– pathological local expansion of a section of the main artery, due to the weakness of its walls. Depending on the location, an aortic aneurysm may manifest as pain in the chest or abdomen, the presence of a pulsating tumor-like formation, and symptoms of compression of adjacent organs: shortness of breath, cough, dysphonia, dysphagia, swelling and cyanosis of the face and neck. The basis for diagnosing an aortic aneurysm is X-ray (radiography of the chest and abdominal cavity, aortography) and ultrasound methods (ultrasound, ultrasonography of the thoracic/abdominal aorta). Surgical treatment of an aneurysm involves its resection with aortic replacement or closed endoluminal replacement of the aneurysm with a special endoprosthesis.
General information
Aortic aneurysm is characterized by irreversible expansion of the lumen of the arterial trunk in a limited area. The ratio of aortic aneurysms of different locations is approximately the following: aneurysms of the abdominal aorta account for 37% of cases, ascending aorta – 23%, aortic arch – 19%, descending thoracic aorta – 19.5%. Thus, aneurysms of the thoracic aorta in cardiology account for almost 2/3 of all pathology. Thoracic aortic aneurysms are often combined with other aortic defects - aortic insufficiency and coarctation of the aorta.
Causes
According to etiology, all aortic aneurysms can be divided into congenital and acquired. The formation of congenital aneurysms is associated with hereditary diseases of the aortic wall:
- Erdheim syndrome
- hereditary elastin deficiency, etc.
Acquired aortic aneurysms can have inflammatory and non-inflammatory etiologies:
- Post-inflammatory aneurysms occur as a result of specific and nonspecific aortitis due to fungal infections of the aorta, syphilis, and postoperative infections.
- Non-inflammatory degenerative aneurysms caused by atherosclerosis, defects in suture material and aortic prostheses.
- Hemodynamic-poststenotic and traumatic aneurysms associated with mechanical damage to the aorta
- Idiopathic aneurysms develop with medianecrosis of the aorta.
Risk factors for the formation of aortic aneurysms are considered to be old age, male gender, arterial hypertension, smoking and alcohol abuse, and hereditary history.
Pathogenesis
In addition to the defectiveness of the aortic wall, mechanical and hemodynamic factors take part in the formation of an aneurysm. Aneurysms often occur in functionally stressed areas that experience increased stress due to high blood flow speed, the steepness of the pulse wave and its shape. Chronic trauma to the aorta, as well as increased activity of proteolytic enzymes, cause destruction of the elastic framework and nonspecific degenerative changes in the vessel wall.
The formed aortic aneurysm progressively increases in size, since the stress on its walls increases in proportion to the expansion of the diameter. Blood flow in the aneurysmal sac slows down and becomes turbulent. Only about 45% of the blood volume in the aneurysm enters the distal arterial bed. This is due to the fact that, upon entering the aneurysmal cavity, blood rushes along the walls, and the central flow is restrained by the mechanism of turbulence and the presence of thrombotic masses in the aneurysm. The presence of thrombi in the aneurysm cavity is a risk factor for thromboembolism of the distal branches of the aorta.
Classification
In vascular surgery, several classifications of aortic aneurysms have been proposed, taking into account their localization by segment, shape, wall structure, and etiology. In accordance with the segmental classification, there are
- aneurysm of the ascending aorta
- aneurysm of combined localization - thoracoabdominal part of the aorta.
Assessment of the morphological structure of aortic aneurysms allows us to divide them into true and false (pseudoaneurysms):
- True aneurysm characterized by thinning and protrusion outward of all layers of the aorta. According to etiology, true aortic aneurysms are usually atherosclerotic or syphilitic.
- Pseudoaneurysm. The wall of the false aneurysm is represented by connective tissue formed as a result of the organization of a pulsating hematoma; the own walls of the aorta are not involved in the formation of a false aneurysm. By origin they are more often traumatic and postoperative.
In shape, there are saccular and fusiform aortic aneurysms: the former are characterized by local protrusion of the wall, the latter by diffuse expansion of the entire diameter of the aorta. Normally, in adults, the diameter of the ascending aorta is about 3 cm, the descending thoracic aorta is 2.5 cm, and the abdominal aorta is 2 cm. An aortic aneurysm is said to occur when the diameter of the vessel in a limited area increases by 2 or more times.
Taking into account the clinical course, uncomplicated, complicated, and dissecting aortic aneurysms are distinguished. Specific complications of aortic aneurysms include ruptures of the aneurysmal sac, accompanied by massive internal bleeding and the formation of hematomas; aneurysm thrombosis and arterial thromboembolism; phlegmon of surrounding tissues due to infection of the aneurysm.
