flanks.
A thoracic aortic aneurysm—that is, an aneurysm in the aorta in the chest area—is characterized by symptoms such as
- chest pain
- coughing
- hoarseness
- Difficulty swallowing
- Shortness of breath
- Abnormal breathing sounds
- Circulatory problems in the arms or brain
If a thoracic aortic aneurysm ruptures, severe chest pain usually occurs, resembling the symptoms of a heart attack.
Bleeding from an aneurysm in the brain arteries—medically known as an intracranial or cerebral aneurysm—can cause symptoms such as
- sudden, severe headaches,
- facial pain,
- nausea, and
- loss of consciousness
may occur.
Cardiac wall aneurysms and aneurysms of the aorta near the heart can
.
An aneurysm is usually diagnosed during a physical examination, in which the treating physician palpates the abdominal or pelvic arteries, as well as through additional imaging tests. Imaging tests suitable for diagnosing an aneurysm include:
Abdominal pain in the lower abdomen may be a sign of an abdominal aortic aneurysm
Whether an aneurysm requires treatment and what the exact course of therapy will be depends, among other factors, on the location and size of the dilated blood vessel, as well as the increase in the aneurysm’s transverse diameter. In general, both conservative and surgical treatment options are available.
Conservative treatment is primarily used for smaller aneurysms that do not cause symptoms. It aims to treat and prevent the underlying causes and risk factors. These risk factors include:
- High blood pressure
- Dyslipidemia
- Tobacco use
- unhealthy diet
- lack of exercise
This is intended to prevent the aneurysm from growing larger or rupturing.
The larger an aneurysm is, the greater the risk that it will rupture. In such cases, doctors generally recommend surgery to remove the aneurysm. There are various surgical methods to choose from, including the use of a vascular prosthesis or a stent in the affected blood vessel. For aneurysms of the cerebral arteries, two surgical procedures are generally considered: clipping or coiling.
How does an aortic or cardiac aneurysm develop?
An aneurysm develops when the wall of the aorta becomes abnormally dilated, creating a weak spot. Causes include arterial damage, a ventricular aneurysm following a heart attack, an aortic dissection, or changes in the vessel wall that cause it to lose strength with age. Men aged 65 and older have a significantly increased risk of developing an aortic aneurysm, and four to eight percent of all men are affected. Many aneurysms are discovered during routine examinations or other diagnostic procedures.
What are the symptoms of an aortic aneurysm?
Symptoms always depend on the location of the aneurysm. Symptoms usually do not appear until the bulge grows larger or there is a risk of rupture. Typical symptoms include pain in the chest, abdomen, and back. If the aortic aneurysm is located in the thoracic region, shortness of breath, coughing, or hoarseness may also occur. If symptoms appear suddenly, this is a sign of a dangerous condition and requires prompt medical evaluation.
How is an aneurysm diagnosed?
An aneurysm is usually detected by ultrasound during other examinations. If an aortic aneurysm is suspected, a CT scan, MRI, or angiography is performed to determine the exact location of the aneurysm. The appropriate diagnostic method is selected based on the aneurysm’s location—in the chest or abdomen. This approach also allows for the reliable detection of an aneurysm of the ascending aorta or a concomitant aortic dissection.
When is surgery necessary?
Surgery is recommended if an aneurysm has a diameter of several centimeters or more, or if symptoms appear that indicate an unstable vessel wall. Depending on the location of the aneurysm, this may involve the aorta in the chest or abdomen. Doctors make an individualized decision regarding when surgery is necessary, as the risk of rupture increases with size. The location of the aneurysm also influences whether surgical treatment or a less invasive approach is possible.
How is an aneurysm treated?
Surgical treatment involves either traditional open surgery through the chest or abdomen—often using a heart-lung machine—or an endovascular procedure in which stents are inserted through the femoral artery. The choice of surgical treatment depends on the size, location, and causes of the aortic dissection or vascular weakness. If an aortic aneurysm remains untreated, it can lead to a rupture with life-threatening consequences.
Can an aneurysm go away on its own?
No, a pathological enlargement of the aorta does not resolve on its own. An aneurysm often continues to grow because the wall of the aorta is weakened at the affected site. If an aneurysm is detected during routine examinations, regular follow-up is important to detect any increase in diameter at an early stage.
How can an aortic aneurysm be prevented?
Prevention primarily involves consistently reducing risk factors. These include treating high blood pressure, quitting smoking, eating a healthy diet, losing weight, and exercising regularly. Men aged 65 and older benefit particularly from a one-time ultrasound screening, as an aneurysm often causes no symptoms for a long time. The risk of a rupture can be significantly reduced through early diagnosis and individually tailored treatment.
