The danger of any aortic aneurysms is that it can happen that the bundle or even rupture, which leads to massive internal bleeding and death.
Aneurysm may promote the formation of bloodclots, which are carried by the flow of bloodthrough the body, getting into other organs,clog blood vessels, causing severe pain, impairedblood flow and necrosis.
Classification according to the aorta
Aneurysm abdominal aorta (suprarenal orinfrarenal torakoabdominalnye and the upper and lower parts of the abdominal aorta)
Aneurysm thoracic aorta - 25% (aneurysm of ascending part, the aortic arch and descending aorta)
The shape of an aortic aneurysm
Saccular - there is a local protrusion of the aortic wall, extending not more than half the diameter of the aorta.
Fusiform - aorta expands at a certain level over the entire circumference.
Exfoliating - formed by laceration of the intima and internal elastic membrane.
Depending on the structure of the wall of the aneurysm of the aorta
True - formed by protrusions affected by the pathological process of the aortic wall and its walls consist of the same layers as the wall of the aorta itself.
Misleading - is a limited scar tissue cavity communicating with the lumen of the aorta.
Risk Factors:
obesity
High blood pressure
smoking
Existence direct relative (mother, brother), ailing aortic aneurysm
Age older than 60 years, especially in men
In some diseases:
Marfan syndrome
syphilis
tuberculosis
Risk of aortic aneurysm increases with age. Aortic aneurysm is more common in men. The larger the aneurysm, the faster it grows and the higher the probability of rupture.
Diagnostics
Chest X-ray
Cardiac ultrasound (sonography)
Magnetic resonance imaging
computed tomography
angiography
Ultrasound duplex or triplex scanning of abdominal aortic
Aneurysm of the thoracic aorta
Symptoms in patients with aneurysms of the thoracic aortic aneurysm depends on the location, its size, the presence of the bundle.
Pain in the lower jaw, neck and upper back
Chest pain, localized in the upper half of the chest, are characterized by gradual onset, slowly subsided and the lack of a pronounced effect after application of nitroglycerin
Cough, hoarseness, difficulty breathing, shortness of breath
with significant amounts aneurysm can privesti to the development of congestive heart failure
breathing may be obstructive, especially with the patient on his back when the aneurysm heavily compresses theairways. This causes patients to take a forced posture - a high position in bed on his side
dysphagia (difficulty swallowing) associated with compression of the esophagus
Symptoms bundle aneurysm of the thoracic aorta can occur suddenly, usually severe burning pain in the chest, radiating to the back.
The risk of rupture increases when the size of the aneurysm is twice the diameter of the normal aorta.
Abdominal aortic aneurysm
Under the abdominal aortic aneurysm understand the increase in diameter of the aorta more than doubled in comparisonwith the norm or local bulging of its walls.
The diameter of the normal aorta is approximately 2 cm on the share of atherosclerotic aneurysms account for 96% of the total number of abdominal aortic aneurysms, most often they are located below the renal arteries and have a spindle shape.
Evidence
- Epigastric pain in the navel and left due to the pressure of the aneurysm on the nerve roots and plexus located in the immediate vicinity of the abdominal aorta
- The presence of a pulsating tumor formation in the abdomen, usually located slightly to the left midline
- Above the aneurysm bugged distinct systolic murmur, which takes place on the femoral artery
- Ishioradikulyarny syndrome, which is manifested by pain, back pain, impaired sensation and movement disorders in the lower extremities
- Abdominalny Sintra, which manifests the appearance of belching, vomiting, constipation or unstable stool, lack of appetite and weight loss
- Urological syndrome, which is manifested by pain and the severity of back pain, impaired urination, blood in urine
- Cindrom chronic lower limb ischemia. Manifested in the appearance of pain in the muscles of the lower limbs when walking, sometimes alone, cooling the skin of the lower limbs.
Harbingers gap
increasing pain in the abdomen
severe weakness, dizziness
Metody aortic aneurysm treatment in Germany
If the size of the aneurysm less than 4.5 cm in diameter is greater than the risk of surgery, the risk of rupture. With a diameter of more than 5 cm aneurysm surgery is becoming the preferred, since an increase in the size of the aneurysmincreases the risk of aneurysm rupture.
Under the surgical treatment of aortic aneurysms understood its excision and replacement remote (aneurysmal) aortasynthetic prosthesis. Surgical treatment is aimed at preventing life-threatening complications.
The average mortality rate for open interventions range from 3-5%, but may be higher when involved in renal aneurysmand / or iliac arteries, as well as by virtue of existing patient comorbidities.
The risk of complications during surgery increased in the following comorbidities:
congestive heart failure
diabetes mellitus
chronic obstructive pulmonary disease, when there are violations of pulmonary ventilation
angina
Complications after surgery for aortic aneurysm:
cardiac complications
lung complications
complications of renal
complications of the bowel
Infectious complications of the surgical wound
urinary tract infection and lung
very rarely due to the spread of blood clots in the vessels of the surgical site may be stroke and paralysis.
retrograde ejaculation (men), when the sperm on deferens goes back to the seminal vesicles.
All these complications are associated mainly with emergency interventions aneurysm.
Open surgery - resection of the aneurysm with subsequent prosthetic its synthetic prosthesis
Endovascular aortic
Endoprosthesis aorta is a modern alternative to open intervention. The operation is performed through small incisions /punctures in the groin area. This technique reduces the incidence of early complications, shorten the time of hospital stayand reduce the mortality rate of 1-2%.
Observation in the postoperative period is performed every 4-6 months using ultrasonic techniques, CT angiography,rentgenkontratnoy angiography. Endovascular treatment is certainly less traumatic.
Stenting - a modern method of treating aortic aneurysm stenting. This type of operation is minimally invasive.Rehabilitation period after this type of operation only 2 - 3 days. This method is not applicable if there is renal failure.
Aortic dissection (dissecting) - aortic rupture, which leads to the fact that the blood flows into between layers of the wallof the aorta and stratifies on. If the bundle breaks aortic wall completely (all three layers), then there is a rapid blood loss.In over 90% of cases this leads to death, even if the correct treatment time started.
Depending on the factors listed above pain may be localized or radiate to the chest, arms, neck, back, abdomen, waist, legs. Characterized by the most severe pain (tearing, burning, tearing, pressing), leading to motor stimulation. Fainting is possible in case of damage to the brain outgoing vessels or in connection with anemizatsiey. Cyanosis of the upper half of the body is possible in connection with hemopericardium. In the initial period possible aetiology in the stimulation of depressor nerves in laceration of the intima, internal bleeding occurs when it is replaced by tachycardia.
Increasing throbbing abdominal swelling characteristic of dissecting aneurysm of the abdominal aorta. In the initialperiod of the disease, regardless of the signs of peripheral circulatory failure (pallor, cold sweat) may be an increase in A /D.
Emergency
analgesia
Emergency surgery
Occlusive disease of aortic arch branches accompanied by cerebral ischemia, eyes, upper limbs.