A special type is a dissecting aortic aneurysm, when blood penetrates between the layers of the artery wall through a rupture in the inner lining and spreads under pressure along the vessel, gradually dissecting it.
Symptoms of aortic aneurysm
Clinical manifestations of aortic aneurysms are variable and are determined by the location, size of the aneurysmal sac, its length, and the etiology of the disease. Aneurysms can be asymptomatic or accompanied by scanty symptoms and are detected during routine examinations. The leading manifestation is pain caused by damage to the aortic wall, its stretching or compression syndrome.
Abdominal aortic aneurysm
The clinical picture of an abdominal aortic aneurysm is manifested by transient or constant diffuse pain, discomfort in the abdominal area, belching, heaviness in the epigastrium, a feeling of fullness in the stomach, nausea, vomiting, intestinal dysfunction, and weight loss. Symptoms may be associated with compression of the cardiac part of the stomach, duodenum, and involvement of the visceral arteries. Often patients independently determine the presence of increased pulsation in the abdomen. On palpation, a tense, dense, painful pulsating formation is determined.
Thoracic aortic aneurysm
For an aneurysm of the ascending aorta, pain in the region of the heart or behind the sternum is typical, caused by compression or stenosis of the coronary arteries. Patients with aortic insufficiency are concerned about shortness of breath, tachycardia, and dizziness. Large aneurysms cause the development of superior vena cava syndrome with headaches, swelling of the face and upper half of the body.
Aneurysm of the aortic arch leads to compression of the esophagus with symptoms of dysphagia; if the recurrent nerve is compressed, hoarseness (dysphonia) and dry cough occur; involvement of the vagus nerve is accompanied by bradycardia and drooling. With compression of the trachea and bronchi, shortness of breath and stridor breathing develop; when the root of the lung is compressed, congestion and frequent pneumonia occur.
When the periaortic sympathetic plexus is irritated by the aneurysm of the descending aorta, pain occurs in the left arm and scapula. If the intercostal arteries are involved, spinal cord ischemia, paraparesis and paraplegia may develop. Compression of the vertebrae is accompanied by their usuration, degeneration and displacement with the formation of kyphosis. Compression of blood vessels and nerves is clinically manifested by radicular and intercostal neuralgia.
Complications
Aortic aneurysms can be complicated by rupture with the development of massive bleeding, collapse, shock and acute heart failure. An aneurysm can rupture into the superior vena cava system, the pericardial and pleural cavity, the esophagus, and the abdominal cavity. In this case, severe, sometimes fatal conditions develop - superior vena cava syndrome, hemopericardium, cardiac tamponade, hemothorax, pulmonary, gastrointestinal or intra-abdominal bleeding.
When thrombotic masses are separated from the aneurysmal cavity, a picture of acute occlusion of the vessels of the extremities develops: cyanosis and soreness of the toes, livedo on the skin of the extremities, intermittent claudication. With thrombosis of the renal arteries, renovascular arterial hypertension and renal failure occur; with damage to the cerebral arteries - stroke.
Diagnostics
The diagnostic search for aortic aneurysm includes assessment of subjective and objective data, X-ray, ultrasound and tomographic studies. An auscultatory sign of an aneurysm is the presence of a systolic murmur in the projection of the aortic dilatation. Abdominal aortic aneurysms are detected upon palpation of the abdomen in the form of a tumor-like pulsating formation. Instrumental diagnostics:
- Radiography. The plan for an X-ray examination of patients with a thoracic or abdominal aortic aneurysm includes fluoroscopy and chest radiography, survey radiography of the abdominal cavity, radiography of the esophagus and stomach. At the final stage of the examination, aortography is performed, according to which the location, size, extent of the aortic aneurysm and its relationship to adjacent anatomical structures.
- Ultrasound. When recognizing aneurysms of the ascending aorta, echocardiography is used; in other cases, ultrasound scanning of the thoracic/abdominal aorta is performed.
- CT scan. CT (MSCT) of the thoracic/abdominal aorta allows you to accurately and clearly present aneurysmal dilation, identify the presence of dissection and thrombotic masses, para-aortic hematoma, and foci of calcification.
Based on the results of a comprehensive instrumental examination, a decision is made on indications for surgical treatment. Aneurysm of the thoracic aorta should be differentiated from tumors of the lungs and mediastinum; abdominal aortic aneurysm - from space-occupying formations of the abdominal cavity, lesions of the mesenteric lymph nodes, retroperitoneal tumors.
Treatment of aortic aneurysm
In case of asymptomatic, non-progressive course of aortic aneurysm, dynamic observation by a vascular surgeon and x-ray control are limited. To reduce the risk of possible complications, antihypertensive and anticoagulant therapy and cholesterol reduction are carried out.
