The aorta is the largest unpaired artery. It belongs to a large circle of blood circulation and nourishes all organs of our body with blood. The aorta is divided into 3 sections and 2 parts - abdominal and thoracic. Most often (in 95% of cases) there is an aneurysm of the abdominal aorta, which we will talk about today.
Aneurysm is an enlargement or protrusion of the aorta. This disease is still the basis of many discussions, because doctors cannot agree on what degree of expansion of the vascular wall can be diagnosed as an aneurysm. Previously, the diagnosis was confirmed when the aorta was enlarged by 2 times or when its diameter expanded by more than 3 cm. But given that the aorta has a diameter of 15 to 32 cm, the concept of "more than 3 cm" is clearly quite vague. Therefore, in 1991, thanks to a study by American scientists, an aneurysm began to be considered a pathological expansion of the aortic lumen by 50% more than its normal diameter. But this toothe definition remains rather arbitrary.
This question becomes especially important when choosing the tactics of surgical intervention, however, alas, it still remains open. Meanwhile, about 15,000 Americans die every year from aneurysms. In most cases, they simply do not have time to diagnose it.
Which doctor treats an aneurysm?
This disease is treated by a vascular surgeon, since the main treatment of the problem is operative. If the operation is not indicated, the patient should be observed by a general practitioner, cardiologist or internist (specialist in internal medicine), carefully monitor their condition. An aneurysm is insidious enough that it can begin to grow suddenly, increasing the risk of its most serious complication - rupture.
Who is at risk?
Aneurysm is diagnosed in both men and women (in the latter, however, much less frequently). However, it has been observed that in men over 65 years of age, it occurs more often. This is largely due to the passion of many for smoking, which is especially detrimental in old age.
So, the risk group includes:
- people suffering from arterial hypertension;
- smokers;
- individuals in whose family an aneurysm of the abdominal aorta or other cardiovascular diseases and / or pathologies of the peripheral circulation have already been diagnosed;
- overweight and sedentary.
Attention! Studies show that many aneurysms are inherited from ancestors.
Types of abdominal aortic aneurysms: classification
Aneurysm of the abdominal aorta is divided into several types depending on its shape, localization and pathological features:
- Saccular (resembles a sac that is connected through the neck to the lumen of the aorta).
- Spindle. The shape resembles a spindle, which through the hole is connected to the lumen of the aorta. The most common form of aneurysm.
According to pathological features, the following types of aneurysms are distinguished:
- True. Its vessel wall is expanded, as it is formed from many layers of the aorta.
- Pseudoaneurysm. Appears after an injury due to the development of a pulsating hematoma.
- Exfoliating. That is, its walls are stratified, and the cavities are filled with an intramural hematoma, which is connected to the aortic lumen through the wall of the damaged vascular tissue.
It is also distinguished by localization:
- Infrarenal abdominal aortic aneurysm is located above/below a branch of the renal arteries.
- Suprarenal is located above the branching of the arteries
- Total aneurysm is spreading along the entire length of the vessel.
What causes an aneurysm?
- Atherosclerosis, in which the vascular wall becomes thick and loses elasticity, and fat forms on its walls in the form of atherosclerotic plaques. Plaque contains bad cholesterol and other fats. While doctors have not fully determined exactly how atherosclerosis affectsthe development of an aneurysm, but it is assumed that as a result of this disease, circulatory disorders appear in the vessel and the supply of nutrients stops. As a result, the vascular tissue is damaged, followed by its splitting. As a result, a diagnosis of "abdominal aortic aneurysm" is made.
- Diabetes mellitus, which "likes" to hit the blood arteries. It is often accompanied by retinopathy, nephropathy, aneurysm.
- Genetics. In some congenital syndromes (Ehlers-Danlos, Marfan, Erdheim's cystic medial necrosis, etc.), arteries, including the abdominal aorta, suffer. It is often possible to trace the relationship between an aneurysm of the abdominal aorta and genetic diseases.
- Infectious diseases. These include diseases that affect the inner layer of the heart (endocart) - syphilis, ecdocarditis, salmonellosis, etc.
