Aneurysm

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An aneurysm is an abnormal focal dilatation of an artery, the main complications being rupture and predisposition to thrombosis.
Although it is the most frequent cause, atherosclerosis is not the only disease that produces aneurysms; any abnormality that weakens the media may produce an aneurysm, although permanent or transient hypertension is also an important factor in their enlargement and rupture

'Dissecting aneurysm' is not a true aneurysm

In dissecting aneurysm, a tear in the intima leads to tracking of blood into the arterial media, which splits.
The most common site for this is the aorta, where the split forms a false channel, usually between the inner two-thirds and outer third of the medial thickness.

Among the predisposing factors are hypertension, present in 70% of cases, and degenerative changes in the aortic media (medial mucoid degeneration), which sometimes arise as part of a recognized hereditary disorder of support tissues, e.g. Marfan's syndrome due to defective fibrillin, and Ehlers-Danlos syndrome.
Atherosclerosis is also a predisposing factor, the original intimal tear occasionally occurring at the edge of an atheromatous plaque.
This pattern is particularly important in the distal aorta.

Dissection due to instrumentation of an artery wall is a rare complication of arterial puncture or cannulation.
It often heals spontaneously without rupture, since the medial wall is usually healthy, limiting the extent of blood tracking.

External rupture, usually lower down the thoracic aorta, with massive fatal haemorrhage into the thoracic cavity.
Retrograde spread (back towards the heart) with rupture into the pericardial cavity, with fatal haemopericardium.
Internal rupture, with blood tracking back into the lumen by rupturing through the inner media and intima, to produce a double-barelled aorta. This is rare.

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