Surgical intervention is indicated for abdominal aortic aneurysms with a diameter of more than 4 cm; aneurysms of the thoracic aorta with a diameter of 5.5-6.0 cm or when smaller aneurysms increase by more than 0.5 cm over six months. When an aortic aneurysm ruptures, the indications for emergency surgery are absolute.
In case of hemodynamically significant aortic insufficiency, resection of the ascending thoracic aorta is combined with aortic valve replacement. An alternative to open vascular intervention is endovascular replacement of an aortic aneurysm with installation of a stent.
Prognosis and prevention
The prognosis of an aortic aneurysm is mainly determined by its size and concomitant atherosclerotic damage to the cardiovascular system. In general, the natural history of aneurysm is unfavorable and is associated with a high risk of death from aortic rupture or thromboembolic complications. The probability of rupture of an aortic aneurysm with a diameter of 6 cm or more is 50% per year, and for a smaller diameter - 20% per year. Early detection and planned surgical treatment of aortic aneurysms is justified by low intraoperative (5%) mortality and good long-term results.
Preventive recommendations include monitoring blood pressure, organizing a healthy lifestyle, regular monitoring by a cardiologist and angiosurgeon, and drug therapy for concomitant pathologies. Individuals at risk for developing an aortic aneurysm should undergo screening ultrasound examination.
32. Diagnosis and treatment of dissecting aortic aneurysm.
Dissecting aortic aneurysm (aortic dissection) is understood as the formation of a defect (rupture) in the inner lining of the aortic wall with the subsequent flow of blood into the degeneratively changed middle layer, the formation of an intramural hematoma and longitudinal dissection of the aortic wall into the inner and outer layers with the formation of an additional intravascular canal (false lumen) . Dissection most often occurs in the distal (antegrade) direction, less often in the proximal (retrograde) direction. An aneurysm (dilatation of the aorta) can form in the case of significant expansion of the false lumen, however, the dilation of the aorta itself in some cases is moderate or absent. The clinical picture of the disease is determined by 3 pathoanatomical factors underlying the dissection: dissection of the aortic wall, the development of extensive intramural hematomas and compression or separation of the branches of the aorta supplying vital organs (heart, brain and spinal cord, kidneys), followed by ischemia. Sudden aortic dissection itself causes pain.
The formation of an intramural hematoma in the area of the ascending aorta leads to compression of the coronary arteries, narrowing of the LV outflow tract, acute circulatory failure, and proximal coarctation. An extensive intramural hematoma, containing a large amount of blood, creates a kind of “oligemic syndrome.”
Symptoms of aortic dissection can vary, because... dissection is a dynamic process and the initial picture of the disease may differ from the final one. They can mimic almost all cardiovascular, neurological, surgical and urological diseases.
The leading and most common (in 90-96% of cases) aortic dissection syndrome is pain (except for patients with impaired consciousness). The pain is unusually intense and occurs suddenly, with maximum severity at the beginning of the dissection, in contrast to myocardial infarction (MI), where it gradually increases. In some cases, the pain can become unbearable. The pain has a tearing, tearing, shooting nature, can be migrating from the site of origin in the direction of the dissection, and may initially be accompanied by vagal manifestations, nausea, vomiting, and increased blood pressure. The localization of pain in RA is determined by the location of the onset of dissection. Pain behind the sternum, in front of the chest, simulating MI, is characteristic of proximal dissection (more than 90% of cases), especially if it extends to the root and causes compression of the coronary arteries. With further dissection (type 1), the pain moves to the interscapular space, then moves along the spine. Migrating pain along the path of dissecting hematoma is observed in 17-70% of patients. Pain in the neck, pharynx, jaw, face, teeth indicates involvement of the ascending aorta and arch. Pain in the chest behind, back, and lower extremities is characteristic of distal dissection, and it is initially localized in the interscapular space. The absence of pain in the interscapular space is sufficient evidence against distal dissection. When aortic dissection types I and II spread to the abdominal aorta, the pain is localized in the epigastrium, hypogastrium, and lower back, simulating acute diseases of the gastrointestinal tract and urological diseases.
An asymptomatic (painless) course (except for patients with impaired consciousness) may occur in patients with chronic dissection.
Less common initial signs of aortic dissection (with or without pain) may include:
Symptoms of cerebral or spinal cord ischemia, peripheral neuropathy, syncope without local neurological symptoms (in 4-5%), which are more often associated with rupture of the dissected aorta into the pericardium or pleural cavity;
Aortic insufficiency and acute circulatory failure;
Renal ischemia;
Ischemia of the digestive organs;
Cardiac arrest and sudden death.
Physical examination findings in aortic dissection are variable and, to varying degrees, are related to the location of the aorta and the degree of cardiovascular involvement. In other cases, even in the presence of extensive dissection, objective data may be subtle or completely absent.