- Injuries received in the abdomen. For example, with a strong blow to the chest or abdomen, the aorta may be affected.
- Inflammatory processes. Nonspecific aortoarteritis, for example, causes a weakening of the aortic wall. True, there is no specific information on this issue yet. But non-inflammatory diseases of the vascular wall often occur due to atherosclerotic plaques.
In general, smoking, physical inactivity and age are the most common causes of aneurysm. It is extremely important to diagnose it in time. Thoracic and abdominal aortic aneurysms have different symptoms, which we will now consider.
What aresymptoms of an abdominal aortic aneurysm?
Most often, an aneurysm does not make itself felt at all and is diagnosed quite by accident during the examination. Since it displaces the organs, disrupting their vital functions, the diagnosis can be made incorrectly, therefore it is extremely important to conduct an ultrasound of the abdominal cavity. Doctors note that the aneurysm of the thoracic region is especially “secret”. It may not appear at all, or it may cause chest pain, coughing, and shortness of breath. In the case of its increase, an aneurysm of the abdominal aorta becomes relevant.
From the few symptoms of an aneurysm, there are several that occur together or separately:
- Heaviness in the abdomen, an unpleasant feeling of fullness and a pulse that resembles an increased heart rate.
- Pain in the abdomen, not acute, rather, aching, dull character. It is localized directly in the navel or to the left of it.
And by indirect signs, an aneurysm of the abdominal aorta makes itself felt. Its symptoms are so different that it is very difficult to suspect a true problem in them. This is due to the fact that a growing aneurysm can disrupt the functioning of various organs and systems. As a result, it can be confused with renal colic, pancreatitis, or sciatica.
Ischioradicular syndrome causes pain in the lower back (particularly the lower back) and loss of sensation in the legs, along with impaired movement.
Abdominal syndrome is manifested by vomiting, belching, diarrhea or constipation, as well as the absenceappetite, resulting in weight loss.
Chronic ischemia of the legs is expressed in circulatory disorders (cold feet), muscle pain during walking and at rest, periodic lameness.
Urological syndrome reports itself with urination disorders, pain, a feeling of heaviness in the lower back and even the appearance of red blood cells in the urine.
A ruptured abdominal aortic aneurysm begins with increased abdominal pain, general weakness, and dizziness. Sometimes the pain radiates to the lower back, groin or perineum. In this case, the patient needs immediate medical attention, as the condition is fraught with death. Often an aneurysm breaks into the middle section of the small intestine, stomach or duodenum, less often into the large stomach. When an abdominal aortic aneurysm ruptures, symptoms may be accompanied by nausea and vomiting. In the left abdomen, a formation is palpable, slowly increasing and with a strong pulsation. Its borders are not felt.
When an aneurysm ruptures, the symptoms are very bright, but they can be easily confused with other he alth-threatening conditions, so for any acute pain in the abdomen or chest, be sure to call an ambulance.
Diagnosis of disease
The first diagnostic stage is an examination by a doctor, who, on palpation, feels a strong pulsation in the abdomen, this is an aneurysm of the abdominal aorta. Its diagnosis includes studies that allow you to visualize what is happening in the abdominal cavity. First of all, it is an ultrasound, as well ascomputed tomography (CT) and multispiral computed tomography of the aorta (MSCT).
If an abdominal aortic aneurysm is suspected, ultrasound makes it possible to confirm its presence with almost one hundred percent certainty. It shows the exact location of the aneurysm, the condition of the vascular wall, the location of the rupture, if any.
CT scan or MSCT is performed to detect calcification, dissection, intrasaccular thrombosis, threatened rupture or existing rupture.
In the event that the above diagnostic studies do not allow an accurate diagnosis (although this happens quite rarely), aortography is prescribed. The method allows real-time examination of the aorta and its branches by introducing a special liquid into the vessel. It is shown in the event that there is a suspicion of damage to the visceral and renal arteries, the state of the distal bloodstream is unknown.
