An aneurysm is a ballooning or bulging that forms in the wall of an artery. This condition develops when a section of the arterial wall becomes weakened, allowing the continuous force of blood flow to push the area outward. If the wall stretches too far, it risks rupturing, which can lead to life-threatening internal bleeding or a hemorrhagic stroke. Because of the serious consequences of a rupture, patients often wonder if this weakened structure can heal and disappear naturally.
What Exactly Is an Aneurysm?
Aneurysms are classified based on their shape and location. The two primary shapes are saccular and fusiform. A saccular aneurysm, often called a berry aneurysm, is a rounded, blood-filled sac that protrudes from one side of the artery. In contrast, a fusiform aneurysm involves a uniform bulging or dilation that affects the entire circumference of a blood vessel.
Aneurysms can form in any artery, but they are most frequently found in the brain (cerebral aneurysms) and in the body’s largest artery, the aorta. When located in the aorta, they are termed aortic aneurysms, most commonly occurring in the abdominal area.
The Likelihood of Natural Resolution
The straightforward answer to whether an aneurysm can resolve on its own is generally no; these structural defects typically persist or slowly expand over time. This weakness is a fundamental structural flaw that the body cannot easily repair or reverse once the ballooning has begun. The continuous pressure exerted by blood flow, known as hemodynamic stress, constantly pushes against the thinned wall, promoting further expansion. While some rare types of aneurysms related to infection or trauma may spontaneously thrombose (clot off), most true saccular and fusiform aneurysms remain permanent. The medical focus is therefore on observation or intervention to prevent continued growth and rupture.
Monitoring and Management of Stable Aneurysms
When a small or stable aneurysm is discovered incidentally, a strategy of watchful waiting, or surveillance, is often recommended instead of immediate intervention. This management approach relies on regular, non-invasive imaging techniques, such as computed tomography (CT) or magnetic resonance imaging (MRI) scans, to monitor the aneurysm’s size and shape over time. The primary goal of surveillance is to prevent growth and reduce the risk of rupture by managing modifiable health factors. Controlling high blood pressure (hypertension) is the most significant step, as it directly reduces the force pushing against the weakened arterial wall. Patients are typically prescribed medications to keep their blood pressure within a target range to minimize hemodynamic stress.
Lifestyle modifications are also strongly emphasized, particularly smoking cessation, which is a major contributor to arterial wall degradation and aneurysm growth. Additionally, managing high cholesterol and other cardiovascular risk factors helps maintain the overall health of the remaining blood vessel walls. Surveillance imaging is typically performed periodically, often annually, to detect any measurable change that might signal an increased rupture risk and necessitate active treatment.
Medical Interventions for Aneurysms
When an aneurysm is determined to be at a high risk of rupture due to its size, location, or growth rate, active medical intervention is necessary to secure the weakened vessel. These interventions fall into two main categories: open surgical repair and minimally invasive endovascular procedures. The choice between them depends on the aneurysm’s specific characteristics and the patient’s overall health profile. Open surgical repair for a cerebral aneurysm involves microsurgical clipping, where a permanent titanium clip is placed across the neck of the aneurysm to isolate the sac from circulation. For aortic aneurysms, open surgery typically involves replacing the weakened segment of the aorta with a synthetic graft.
Minimally invasive endovascular techniques offer a less invasive alternative, performed from inside the blood vessel using a catheter inserted through an artery, usually in the groin. Endovascular coiling involves packing the aneurysm sac with soft, platinum coils, which promotes clotting and seals the aneurysm off from the bloodstream. Another endovascular technique is flow diversion, which utilizes a mesh stent placed in the parent artery to redirect blood flow away from the aneurysm opening, eventually causing the sac to thrombose and shrink.