1) Hypertension at the onset of the disease (with a possible clinical picture of shock) is observed more often with distal dissection (in 80-90% of cases), less often with proximal dissection. Arterial hypotension is more common with proximal dissection. Its causes are most often cardiac tamponade, or intrapleural or intraperitoneal rupture of the aorta.
2) Asymmetry of the pulse (decrease in its filling or absence) and blood pressure in the upper or lower extremities is observed in half of the patients with proximal and in 15% with distal RA (with the involvement of the femoral or subclavian arteries). The narrowing is caused either by extension of the aortic dissection to one artery or another, with a decrease in the true lumen, or by proximal obstruction by an intimal flap overlying the ostium of the involved artery. Although the presence of pulse asymmetry in a patient with acute pain suggests RA, erroneous interpretations are possible.
3) Aortic regurgitation with a diastolic murmur of aortic insufficiency - an important sign of proximal dissection - occurs in 50-75% of patients. The murmur may have a musical tone and is better heard along the right edge of the sternum. It can be increasing, decreasing, of varying intensity, depending on the value of blood pressure. In severe aortic insufficiency, there may be peripheral signs: fast, galloping and high pulse and high pulse pressure. In some cases, with the development of congestive heart failure, due to acutely developed aortic insufficiency, the diastolic murmur may be subtle or absent.
4) Neurological disorders occur in 6-19% of all aortic dissections and include cerebrovascular disorders, peripheral neuropathy, disturbances of consciousness, and paraplegia. Cerebrovascular disorders occur in 3-6% of cases, due to involvement of the innominate or left common carotid artery. Less commonly, there may be disturbances of consciousness or even coma.
When the spinal arteries are involved (usually with distal dissection), there may be paraplegia or paraparesis due to spinal cord ischemia.
5) More rare manifestations of aortic dissection may be: MI, renal infarction, etc. In 1-2% of cases of proximal dissection, the ostia of the coronary arteries may be involved and secondary MI may develop (more often - posterior/inferior, due to more frequent damage to the right coronary artery). Due to the presence of symptoms of aortic dissections, myocardial infarction may not be clinically evident. On the other hand, the ECG of acute MI may not recognize aortic dissection, and the use of thrombolysis can lead to fatal consequences. Therefore, in case of posterior/inferior myocardial infarction, one should not forget about the possibility of RA, and before thrombolysis, some authors consider it necessary to conduct an X-ray examination to exclude aortic dissection.
The spread of dissection to the abdominal aorta can cause various vascular disorders: renal ischemia and infarction, leading to severe hypertension and acute renal failure; mesenteric ischemia and infarction of the corresponding area (in 3-5% of aortic dissections); acute ischemia of the lower extremities (with the spread of dissection to the iliac arteries).
6) The clinical manifestation of aortic dissection may be pleural effusions, usually on the left, due to either a secondary exudative reaction around the affected aorta or as a result of rupture or leakage of blood into the pleural cavity.
7) Very rare manifestations of aortic dissection may include:
Pulsation of the sternoclavicular joint
Compression of the trachea and bronchi with symptoms of stridor or bronchospasm
Hemoptysis due to rupture in the tracheobronchial tree
Dysphagia
Vomiting blood due to rupture in the esophagus
Horner's syndrome
Superior vena cava syndrome
Pulsation of neck tissues
Atrioventricular block (with septal involvement)
Fever of unknown origin caused by exposure to pyrogenic substances from the hematoma or associated effusion
Murmurs caused by rupture of a dissected aorta in the cavity of the atria or right ventricle with the development of heart failure.
If aortic dissection is suspected, it is important to quickly and accurately verify the diagnosis.
Chest X-ray, while not a method of verifying the diagnosis, can nevertheless be the first to reveal signs suspicious of aortic dissection. X-ray examination data are not specific, but may provide grounds for other research methods. The main radiological signs indicating the possibility of RA are:
I. Expansion of the aortic shadow (in 81-90% of cases, according to our data), better identified in the left oblique projection (sometimes local protrusion in the area of dissection, less often - expansion of the upper mediastinum). Enlargement of the aortic shadow was detected in 50% of patients with type I dissection (- and in 10% - type III). Uneven contours of the descending aorta and deformation of its shadow were noted.
2. Separation (separation) of calcified intima in the area of protrusion from the adventitia by more than 1 cm (normally up to 0.5 cm) is a presumptive, but also not a diagnostic sign.
3. Changes in the shadow of the contours of the aorta or mediastinum when compared with the data of the previous study.
4. Deviation of the trachea or pleural effusion (usually left-sided).
5. A sharp decrease or absence of pulsation of an abnormally wide aorta. Although most patients with RA have one or more radiographic findings, 12% of patients have a normal radiograph. The absence of changes on X-ray does not exclude the diagnosis of aortic dissection.
