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"Can embolization treat aneurysms?"
I am a 38 year old female with an aneurysm. My doctor wants to try embolization. Wil this get rid of it?
An aneurysm is an abnormal widening or ballooning of a portion of an artery due to weakness in the wall of the blood vessel. Aneurysms can occur in any major or minor blood vessel in the body. The clinical presentation, complications, treatment, and prognosis of aneurysmal disease vary widely between different aneurysms. Some general points are as follows. Most aneurysmal disease occurs in arteries. The major risk of aneurysms are that the wall of an aneurysm is not as strong as that of a normal artery, so aneurysms are prone to rupture, leading to major bleeding. The treatment options for an aneurysm depends in large part on whether or not and an artery is essential for the preservation of life or limb. I will give some common examples to illustrate this point. The aorta is the major blood vessel that carries blood out of the heart to the rest of the body. As such, it is absolutely essential to the preservation of life, so the treatment options must focus on reinforcing the wall of the artery while still preserving the flow of blood through the artery. Thus, aortic aneurysms are treated by a vascular surgeon who places a stent or some other conduit to guide blood through or around the aneurysm so that tension is not placed on the wall of the aneurysm, preventing rupture. The spleen is an organ that removes old blood cells from the blood and removes certain bacteria from the bloodstream, but it is not actually essential to life. Some people can develop aneurysms of the artery feeding the spleen. To prevent complications from these aneurysms, the spleen can either be removed or the aneurysm can be caused to thrombose “clot off” by coiling (discussed later) or by embolization. Embolization is where a radiologist or surgeon uses chemical agents or particles that are delivered through a catheter and then embolize (travel downstream and get stuck) in order to cause an aneurysm to thrombose. This prevents bloodflow through the aneurysm, takes pressure off the wall, and reduces or eliminates the risk of rutpure of the aneurysm. The final situation is one that commonly occurs in the brain. Some people have aneurysms in the brain called berry aneurysms. These aneurysms are usually of a type called secular aneurysms. This means they hang off the artery on a small stem, like a piece of fruit hangs off a tree. There are multiple forms of treatment for these aneurysms. One option is to have the aneurysm removed by a brain surgeon. Another treatment that can be performed by a brain surgeon is placing a clip on the neck “stem” of the aneurysm so no blood can flow into it. Finally, the aneurysm can be treated by coiling, where a brain surgeon or an interventional radiologist finds the aneurysm by using an angiogram and then threads an extremely fine wire through a catheter into the aneurysm. A blood clot forms around this wire and hardens, preventing blood from flowing into the aneurysm in the future. In all of these options the aneurysm is treated but, because the aneurysm hangs off the side of the artery, bloodflow through the artery itself can still occur. As I stated previously, depending on what kind of aneurysm you have, the treatment options and the success of different treatments are completely different depending on what kind of aneurysm you have. This is why you can only get accurate information and make good decisions about treatment when you sit down and talk in person with the kind of physician who performs these kind of procedures. If your aneurysm is in your brain, you need to see a neurosurgeon or neurologist. If your aneurysm is in or very near you heart, you need to see a cardiologist or cardiothoracic surgeon. If your aneurysm is anywhere else in your body, you need to see a vascular surgeon. As always, if you are unsure of what type of specialist you may need to see, visit your primary care physician first and he or she can refer you to the appropriate specialty physician. Aneurysms are a serious and potentially life threatening problem, so I recommend you see a physician in person as soon as possible to discuss the right treatment option for you.
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