Aneurysms: unnoticed weak point

Last updated on April 22, 2024 First published on April 18, 2024

They are considered ticking time bombs: aneurysms. However, an aneurysm does not always have to be operated on if it is detected early and well monitored. And if they do, they look for the gentlest and most suitable treatment method.

An aneurysm is initially small, grows slowly, causes no symptoms and therefore goes unnoticed for a long time. The bulge in the vascular wall of a blood vessel acts like a small balloon. If this loses much of its elasticity over time and expands too much, the aneurysm can eventually rupture, causing bleeding inside the body – a life-threatening condition that requires emergency surgery.

Widespread – hardly known

Aneurysms most frequently form on the aorta, the main artery in the abdomen or chest. “4-8 percent of men over 65 and 0.5-1.5 percent of women over 65 have an aortic aneurysm of at least three centimetres in diameter,” explains Alexander Zimmermann, Director of the Clinic for Vascular Surgery. Brain aneurysms, the second most common form, occur in 2-3 percent of the population.

Apart from a few congenital aneurysms, most develop in the course of life. “One factor here is the normal ageing process, as blood vessels automatically become less elastic with age,” explains Zsolt Kulcsár, Clinic Director of Neuroradiology. If other factors that are harmful to the cardiovascular system such as smoking, high blood pressure, obesity or high blood lipid levels are added to this, the risk of developing an aneurysm increases. “Controlling vascular risk factors is therefore an important measure to prevent serious consequential damage,” emphasizes Luca Regli, Clinic Director of Neurosurgery.

Regular checks

Because aneurysms usually do not cause any symptoms, they are often discovered by chance during an examination. At the USZ, they are then assessed and treated on an interdisciplinary basis. Special imaging techniques and other tests are used to analyze the size and composition of the tumor. “With the majority of aneurysms, there is no acute danger. They just need to be checked regularly,” explains Alexander Zimmermann. Regular follow-up checks allow growing aneurysms to be detected early and, if necessary, treated more safely. “We also provide advice on lifestyle changes. This has an influence on how an aneurysm develops,” adds Zsolt Kulcsár.

Aneurysm treatment

Intracranial aneurysms occur in around two to five out of every 100 people and are often discovered by chance during imaging examinations of the head. They are assessed at the USZ by a team of specialists in neuroradiology and neurosurgery. A decision is made as to whether a randomly found aneurysm should be treated or observed.

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As little as possible, as much as necessary

If there is a risk of the aneurysm rupturing, it must be treated. “An elastic tube, a stent or microcoils can often be placed in the right place in a minimally invasive way with a catheter from the groin via the bloodstream,” explains Zsolt Kulcsár. This is done under constant fluoroscopy in neuroangiography to ensure that the implant is in the right place. Depending on the location and size of the aneurysm, surgery may be necessary.

In the case of aneurysms in the head, this is separated from the healthy vessel wall using clips. “These operations are performed under a microscope so that the highest precision can be achieved. The USZ is a national and international reference center in this field,” explains Luca Regli. Aneurysms in the abdominal and thoracic cavities are treated with customized prostheses. Vascular surgery at the USZ offers a specialty in these prostheses: it is one of the few hospitals in Europe that can also place large prostheses that replace the entire aorta using minimally invasive techniques. This means that people who cannot be operated on due to poor health can also be helped.

Unique procedure at the USZ

Interdisciplinary experience as a trump card

The vast experience of the numerous specialists involved is crucial for the structured, innovative and therefore very successful treatment of aneurysms at the USZ. A large number of aneurysm operations are performed at the USZ. Thanks to this routine, a high level of patient safety is achieved. For Alexander Zimmermann, what is still missing is a standard for early detection: “Regular screening of the aorta with an ultrasound device would be desirable from a certain age and could save lives. Unfortunately, this has not yet been standard practice in Switzerland.”

Preventive screening is also an issue in the case of brain aneurysms. “We recommend it for familial clustering. As today’s globally established gold standard for the treatment of brain aneurysms was developed at the USZ, our patients benefit from a wealth of experience,” adds Luca Regli.

Responsible specialists

Alexander Zimmermann, Prof. Dr. med.

Director of Department, Department of Vascular Surgery

Tel. +41 44 255 20 39
Specialties: Catheter-based and open aortic surgery, Open surgery of the carotid artery, Bypass surgery

Zsolt Kulcsar, PD Dr. med.

Director of Department, Department of Neuroradiology

Tel. +41 44 255 56 00
Specialties: Diagnostic and interventional neuroradiology, Minimally invasive treatment of neurovascular disease patterns., Neurovascular imaging

Luca Regli, Prof. Dr. med.

Director of Department, Department of Neurosurgery

Tel. +41 44 255 29 92