Electrocardiography in 12 standard leads reveals signs of left ventricular hypertrophy and associated changes (ST segment depression, negative T wave) that are nonspecific for RA. In 1/3 of patients the ECG remains normal!!! However, taking an ECG is important for two reasons:
The absence of changes in the ECG in a patient with severe pain in the chest is the reference differential diagnostic criterion for RA with MI;
The presence of signs of AMI on the ECG (usually lower localization), when compared with X-ray data, allows not only to assume that the patient has aortic dissection, but also indicates the involvement of the coronary arteries.
Laboratory signs are not very indicative in the diagnosis of aortic dissection:
A. anemia - with significant sequestration of blood in the false canal or rupture in the cavity;
b. small (moderate) neutrophilic leukocytosis (up to 12-14 thousand/mm3);
V. increased LDH and bilirubin (due to hemolysis of blood in the false channel);
d. normal levels of CPK and transaminases;
D. Occasionally, the development of disseminated intravascular coagulation syndrome is possible.
According to objective and routine examination methods, the diagnosis of aortic dissection can be made in only 62% of patients. The rest at the onset of the disease have signs of myocardial ischemia, congestive circulatory failure, non-dissecting aneurysm of the thoracic or abdominal aorta, symptoms of aortic stenosis, pulmonary embolism, etc. Among these patients with initially undiagnosed aortic dissection, 2/3 of aortic dissections were diagnosed by other research methods used to resolve other clinical issues. In 1/3 the diagnosis was made only at autopsy.
The main methods for diagnosing aortic dissection are currently considered methods that allow visualization of the aorta:
Aortography
Contrast-enhanced computed tomography (CT)
Nuclear magnetic resonance (NMR)
Transthoracic and transesophageal echocardiography.
Each technique has its own advantages and disadvantages. The choice of method depends on opportunity and experience.
Aortography has long been considered the standard and the only accurate, highly sensitive method for diagnosing aortic dissections. Direct signs of aortic dissection during aortography are: visualization of two lumens (true and false), intimal flap, and indirect signs are deformation of the aortic lumen, expansion and deformation of its wall, abnormal origin of vascular branches, the presence of aortic regurgitation. Aortography allows:
1. determine the length of the delamination
2. identify involvement of aortic branches
3. determine the location of the initial rupture and the exact location of the proximal fenestration
4. presence or absence of distal fenestration
5. assess the degree of health of the aortic valve and coronary arteries.
However, the false lumen, most often detected in the descending aorta, thromboses in 10-15% of cases; the true lumen is narrowed. With transfemoral access, the catheter may not enter the true lumen of the aorta. It is possible to detect the presence of an intimal flap (i.e., a detached inner membrane between the true and false lumen) in 1/3 of patients.
The disadvantage of aortography is the possibility of obtaining false-negative results, which happens with weak contrast of the false lumen (due to its possible thrombosis), equally uniform contrast of both channels, small and local dissection.
The difficulties of using this method include the risk of an invasive procedure and the introduction of a contrast agent (its intolerance), the impossibility of performing aortography in unstable (non-transportable) patients. In addition, the introduction of alternative diagnostic techniques has shown that the sensitivity and specificity of aortography are 77-88% and 95%, respectively. Thus, the false tract is visualized in 87% of patients, the intimal flap in 70%, and the site of the initial intimal tear in only 50% of patients with aortic dissections.
Echocardiography is an accessible and non-invasive method for diagnosing RA. According to the literature, transthoracic echocardiography can detect 80% of aortic dissections. Currently, a special role in the diagnosis of aortic dissection is given to transesophageal echocardiography (the sensitivity of the method is 95%, and the specificity is 75%), which is the method of choice in case of an unstable patient’s condition, because can be quickly performed at the patient’s bedside, in the operating room, immediately before surgery, and does not require cessation of monitoring and ongoing therapeutic measures. Echocardiography allows visualization of dilation of the aortic bulb, increased aortic wall thickness, aortic valve function, identification of the mobile flap in the aortic lumen, and also provides additional information about cardiac structures and function.
If transesophageal echocardiography is not possible, computed tomography with contrast injection is the method of choice. On contrast-enhanced CT, aortic dissection is identified by the presence of two distinct lumens, apparently separated by an intimal flap, or by a different rate (degree) of contrast opacification. The method has a sensitivity of 83-94% and a specificity of 87-100%.
The advantages of CT are: non-invasiveness, although IV contrast is required; availability; the ability to establish a diagnosis of aortic dissection in the case of false lumen thrombosis; the ability to determine the presence of pericardial effusion.
