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Aspects of diagnosis and treatment of abdominal aortic aneurysm

Cardiovascular diseases occupy leading positions among the causes of death in modern civilized society. Even people far from medicine know what is atherosclerosis, coronary heart disease, myocardial infarction, stroke. However, not everyone knows such a disease as an aortic aneurysm. The most common aneurysms of the aorta, located in the abdominal cavity.

Content

What is abdominal aortic aneurysm?

The aorta is a major vessel of the body, having the largest diameter and feeding the whole body with blood. In the structure of the aorta are the following sections:

  • ascending aorta - carries blood supply to the heart muscle;

  • aortic arch - carries blood to the organs of the head, neck and upper limbs;

  • Thoracic aorta - nourishes the organs of the thoracic cavity (lungs, esophagus, trachea, diaphragm), intercostal muscles;

  • abdominal aorta - supplies blood to the organs of the abdominal cavity, small pelvis and lower limbs.

Depending on the location of the area of ​​the aorta relative to the renal arteries, suprarenal (located above the renal arteries), intrarenal (at the site of the renal arteries discharge) and infrarenal (below the discharge of the renal arteries) are separated.

Aneurysm

The location of the aneurysm in the departments of the aorta

The term "aortic aneurysm" implies a significant expansion of its diameter. It can affect as a separate section of the vessel, and several departments at once until the development of the pathological process along its entire length. Aneurysm can form in any part of the aorta, but more often it is found in the abdominal cavity.

The walls of the aorta are strong and resilient and withstand abrupt changes in pressure over a wide range. However, with the development of aneurysm tissue of the vessel may partially lose its properties. Then the weakened part of the aortic wall begins to bulge, unable to withstand high internal pressure. If such an expansion exceeds half the diameter of the unchanged aorta, it is called an aneurysm. Most often the disease occurs in men older than 60 years.

The illness may not manifest itself, but there is a risk of a sudden rupture of the aneurysm, which most often fails to save the patient. Aneurysm of the abdominal aorta is the 15th most common cause of death.

Causes of the disease

Causes of aneurysm formation include:

  1. Atherosclerosis, leading to the appearance of cholesterol plaques on the aorta wall (90–96% of all aneurysms). The process is complicated by the formation of calcifications and the growth of connective tissue, which makes the vessel fragile.

    Aortic atherosclerosis

    Atherosclerotic plaque as the basis for the formation of aortic aneurysm

  2. Aortitis is an inflammatory process in the walls of the aorta;

  3. Congenital malformations of the vessel (the so-called aortic coarctation);

  4. Congenital systemic diseases of the connective tissue, such as Marfan syndrome;

  5. Injuries to the aortic wall (injuries, car accidents);
  6. Complications after interventions on the aorta.

Additional factors for the development of aortic aneurysms are white race, age, presence of bad habits (smoking), arterial hypertension, atherosclerotic lesion of other arterial pools.

Risks of abdominal aortic aneurysm - video

Classification

  1. True aneurysms - direct expansion of the vessel in diameter relative to normal sizes. In shape, such aneurysms can be sacculate and spindle-shaped.
  2. False aneurysms - the cavity of the aneurysm is filled with blood due to a defect in the aortic wall (for example, in case of injuries).
  3. Dissecting aneurysms are the sudden onset of an aortic wall defect and blood penetration between vessel membranes, as a result of which a tissue flap forms in its lumen.

Symptoms of abdominal aortic aneurysm

The clinical picture of abdominal aortic aneurysm may be different:

  • A variant is possible in which there are no signs of the disease, the aneurysm is not determined by objective examination (asymptomatic form).
  • The second option - the pain is absent, but the aneurysm can be determined by probing the anterior abdominal wall as a tumor-like pulsating formation.
  • The third option is characterized by pains of varying intensity in the abdomen, radiating to the back, lower back, sacrum. In addition, a number of additional symptoms can be attributed to this type: circulatory disorders in the intestines (vomiting, constipation and other disorders), renal blood flow (urinary disorders), blood supply to the lower extremities (intermittent claudication).

In the stage of development of complications, symptoms of threatening rupture (intense pain), rupture (clinic of internal bleeding - rapid pulse, low blood pressure) and dissection appear.

Aneurysm of the abdominal aorta

Aneurysm of the abdominal aorta

Diagnostic methods for abdominal aneurysm

In order to make the correct diagnosis, careful history taking is needed (patient complaints, the presence of predisposing factors, comorbidities and bad habits). In addition, the doctor may prescribe additional research methods:

  • Ultrasonic scanning of the aorta and arteries - the size of the aneurysm, the presence of blood clots in its lumen, the separation of the aortic wall and the arteries extending from it are determined.

  • Computed tomography of the aorta allows you to establish the prevalence of aneurysm, its size at different levels, the presence of dissection.

    CT aortography

    Computed tomography of the abdominal aorta

  • Magnetic resonance imaging, allowing to obtain an image with high resolution.

  • Angiography of the aorta - the study of the vessel with the help of x-ray apparatus.

  • Surgical treatment of aneurysm should be preceded by visualization of the heart vessels, cerebral blood flow and blood circulation of the lower extremities using ultrasound.

Treatment

You should not hesitate to go to the doctor to establish an accurate diagnosis. The main method of treating aneurysms is operative. Delay is life threatening.

Folk remedies in the treatment of aneurysm

Effective folk remedies for the treatment of abdominal aortic aneurysm does not exist, because it is based on a violation of the integrity of the vessel.

