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 an extension 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 2 times or with the expansion of its diameter more than 3 cm. But taking into account the fact 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 study of American scientists aneurysm, the pathological expansion of the aortic lumen was considered to be 50% greater than its normal diameter. But this definition remains rather arbitrary.

This issue becomes especially important when choosing tactics for surgical intervention, but, alas, it is still open. Meanwhile, about 15,000 Americans die each year 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, since the main treatment for the problem is prompt. If the operation is not indicated, the patient should be observed by the therapist, cardiologist or internist (specialist in internal diseases), carefully monitor their condition. An aneurysm is cunning enough, it can start to grow suddenly, increasing the risk of its most serious complication - a rupture.

Who is at risk?

Aneurysm is diagnosed in both men and women (in the latter, however, much less often). However, it is noted 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 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 pathologies of peripheral circulation;
• Overweight and people leading a sedentary lifestyle.

Attention! As studies prove, 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. The shape 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 located above the branching of the arteries
3. A total aneurysm creeps along the entire length of the vessel.

What are the causes of an aneurysm?

• Atherosclerosis, in which the vascular wall becomes thick and loses its elasticity, and its walls form fat 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 supply of nutrients ceases. As a result, vascular tissue is damaged, followed by its cleavage. As a result, a 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. With some congenital syndromes (Ehlers - Danlos, Marfan, cystic medoneecrosis Erdheim, etc.), arteries, including the abdominal aorta, suffer. It is often possible to trace the relationship between the 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 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 arise because of atherosclerotic plaques.

In general, smoking is most often caused by an aneurysm, hypodynamia 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 all and 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". She 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 an 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, blunt. It is localized right at the navel or to the left of it.

And the aneurysm of the abdominal aorta makes itself felt indirectly. Symptoms of it are so different that it is very difficult to suspect the 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 movements.

Abdominal syndrome manifests as 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 disturbances 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 begins with an increase in soreness in the abdomen, general weakness and dizziness. Sometimes pain gives in the lower back, groin or perineum. In this case, the patient needs immediate medical attention, since the condition is fraught with death. Often an aneurysm breaks through 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 who, when palpated, feels a strong pulse in the abdomen, this is an aneurysm of the abdominal aorta. Diagnosis of it involves 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 aneurysm of the abdominal aorta is suspected, ultrasound can almost certainly confirm its presence with 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 in order to identify calcification, stratification, intramuscular thrombosis, a threat of rupture or an existing rupture.

If the above diagnostic tests do not allow you to accurately diagnose (although this is rare enough), 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.

The dissecting aneurysm of the abdominal aorta is 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 aneurysm is 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, with acute pain in the abdomen and chest, call for 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 aneurysm of the abdominal aorta

Many people mistakenly believe that with the diagnosis of an aneurysm of the abdominal aorta, 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 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 preferable for them, because the risk of rupture of the aorta 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%.

For elderly people who have an aneurysm of the abdominal aorta, treatment should preferably be performed using 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 also has its own nuances, that's why it's not for everyone. The main drawback of this operation is that in 10% of cases there is a distal migration of the installed stand.

If a diagnosis is made of an aneurysm of the abdominal aorta, the operation is often open. During its carrying out, the affected aortic site is removed and replaced with a denture made of dacron (a synthetic fabric based on polyester). 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, a noticeable scar remains.

The patient is recovered about two weeks. The resumption of labor in some cases is possible only after 4-10 weeks. The patient is strictly prohibited physical activity, shows peace and walks.

Contraindications to open surgery

Surgical intervention is prohibited under the following conditions:

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

Rehabilitation period after surgery

Certainly, the presence of complications after surgery is affected by age 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 general anesthesia, which is not tolerated by all, the development of infection, damage to internal organs and bleeding. In a very small number of cases, the operation ends in a lethal outcome.

If the operation is planned, doctors recommend a 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 recurrence is extremely small, but if a person suddenly starts to worry about pain in the back or abdominal area, nausea, vomiting, numbness in the legs, or general unwell, it's worth to see a doctor immediately.

Prevention of aneurysm

An aneurysm of the abdominal aorta will arise in you with less probability, 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!