The main disadvantages of CT are: relatively low sensitivity for diagnosing aortic dissections; inability to identify an intimal flap in 1/3 of cases; the rarity of identifying the location of the initial rupture; inability to detect the presence of aortic regurgitation and involvement of vascular branches.
NMR is a non-invasive technique that does not require IV contrast, while providing high-quality images in several planes. NMR facilitates the recognition of RA, allows the identification of branch involvement, and also diagnoses aortic dissection in patients with pre-existing aortic diseases. The sensitivity and specificity of the method are about 98%, while the sensitivity is 88% for determining the site of intimal rupture and aortic regurgitation, 98% for diagnosing the presence of thrombosis and 100% for detecting pericardial effusion. The unusually high accuracy makes NMR the modern “gold standard” in the diagnosis of RA, especially in stable patients and with chronic dissection.
However, the method still has a number of disadvantages: NMR is contraindicated in patients with a pacemaker, in the presence of a certain type of vascular staples, and some old types of prosthetics with metal artificial valves; is not a widely available method. Some authors consider the unstable condition of the patient, requiring intravenous administration of antihypertensive drugs and blood pressure monitoring, to be a relative contraindication to NMR.
Treatment for aortic dissection is aimed at stopping the progression of the dissecting hematoma.
The pain should be relieved with IV morphine.
To reduce cardiac output and reduce the rate of LV ejection, b-blockers are used in increasing doses until the heart rate decreases to 60-80 per minute.
If there are contraindications to the use of b-blockers (bradycardia, AV block, bronchospasm), calcium channel antagonists are now increasingly used. Nifedipine sublingual can be used immediately while other drugs are prepared for administration. The disadvantage of nifedipine is its weak negative inotropic and chronotropic effects, and therefore diltiazem and verapamil can be used.
If beta blockers are ineffective, sodium nitroprusside can be used at a dose of 0.5-10 mg/kg*min IV.
For refractory hypertension, as a result of involvement of the renal arteries, the most effective is the use of ACE inhibitors (enalapril - 0.625 mg intravenously every 4-6 hours with a gradual increase in dose).
In case of hypotension, one should think about the possibility of cardiac tamponade, aortic rupture, which, if possible, requires rapid restoration of blood volume. For refractory hypotension, it is preferable to use norepinephrine and mesaton. Dopamine is used to improve kidney function and only in small doses.
When the patient's condition is stabilized, diagnostic studies are immediately carried out to verify the diagnosis. If the patient's condition is unstable, it is preferable to perform TEE, against the background of continuous monitoring and therapeutic measures.
Further tactics are determined by the type of separation.
A dissecting aortic aneurysm is a damage to the inner lining of the enlarged aorta, which is accompanied by the appearance of hematomas and a false opening. This disease is characterized by longitudinal separation of the aortic walls of varying lengths. In medicine, this pathology is often called a more abbreviated version - “aortic dissection.”
Often, the aorta can dissect in the most hemodynamically weak areas, which include the area of the ascending aorta, the aortic arch and the descending zone. In cardiology, an aneurysm is one of the group of severe pathologies that can cause significant inconvenience and threaten a person’s life. If you do not consult a doctor in a timely manner, the patient may experience bleeding from aortic rupture or acute ischemia.
As a rule, the disease develops in older people over 60 years of age. Doctors diagnose pathology more often in men than in women. The larger a person's aneurysm, the more progressively it enlarges and the chances of it rupturing increase. Accordingly, the risk of rupture increases with the size of the aneurysm, which can be several times larger than the normal diameter of the aortic lumen.
Etiology
Aneurysm dissection can occur for a variety of reasons. The main factor leading to the development of the disease is damage to the walls. With this pathology, specific plaques begin to form in the human aorta, which can serve as a provoking factor. These tumors are composed of cholesterol, calcium and fibrous tissue. With the progression of atherosclerosis, the number of plaques increases, which leads to a decrease in the lumen in the vessel. As a result, the walls lose their elasticity and become weaker. Clinicians also identify other factors leading to dissecting aortic aneurysm:
- excess weight;
- heredity;
- elevated blood pressure;
- nicotine consumption.
Pathology can develop under the influence of various other diseases. People with the following diseases may have a high chance of developing an aneurysm:
Quite rarely, the disease is diagnosed due to mechanical damage.
Classification
Classification of the disease consists in determining the types of the disease according to the characteristics of the course and the localization of the disease. According to the first criterion, doctors identified a rather conventional systematization, which is divided into the following forms:
- chronic – can last for months;
- subacute – the process lasts about 4 weeks;
- acute - death occurs a couple of hours after the exacerbation.
