Aneurysm of the abdominal aorta: symptoms, diagnosis, treatment

The aorta is the largest unpaired artery. It belongs to a large range of blood circulation and nourishes all the organs of our body with blood. The aorta is divided into 3 divisions and 2 parts - the 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 the enlargement or protrusion of the aorta. This disease is still the basis of many discussions, because doctors can not come to a unanimous opinion which degree of expansion of the vascular wall can be diagnosed as an aneurysm. Earlier, the diagnosis was confirmed with augmentation of the aorta by 2 times or with the expansion of its diameter 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 vague enough. Therefore, in 1991, due to the research of American scientists aneurysm, the pathological expansion of the aortic lumen was considered to be 50% larger than its normal diameter. But this definition remains rather arbitrary.

This issue becomes especially important whenthe choice of tactics of surgical intervention, however, alas, is still open. Meanwhile, about 15,000 Americans die annually from an aneurysm. In most cases, it simply does not have time to diagnose it.

Which doctor deals with aneurysm?

This disease is treated by a vascular surgeon, sincethe main treatment of the problem is operational. If the operation is not indicated, the patient should be observed at the therapist, cardiologist or internist (specialist in internal diseases), closely monitor their condition. An aneurysm is cunning enough, it can start to grow suddenly, increasing the risk of its most serious complication - the rupture.

Who is at risk?

Aneurysm is diagnosed in both men and women.women (in the latter, however, much less often). However, it is noted that in men older than 65 years, it occurs more often. In many respects this is due to the passion of many for smoking, which is especially harmful in old age.

So, the risk group includes:

• people with hypertension;
• smokers;
• persons whose family has already been diagnosed with an aneurysm of the abdominal aorta or other cardiovascular diseases and / or peripheral circulation pathologies;
• owners of excess weight and people leading a sedentary lifestyle.

Attention! As research proves, many aneurysms are inherited from ancestors.

Types of aneurysms of the abdominal aorta: classification

Aneurysm of the abdominal aorta is divided into several species depending on its shape, localization and pathological features:

1. Saciform (resembles a sac, which is connected through the cervix with the aortic lumen).
2. Spindle-shaped. In form it resembles a spindle that connects through the aperture with the aortic lumen. The most common form of aneurysm.

On the pathological features the following types of aneurysms are distinguished:

1. True. The wall of the vessel is expanded, since it is formed from a multitude of layers of the aorta.
2. Pseudoaneurysm. Appears after injury due to the development of pulsating hematoma.
3. Overlapping. That is, its walls are stratified and the cavities are filled with an intramural hematoma that connects to the aortic lumen through the wall of the damaged vascular tissue.

There are also localization:

1. An aneurysm of the infrarenal abdominal aorta is located above / below the renal artery branch.
2. Suprarenal is above the branching of the arteries
3. A total aneurysm spreads along the entire length of the vessel.

What are the causes of an aneurysm?

• Atherosclerosis, in which the vascular wallbecomes thick and loses elasticity, and on its walls fat forms in the form of atherosclerotic plaques. The composition of plaques includes harmful cholesterol and other fats. While the doctors did not fully determine how atherosclerosis affects the development of an aneurysm, it is assumed that as a result of this disease blood circulation disorders appear in the vessel and the delivery of nutrients ceases. As a result, vascular tissue is damaged, followed by its cleavage. As a result, the diagnosis is made of an aneurysm of the abdominal aorta.
• Diabetes mellitus, which "loves" to hit the blood vessels. It is often accompanied by retinopathy, nephropathy, aneurysm.
• Genetics. At some congenital syndromes (Ehlers - Danlos, Marfan, cystic medoneecrosis of Erdheim, etc.) arteries suffer, including abdominal aorta. 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 (endocard), - syphilis, ectocarditis, salmonellosis, etc.
• Injuries received in the abdomen. For example, with a strong impact in the chest or abdomen, the aorta can be affected.
• Inflammatory processes. Nonspecific aortoarteritis, for example, causes weakening of the aortic wall. True, there is no specific information on this issue yet. But non-inflammatory diseases of the vascular wall often arise because of atherosclerotic plaques.