Complications of abdominal aortic aneurysm
This condition is dangerous not only for he alth, but also for life. First of all, the aorta can cause embolism (blockage) of the arteries, infectious complications, and develop heart failure.
Dissecting aneurysm of the abdominal aorta is a dangerous complication, which consists in its rupture and blood entering the layers of the vascular body. If all 3 layers are stratified and the aorta breaks completely, intense blood loss occurs.
But, of course, the worst complication of an aneurysm is its rupture. Many patients with untreated aneurysms die within 5 years. Before the break, a person feels severe pain belowabdomen and in the lumbar region. If the aneurysm of the abdominal aorta is ruptured, the course of the disease is characterized by profuse bleeding, which leads to shock and death. Therefore, with acute pain in the abdomen and chest, be sure to call an ambulance, as it is dangerous to delay. As statistics show, only 3% of patients die immediately after aortic rupture, while others live from 6 hours to 3 months. In most cases, they die within a day. How are aneurysms treated? Consider below.
Treatment of abdominal aortic aneurysm
Many mistakenly believe that the diagnosis of "abdominal aortic aneurysm" treatment can only be surgical. In fact, everything here is individual.
If the aneurysm does not reach a diameter of 4.5 cm, then the operation is not indicated, because it itself can carry a greater risk to life than the enlarged vessel itself. Usually this trend is observed in older men who suffer from comorbidities and, in addition, do not stop smoking (and with such a diagnosis, it is simply necessary to stop smoking!). For them, expectant management is preferable, because the risk of aortic rupture with this diameter is only about 3% per year. In this case, every six months the patient is forced to do an ultrasound in order to find out the size of the aorta. If the vascular wall gradually expands, then this is the main indication for surgery, because the probability of its rupture increases by 50%.
Elderly people who have been diagnosedaneurysm of the abdominal aorta, treatment is preferably carried out using an endovascular, minimally invasive method. During the operation, a catheter is inserted into the patient's artery, through which the stent enters. Once in the aorta, it opens and clasps the artery, thereby replacing the affected area of her body. The advantages of the operation include easier tolerance and a short recovery period - only a few days. But this method also has its own nuances, therefore it is not carried out by everyone. The main drawback of this operation is that in 10% of cases, distal migration of the installed stand is noted.
When an abdominal aortic aneurysm is diagnosed, surgery is often open. During the procedure, the affected area of the aorta is removed and replaced with a prosthesis made of Dacron (polyester-based synthetic fabric). In order to provide access to the aorta, a median laparotomy is used. The duration of the operation is usually about 2-3 hours. After surgery, a noticeable scar remains.
The patient recovers in about two weeks. The resumption of labor activity in some cases is possible only after 4-10 weeks. The patient is strictly prohibited from physical activity, rest and walks are shown.
Contraindications for open surgery
Surgical intervention is prohibited under the following conditions:
- Recent heart attack (at least a month).
- Heart and lung failure.
- Renalfailure.
- Affected iliac and femoral arteries.
Rehabilitation period after surgery
Of course, the presence of complications after surgery is affected by the age and concomitant diseases of the patient. Also, the patient's condition may worsen if his body is already weakened (HIV, cancer, diabetes), obesity and heart disease occur. Moreover, a pre-planned operation gives the patient a better chance of survival and recovery than an emergency intervention for a ruptured aortic aneurysm.
Complications can occur as a reaction to general anesthesia, which not everyone tolerates, the development of infection, damage to internal organs and bleeding. In a very small number of cases, the operation ends in death.
If an operation is planned, doctors recommend stopping blood thinners and anti-inflammatory drugs (aspirin, etc.) a week before the operation. Be sure to tell your doctor what medications you are currently taking before your surgery.
The risk of recurrence is extremely low, but if a person suddenly begins to worry about pain in the back or abdomen, nausea, vomiting, numbness in the legs or general feeling unwell, you should immediately consult a doctor.
Aneurysm prevention
Abdominal aortic aneurysm is less likely to occur if you refuse (and ideally do not acquire this habit at all) from smoking, control your blood pressure and your weight. It is also important to lead an active and he althy lifestyle. Stay he althy!