According to the location of the disease, the classification of the disease consists of 3 types:
- Type 1 – dissection occurs in the area of the ascending aorta, and smoothly passes to the thoracic and abdominal region;
- Type 2 – damage is localized exclusively in the ascending section;
- Type 3 – from the descending zone the lesion moves to the area of the abdominal aorta.
Symptoms
In the development of the clinical picture of pathology, doctors distinguish two stages of formation. With dissecting aortic aneurysm at the initial stage, the disease manifests itself in the three above-mentioned forms of the disease - acute, subacute, chronic.
During an acute attack of wall dissection, the patient is overcome by the following symptoms:
Dissecting aortic aneurysm is a disease that quickly subsides, but can provoke a reflex decrease in blood pressure and fainting. After a while, the patient begins to experience severe, burning pain in the sternum, arms, neck, and shoulder blades. During moments of exacerbation, the patient also exhibits other symptoms: dry cough, feeling of lack of air, decreased blood pressure, collapse.
Diagnostics
The development of aortic disease with wall dissection can only be determined by instrumental examination. To accurately determine the cause of the development of pathology, the patient is prescribed to undergo research using such methods;
- radiography;
- tomography;
- angiography.
Thanks to an examination using an ECG, the doctor can rule out myocardial ischemia, which also provokes pain in the chest. X-ray helps to identify sudden changes in the structure of the vessel - an increase in the lumen and upper mediastinum, changes in contours, the presence of pleural effusion, a decrease in the pulse in the dilated part.
The patient is prescribed constant monitoring of blood pressure, diuresis and monitoring of ECG changes. To determine the dynamics of aneurysm progression and the presence of fluid in the pericardium and pleural cavities, the patient undergoes radiography.
It is important to perform tomography to identify intramural hematoma and penetration of atherosclerotic ulcers of the thoracic aorta.
In diagnosing the disease, it is also important to conduct a differential examination and distinguish a dissecting aneurysm from the following ailments:
- occlusion of mesenteric vessels;
- spicy ;
- aorta;
- without delamination of walls;
- mediastinal tumor.
Treatment
If a patient has been diagnosed with an abdominal or thoracic aortic aneurysm, he is prescribed therapy depending on the type of dissection and the presence of consequences.
Drug therapy is used in the treatment of various forms of aneurysms. Medicines are the initial stage of eliminating the symptoms and causes of the disease. The patient is then scheduled for aortography and surgery.
Treatment with medications is based on the following goals:
- prevention of the development of further aortic dissection;
- normalization of hemodynamics and homeostasis;
- decrease in blood pressure indicators.
Doctors prescribe treatment of pathology with drugs from the following groups - beta-blockers, calcium antagonists, ACE inhibitors, nitroglycerin.
If conservative treatment turns out to be ineffective, then the patient is prescribed surgical intervention. It is based on resection of the affected area of the aorta, eliminating the false lumen and restoring the damaged parts of the aorta. To achieve these goals, doctors use prosthetics or remove the defective area and stitch the ends of the healthy aorta.
Emergency surgical care is needed only for those patients who are at risk of aortic rupture - with severe vascular insufficiency, progressive dissection, with a saccular aneurysm, with ineffective therapy with conservative methods. Urgent surgical care is also provided if the patient has a hemorrhage in the pericardium or pleural cavity.
Often such operations are performed using artificial circulation. After surgical treatment, the patient begins the stage of rehabilitation in the hospital.
Complications
Complications can develop if a dissecting aortic aneurysm develops too quickly or the patient seeks medical attention too late. The most common consequences of the disease include such pathologies as myocardial infarction, stroke, and often aneurysm rupture and death.
Forecast
For people with this diagnosis, the outcome may be poor. A significant proportion of patients die during surgery or during the recovery period. Doctors have found that with emergency treatment of an acute aneurysm on the operating table, death occurs in 25% of cases, and with treatment of a chronic form of the disease in 17%.
Prevention
Dissecting aortic aneurysm is a severe form of the disease that is important to recognize early in its development. To reduce the chances of developing the disease, doctors advise periodically checking your blood pressure. If a patient has a high level of lipids in the blood, then for preventive purposes he is prescribed diet therapy and lipid-lowering drugs.
Doctors also advise all people to exercise, watch their diet and adhere to a healthy lifestyle.
Is everything in the article correct from a medical point of view?
Answer only if you have proven medical knowledge
Dissecting aortic aneurysm occurs as a result of rupture of the aortic intima against the background of aortic atherosclerosis and hypertensive syndrome. Less commonly, the cause of aortic dissection may be Marfan syndrome.