Drugs in the treatment of disease

Drug treatment of aneurysm, aimed at correcting aortic arterial pressure and the treatment of associated diseases (ischemic heart disease, myocardial infarction, stroke) is necessary. The following medications may be prescribed by a doctor:

  • beta-blockers - normalize blood pressure and pulse rate (Concor, Coronal);
  • ACE inhibitors (angiotensin-converting enzyme) - normalize blood pressure (Perindopril, Fozinopril);
  • acetylsalicylic acid drugs - improve blood flow, reduce the likelihood of blood clots (Aspirin, Thromboc-Ass, Aspirin-Cardio);
  • Statins - reduce the level of cholesterol in the blood, prevent the formation of atherosclerotic plaques (Liprimar, Atorvastatin, Torvakard).

Surgery for aneurysm

Most often, the best tactic for abdominal aneurysm is surgery. However, the choice of method depends on the state of the body and the presence of complications. If the aneurysm is small, then the doctor may suggest a waiting tactic. The presence of possible contraindications for surgical treatment is also taken into account. These include:

  • myocardial infarction less than 3 months old;

  • stroke lasting less than 6 weeks;

  • marked changes in the lung;

  • common atherosclerosis of lower limb arteries

In an emergency situation, i.e., in case of aneurysm rupture, there are no contraindications.

The technique of surgical intervention in resection of the aneurysm

Resection of the abdominal aortic aneurysm is a surgical excision of the aortic aneurysm and the subsequent insertion of the prosthesis. Access to the aneurysm is carried out under general anesthesia by cutting the abdomen in the midline. At the location of the aneurysm below the discharge of the renal vessels, the main method of operation is intrametropal prosthetics - dissection of the affected area, insertion of the prosthesis, hemming on top of the section of the abdominal aorta. It is also possible to remove the affected area of ​​the aorta with subsequent restoration of integrity.

Intra-gangular aortic prosthetics

Scheme of operation intraperitoneal prosthetic abdominal aorta

With the location of the aneurysm above the discharge of the renal vessels, prosthetic repair of the renal arteries is added to the main stage of the operation.

New method of surgical treatment - endovascular implantation of stent graft

The development of medicine and the results of technological progress led to the development of a fundamentally new method of treating aortic aneurysms, called endoprosthetics. A stent graft is a metal construction implanted into the aortic lumen to strengthen its wall. The stent graft is inserted through a puncture of the femoral artery using a balloon and a delivery system under the control of an x-ray image. The advantages of the method include the absence of anesthesia and operating injury.

Stent graft

New method of treatment of aortic aneurysm - stent-graft implantation

Possible complications

Surgical intervention carries certain risks. According to statistics, most often there are complications such as:

  • significant blood loss;

  • myocardial infarction;

  • stroke;

  • difficulty breathing;

  • circulatory disorders in the intestines;

  • renal failure;

  • deterioration of the blood supply to the lower extremities;

  • infection of the prosthesis.

Diet: what foods should not be eaten

Patients are advised to follow a diet and principles of healthy eating.

Products recommended for use:

  • vegetables (broccoli, beans, beans, pumpkin);
  • fruit (avocado, grapefruit, pomegranate);
  • lean meat (rabbit, turkey);
  • durum wheat pasta;
  • wholemeal bread;
  • fish (salmon, trout, tuna, sardine).

Products whose use should be limited:

  • bread and pasta made from high-grade flour;
  • chocolate (except black);
  • fatty meat (lamb, pork);
  • fat;
  • sweet soda;
  • cream pastries;
  • mayonnaise;
  • butter;
  • sausages;
  • hot spices.

Rehabilitation after surgery

In the postoperative period, the patient is in an intensive care unit for some time. In the future, you need to limit physical activity, wearing a bandage, taking medications prescribed by a doctor, controlling cholesterol levels and blood pressure. In the framework of follow-up is carried out computed or magnetic resonance imaging.

Patient Reviews

The operation for abdominal aortic aneurysm is complex and time consuming. But with timely referral to a specialist there are great chances for a successful outcome.

Uncle had! About 4 years ago! Have done a quota operation! Everything is ok with him! At least back to normal, working! 58 years old to him now.

Tatyana

http://www.baby.ru/blogs/post/383737236–258198142/

Unfortunately, the postoperative period is different in all patients, the state of the body and the presence of concomitant diseases are of great importance.

A 70-year-old man lies in a coma, for 10 days after surgery for abdominal aortic aneurysm ... all on artificial devices ... 3 days ago there was a stroke (hemorrhagic) ... pneumonia ... temperature 39 ... bad kidneys ... stomach cancer ... doctors say the condition is serious.

Irulya

https://otvet.mail.ru/question/43948439

Forecast

Aneurysms of the abdominal aorta of medium and large sizes inevitably progress with the outcome in the gap. Small-sized aneurysms can remain stable for a long time. Surgery on the aorta is extremely difficult and is associated with many possible complications, so timely treatment to the doctor and compliance with preventive measures for the disease is necessary.

Disease prevention

To preventive measures include:

  • family screening to identify the family nature of the disease;

  • timely detection and treatment of atherosclerosis;

  • diagnosis and treatment of arterial hypertension, coronary heart disease;

  • tobacco cessation and a healthy lifestyle.

Aneurysm of the abdominal aorta is a serious disease of the cardiovascular system, it is a life-threatening condition, therefore it is especially important to timely refer patients for medical help.

Interesting

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