In general, the most common cause of aneurysm developmentbecome smoking, inactivity and age. It is extremely important to diagnose it in time. Aneurysms of the thoracic and abdominal parts of the aorta have a different symptomatology, which we will now consider.

What are the symptoms of the abdominal aorta aneurysm?

Most often an aneurysm does not make itself felt at alland is diagnosed quite accidentally during the examination. Since it displaces organs, violating their vital functions, the diagnosis can be made incorrectly, therefore it is extremely important to conduct ultrasound of the abdominal cavity. Doctors say that thoracic aneurysm is especially "secretive". It may not manifest at all or cause chest pain, coughing and shortness of breath. In case of its increase, the urgency acquires an aneurysm of the abdominal aorta.

Of the few symptoms of aneurysm, several are isolated, which occur together or separately:

1. Heaviness in the abdomen, unpleasant sensation of raspiraniya and pulse, which resembles an intensified heart rhythm.
2. Pain in the abdomen, acute, rather, aching, dull. It is located directly in the navel or to the left of it.

And indirect signs makes itself feltabdominal aortic aneurysm. Symptoms of it 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 work of various organs and systems. As a result, it can be confused with renal colic, pancreatitis or radiculitis.

Ischioradicular syndrome causes pain in the lower back (in particular, the lower back) and a violation of sensitivity in the legs along with a disorder of movement.

Abdominal syndrome is manifested by vomiting, eructation, diarrhea or constipation, as well as lack of appetite, which entails weight loss.

Chronic ischemia of the legs is expressed in violation of blood circulation (cold feet), muscle pain during walking and at rest, periodic lameness.

Urological sidromo informs about itself by infringements of an emiction, a pain, sensation of gravity in a loin and even occurrence in urine of erythrocytes.

The rupture of the aneurysm of the abdominal aorta beginswith increased soreness in the abdomen, general weakness and dizziness. Sometimes pain gives in the lower back, groin or crotch. In this case, the patient needs immediate medical attention, since 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 thick stomach. When the aneurysm of the abdominal aorta is ruptured, its symptoms may be accompanied by nausea and vomiting. In the left region of the abdomen, the formation is slowly palpable, with a large increase and a strong pulsation. Its borders are not probed.

When the aneurysm ruptures, the symptoms are very bright, but they are easily confused with other dangerous health conditions, so for any acute pain in the abdomen or chest, always call for an ambulance.

Diagnosis of the disease

The first diagnostic stage is examination by a doctor,which, when palpated, feels a strong pulsation in the abdominal region, this is an aneurysm of the abdominal aorta. Diagnosis of it includes research that allows you to visualize what is happening in the abdominal cavity. First of all, this is ultrasound, as well as computed tomography (CT) and multispiral computed tomography of the aorta (MSCT).

If an abdominal aneurysm is suspectedaorta, ultrasound makes it possible to confirm its presence with almost absolute certainty. It shows the exact localization of the aneurysm, the state of the vascular wall, the place of rupture, if it occurs.

CT or MSCT is performed to identify calcification, stratification, intramuscular thrombosis, a threat of rupture or an existing rupture.

If the above diagnosticStudies do not allow you to accurately diagnose (although this happens 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 a lesion of the visceral and renal arteries, the state of the distal blood channel is unknown.

Complications of an aneurysm of the abdominal aorta

This condition is dangerous not only for health, but for life. First of all, the aorta can cause embolism (blockage) of the arteries, infectious complications, develop heart failure.

Stomach aneurysm of the abdominal aorta -a dangerous complication, which consists in its rupture and the ingress of blood into the layers of the vascular body. If all 3 layers are exfoliated and the aorta breaks completely, intensive blood loss occurs.

