The focus of this web site is medicine. In this blog, you’ll read about patient stories. The situations have been changed to be HIPAA compliant. Factual statements may or may not be true. I may change ages, gender or presenting complaints about patients. I may even entirely make up complete patient encounters from my fertile imagination. Trust me, if you think I’m writing about you, I’m not. There are billions of people in this world and readers send me stories about patients all the time. It isn’t you.
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The kids took out a hose to wash our cars. We have several hoses, but the kids like the cheap nylon hose for most of the jobs around the house because it is light and easy to move around. They used the cheap nylon hose to fill up a bucket with some soap and water, got some sponges, and had a lot of fun cleaning the cars. Then they put a spray nozzle on the hose to rinse the cars off. That’s when my daughter came into the house dripping wet to give me some bad news. “Dad … there’s something wrong with the hose.” I went outside and the hose was in bad shape. “The hose has an aneurysm. Not going to last much longer.” “What’s an ann-you-rism?” My youngest daughter asked. Light bulb! What a perfect idea for a blog post! I went to get my camera. At this point, you’re probably asking yourself what a garden hose has to do with a discussion of aneurysms on a medical blog. The simple answer is that the basic principles remain the same whether we’re talking about an abdominal aortic aneurysm, a brain aneurysm, a hose aneurysm, or even a balloon. In medicine, an aneurysm occurs when there is a weakness in the walls of a blood vessel. As the weakness worsens, the walls of the blood vessel around the weakness begin to balloon out. As the walls balloon out, they get weaker. The cycle continues until eventually the wall breaks. Think of a balloon. When you first start blowing up the balloon, it is usually a lot more difficult to get the first breath of air inside. After that, it gets easier and easier to blow more air into the balloon until you reach the limits of the tensile strength in the balloon walls and … POP. Aneurysms almost always occur under pressure, so they almost exclusively occur in arteries. Venous aneurysms can occur, but are rare. This makes sense. Go back to the balloon analogy. If you don’t blow to put pressure inside the balloon, it won’t get bigger. Now think of the hose analogy. My kids didn’t notice the swelling in the hose initially because they didn’t have the spray nozzle on the hose and the water ran freely out of the end – therefore no pressure built up inside the hose. Once the spray nozzle was in place, the water had nowhere to drain, causing pressure to build up inside the hose and making the aneurysm bulge. Think about the human body. Higher blood pressure puts more pressure on aneurysm walls. Therefore, it’s a good idea to keep your blood pressure down with aneurysms. Blood vessels have many layers. Because arteries are under higher pressure than veins, arteries have more layers of reinforcement. See the picture above which was originally posted on Wikipedia. Note how there are more layers in the artery and how the smooth muscle layers are thicker than in the veins? Just like layers of clothing in the winter help to keep in warmth, layers in blood vessel walls help to maintain the blood vessel’s strength. There are two basic types of aneurysms. Fusiform aneurysms are similar to what happens when you partially inflate a “twisty balloon”. Fusiform aneurysms involve the entire diameter of the blood vessel. Berry or saccular aneurysms involve a bulge in the side of a blood vessel or can also occur where a blood vessel divides (often in the brain). Our hose had a berry aneurysm. Now here’s the cool part of the hose analogy (click on the pictures to enlarge). Note the yellow nylon coating ...Read More »