Aneurysm is an enlargement of a vessel that is more than twice its normal diameter. More than 60% of all aneurysms are located in the abdominal aorta. This pathology occurs more often in people suffering from rheumatism, aortoarteritis, syphilis, atherosclerosis, and tuberculosis. A common cause of an aneurysm is abdominal trauma, aortic surgery.
Mechanism of occurrence
The occurrence of expansion is associated with degenerative changes in the elastic framework of the aorta. With an increase in resistance in the distal arteries, pressure in the abdominal aorta increases. In the absence of the ability of the vessel to withstand increased pressure, its expansion occurs in a particular place. An aneurysm is a part of the aorta with turbulent blood flow, in which blood clots often form.
Clinic
With a small diameter aneurysm (less than 20% of cases), an asymptomatic course is possible. In other cases, all clinical signs of an aneurysm are divided into typical and indirect. Typical: pulsating formation in the abdomen, pain, noise during heart contraction over the aneurysm. Pain may resemble hepatic or renal colic, localized to the left of the navel, may radiate to the back or lower back.
Indirect signs
- Abdominal syndrome: nausea, vomiting, lack of appetite, weight loss.
- Urological syndrome: hematuria, dysuric disorders.
- Ischioradicular syndrome: low back pain, motor and sensory disorders in the legs.
- Chronic leg ischemia syndrome: intermittent claudication, trophic changes.
Aneurysm is a progressive disease. More than half of patients die within 2 years of diagnosis from complications.
Diagnosis
Ultrasound examination allows you to establish the location and size of education. On the monitor, an aneurysm is a rounded expansion of a vessel with clear contours, parietal overlays and slow turbulent blood flow. Angiography reveals an enlarged aorta. On a survey X-ray image of the abdominal organs, dilated contours of the aorta with deposition of calcifications are visible, often accompanied by impressions on the vertebrae - usura. CT shows a round formation with clear contours, thin walls, parietal thrombi and calcifications.
Treatment
Aneurysm is a disease in which in the vast majority of cases surgical intervention is performed, which is associated with a high probability of complications. The operation is contraindicated in patients who have suffered an acute myocardial infarction, have a history of circulatory failure, stroke.
Surgery
There are various options for surgical treatment:
- removal of the aneurysm along with the aneurysmal sac, aortic replacement or bypass;
- bagless aneurysm removal with intrapouch prosthesis.
Prosthetics are often accompanied by aortofemoral prosthetics. Mortality after the intervention does not exceed 10%. With a high risk of surgery, aortic stenting is performed: passing a self-expanding prosthesis through the femoral artery.
Complicated aneurysm
The consequences of an aneurysm directly depend on its size: the larger it is, the more likely it is to dissection or rupture.
