What You Need to Know About Brain and Abdominal Aortic Aneurysms
Thinking about something as life-altering as an aneurysm can be unsettling, so it’s important to know a thing or two about them. Colorado medical experts explain how they happen, who is at risk and treatment for two common types: cerebral and abdominal aortic aneurysms.
A cerebral aneurysm, often called a brain aneurysm, is a localized weakness in an artery wall that can take on various shapes and sizes. The artery balloons out, and like a balloon, it can pop, spilling blood, says Dr. Don Frei, a Denver interventional and neuro-interventional radiologist with Radiology Imaging Associates, who works at Swedish Hospital’s Stroke Center.
Curiously, Frei says about 1 percent of the population is walking around with such a weakness in a brain artery, but doesn’t know it because it hasn’t ruptured — and maybe never will.
“You could potentially live your whole life and die of some other reason,” Frei says. “We don’t really know why it ruptures when it does,” adding that things like high blood pressure, diabetes and smoking can increase the likelihood of rupture because they put additional stress on artery walls. However, those behaviors and conditions themselves do not ever cause one, he adds.
Likewise, an aneurysm’s size does not determine whether it will rupture.
Who is at Risk?
People with a family history, such as a parent, sibling or child who have had or have an aneurysm, may be at higher risk, Frei says. He often sees migraine sufferers worry they’re at higher risk but he says there’s not a direct correlation between migraines and brain aneurysms.
What are the Symptoms?
“The sudden onset of the worst headache of your life” is how Frei describes the overarching symptom of a brain aneurysm. The pain is caused by blood leaking from an aneurysm. They are clinically silent, meaning there are no warning signs.
The annual rate of rupture is approximately 8 to 10 per 100,000 people — or about 30,000 people in the United States — according to the Brain Aneurysm Foundation.
Survival, Frei says, is based on how much blood leaks out. Ten percent of people die immediately, and one-third die soon after. Two-thirds do not return to their normal self, having died or been disabled.
The average age for a ruptured brain aneurysm is lower than you might think: middle age, or 40s to 50s. Frei has rarely treated children, but plenty of people in their 20s or 30s.
There are two common exam methods: a magnetic resonance angiography (MRA), which is an MRI that looks at brain arteries, or a computerized tomography angiography (CTA), an angiogram wherein an IV injection of dye gives doctors a clear picture of brain arteries.
Patients do not need both procedures, and neither is superior. Notably, the MRA doesn’t require an IV and there’s no radiation exposure. (People who are severely claustrophobic often opt for the MRA; those with pace makers must.)
Whether people who discover an aneurysm choose surgery, depends on age and other confounding health issues, says Frei who explains the two very successful surgical options: The most invasive procedure involves removing part of the skull and placing a titanium clip across the ballooned artery. The more common surgery is endovascular, where a small incision in the hip allows surgeons to access blood vessels. A coil is then placed into the aneurysm, a method that has been used since about 1995, Frei says.
Abdominal Aortic Aneurysms
Dr. Omar Mubarak, a vascular surgeon at Presbyterian/St. Luke’s Medical Center (P/SL), says the most common aneurysm he sees is not in the brain but in the aorta — the largest artery in the body, just below the kidneys. “When a portion of the artery stretches to more than 50 percent of the original diameter, it is called an aneurysm,” he says.
In the U.S., ruptured aneurysms are the 10th leading cause of death of men over the age of 50, he says. Like the cerebral aneurysm, there are almost always no symptoms, but a rupture would cause extreme abdominal pain that could cause the affected person to pass out.
Who is at Risk?
Mubarak says the most common risk factors for abdominal aortic aneurysms include being over 60, male and a smoker. A family history of abdominal aortic aneurysms also plays a role, especially when a female family member had one. He says males 65 to 75 with a history of smoking should consider an abdominal ultrasound.
“Smoking cessation and controlling hypertension can help avoid the formation of aortic aneurysms,” Mubarak says.
Aortic aneurysms are repaired with endovascular surgery, and Mubarak says survival rates have improved in recent years. They used to say 50 percent would die before reaching the hospital, and 50 percent of that group would die due to complications from repair.
Mubarak feels the numbers are no longer so dire in the Denver area, thanks to P/SL’s new Hybrid Operating Room — the largest hybrid OR in the state opened in 2016, and it can accommodate both adult and pediatric patients.
“The room gives the surgeons every advantage they need to repair an aneurysm with a stent graft,” Mubarak says, “but still have the capability of open surgery if needed.”
Know the Difference
A localized enlargement of an artery caused by a weakening of the artery wall. Arteries can be enlarged.
The sudden death of brain cells due to lack of oxygen caused by blockage of blood flow or rupture of an artery to the brain.
A sudden and sometimes fatal occurrence of coronary thrombosis, typically resulting in the death of part of the heart muscle.
—Source: Dr. Omar Mubarak, vascular surgeon, Presbyterian/St. Luke’s Medical Center.
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