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Overview of Aortic Aneurysms

by John W. Hallett, Jr., MD

Aneurysms are abnormal dilations of arteries caused by weakening of the arterial wall. Common causes include hypertension, atherosclerosis, infection, trauma, and hereditary or acquired connective tissue disorders. Aneurysms are usually asymptomatic but can cause pain and lead to ischemia, thromboembolism, spontaneous dissection, and rupture, which may be fatal. Diagnosis is by imaging tests (eg, ultrasonography, CT angiography, magnetic resonance angiography, aortography). Treatment of unruptured aneurysms is with risk factor modification (eg, strict BP control) plus surveillance imaging or with open or endovascular stent-graft surgery, depending on size and location of the aneurysm and presence of symptoms. Treatment of ruptured aneurysms is immediate repair with either an open surgical synthetic graft or an endovascular stent graft.

Aneurysms, defined as a 50% increase in arterial diameter compared with normal segments, result from localized weakening of an arterial wall. True aneurysms involve all 3 layers of the artery (intima, media, and adventitia). A pseudoaneurysm (false aneurysm) is a communication between the arterial lumen and overlying connective tissue resulting from arterial rupture; a blood-filled cavity forms outside the vessel wall and seals the leak as it thromboses. Aneurysms are classified as fusiform (circumferential widening of the artery) or saccular (localized outpouchings of the artery wall). Thrombi that develop in layers (laminated thrombi) may line the walls of either type and are a sign that blood flow beyond the aneurysm is normal or near normal.

Aneurysms may occur in any artery. Abdominal (see Abdominal Aortic Aneurysms (AAA)) and thoracic aortic (see Thoracic Aortic Aneurysms) aneurysms are most common and significant; aneurysms of the major aortic branches (subclavian and splanchnic arteries—see Aortic Branch Aneurysms) are much less common. Aneurysms of peripheral arteries (see Peripheral Arterial Aneurysms) and the cerebrovascular system (see Vascular Lesions in the Brain) are discussed elsewhere.

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