But, of course, the most terrible complication of an aneurysmIs its rupture. Many patients with untreated aneurysm die within 5 years. Before the rupture, a person feels a strong pain in the lower abdomen and in the lower back. If the aneurysm of the abdominal aorta is torn, the course of the disease is characterized by profuse bleeding, which leads to shock and death. Therefore, if you have acute pain in the abdomen and chest area, be sure to call an ambulance, as it is dangerous to delay. As the statistics show, only 3% of patients die right after the aortic rupture, others live from 6 hours to 3 months. In most cases, they die within a day. How is the aneurysm treated? Consider below.

Treatment of an aneurysm of the abdominal aorta

Many mistakenly believe that with the diagnosis of an aneurysm of the abdominal aorta, treatment can only be surgical. In fact, everything is individual here.

If the aneurysm does not reach a diameter of 4.5 cm, thenthe operation is not shown, because it itself can carry a greater risk to life than the larger vessel itself. Usually this trend is observed in elderly men who suffer from concomitant diseases and in addition do not stop smoking (and with such a diagnosis it is simply necessary to stop smoking!). Waiting tactics are preferred for them, because the risk of aortic rupture at this diameter is only about 3% per year. In this case, every six months the patient is forced to do ultrasound to determine the size of the aorta. If the vascular wall gradually expands, then this is the main indication for the operation, because the probability of its rupture increases by 50%.

People of advanced age who have been identifiedAneurysm of the abdominal aorta, it is desirable to carry out the treatment with the help of an endovascular, minimally invasive method. During the operation, the patient is injected into the artery with a catheter through which the stent enters. Once in the aorta, it opens and clasps the artery, thereby replacing the affected area of ​​her body. The benefits of surgery include easier tolerability and a small recovery period - only a few days. But this method has its own nuances, that's why it is not carried out by everyone. The main drawback of this operation is that in 10% of cases there is a distal migration of the installed stand.

If the diagnosis is made of an aneurysm of the abdominal partaorta, the operation is often open.In this process, the affected area of ​​the aorta is removed and replaced with a denture made of dacron (a synthetic polyester-based fabric) .In order to provide access to the aorta, a medial laparotomy is used.The duration of the operation is usually about 2-3 hours After surgery there is a noticeable scar.

The patient is recovered for about two weeks. The resumption of labor in some cases is possible only after 4-10 weeks. The patient is categorically banned from physical activities, shows rest and walks.

Contraindications for an open surgery

Surgical intervention is prohibited under the following conditions:

• Recently suffered heart attack (not less than a month).
• Cardiac and pulmonary insufficiency.
• Renal failure.
• Affected iliac and femoral arteries.

Rehabilitation period after surgery

Certainly, for the presence of complications after surgeryage and concomitant diseases of the patient. Also, the patient's condition may worsen if his body is already weakened (HIV, onco, diabetes), obesity and heart disease take place. Moreover, a pre-planned operation gives the patient a better chance of surviving and recovering than an emergency intervention in rupturing the aortic aneurysm.

Complications can manifest as a reaction to a commonanesthesia, which is not tolerated by all, the development of infection, damage to internal organs and bleeding. In very few cases, the operation ends in a fatal outcome.

If surgery is planned, doctors recommenda week before it to stop taking medications that dilute the blood, and anti-inflammatory drugs (aspirin, etc.). Be sure to inform your doctor about what medicines you are taking at the moment, before the operation.

The risk of relapse is extremely small, but if a personsuddenly begins to disturb the pain in the back or abdomen, nausea, vomiting, numbness of the legs or general poor health, it is worth immediately contacting the doctor.

Prevention of aneurysm

Aneurysm of the abdominal aorta will arise in you withless likely, if you refuse (and ideally do not get this habit) from smoking, you will control the pressure and your weight. It is also important to lead an active and healthy lifestyle. Be healthy!