The leading clinical syndrome of dissecting aneurysm is severe pain in the chest, which occurs suddenly and lasts for hours, often against the background of elevated blood pressure. After a few hours, a systole-diastolic murmur may be heard on the aorta, and increased pulsation appears in the jugular fossa. There are 2 possible variants of ECG changes against the background of dissecting aortic aneurysm:
1) dissecting aneurysm electrocardiographically resembles myocardial infarction of the posterior wall, in leads III, avF the amplitude R decreases, the amplitude and duration of Q increases, ST depression, T wave is negative; 2) a decrease in QRS amplitude in all leads, a slight rise in ST (1–2 mm), convexly directed upward with a transition to a negative T wave (Fig. 73).
Signs of dissecting aortic aneurysm
Dissecting aortic aneurysm often gives a clinical picture similar to that of myocardial infarction. Dissection of the aortic wall usually appears against the background of an inflammatory process of various etiologies (including syphilitic mesoaortitis), as well as severe atherosclerosis. Dissection of the aortic wall can often be promoted by prolonged and severe hypertension, and less commonly by chest trauma.
Clinical picture and diagnosis of dissecting aortic aneurysm
The most important sign of a dissecting aortic aneurysm is pronounced pain, occurring in most cases acutely in the chest. The onset of pain does not always coincide with complete aortic dissection. Sometimes the appearance of pain only indicates the beginning of the process, a tear in the aorta. At the moment of complete dissection and formation of an aneurysm, a significant drop in blood pressure often occurs, accompanied by fainting and even collapse.
Particularly severe pain occurs at the moment when the aortic wall ruptures. Then they weaken, but then, when the aneurysm spreads lower along the aorta, the pain may periodically intensify. As the aneurysm progresses, the pain increases, radiating to the back, spine, lower back, sacrum, sometimes to the groin areas, and both legs. Such localization and migrating nature of pain are not typical for myocardial infarction.
The activity of “cardiac enzymes” (CPK, LDH, AST, ALT) with a dissecting aneurysm may remain normal or slightly increase, the level of myoglobin does not change significantly. The ECG may reveal signs of subendocardial ischemia (decrease in the ST segment), as well as disturbances in the repolarization phase in the ventricular myocardium (change in the shape of the T wave).
Cases of compression of the ostium of the coronary artery by a dissecting aneurysm with the development of myocardial infarction have been described. Almost always, coronary circulation suffers to a certain extent due to a drop in blood pressure in the aorta. Therefore, the above changes are more often recorded on the ECG.
The lethal outcome of dissecting aortic aneurysm usually occurs suddenly, but sometimes, with a slowly progressive process and an increase in clinical symptoms, after 1 - 2 weeks or later. If death does not occur immediately, then on the 2-3rd day moderate anemia appears, which is not typical for myocardial infarction.
Occasionally, the condition of patients with a dissecting aneurysm gradually stabilizes, the dissection stops, and a chronic aortic aneurysm forms. X-ray contrast and echocardiographic studies are of great importance in the diagnosis of dissecting aortic aneurysm, including chronic ones.
Treatment of dissecting aortic aneurysm
Surgery is performed in specialized hospitals. In the prevention of the disease, an important role is played by the correction of blood pressure, treatment and prevention of atherosclerosis, as well as other diseases of the aorta.
“Signs of dissecting aortic aneurysm” and other articles from the section Other diseases of the cardiovascular system
Causes and treatment of dissecting aneurysm
Dissecting aortic aneurysm is a life-threatening pathological condition characterized by dissection of the aortic wall at the site of injury.
To better understand what we are talking about, let’s consider what the aorta is? It is through the aorta, the largest artery, that blood flows from the heart to the tissues and organs. Leaving the heart, the blood flows through the thoracic region to the organs located in this area. Passing through the diaphragm, at the bottom it is divided into two parts - the iliac arteries, which provide blood supply to the lower abdomen, legs and genitals.
A dissecting aneurysm is characterized by dilation and dissection of the aortic walls due to the gradual thinning of the aortic walls. Medical statistics indicate that every fourth aneurysm forms in the thoracic region. The weakened aortic wall cannot withstand the strong blood pressure and inevitably expands. The diameter of the aorta in a normal state is two centimeters, while in a patient with an aneurysm the aorta expands to a much larger size, threatening the patient’s life. An aneurysm can form in any part, it can dissect or rupture. Subsequently, internal bleeding and quick death are inevitable.
Causes
Dissecting aneurysm is a distinct form of aneurysm that occurs due to frequent increases in blood pressure. The dissection is very dangerous and seriously threatens the patient's life. If the dissection extends through the entire aorta, blood flow to the brain, kidneys, limbs and other organs stops.
This pathology most often occurs in men over 50. The main cause of the disease lies in prolonged arterial hypertension. However, aortic dissection can also occur against the background of hereditary connective tissue pathology. The risk of the disease is also high in people who suffer from defects of the cardiovascular system.
Also, damage to the aorta by atherosclerosis can be a cause, or better to say, a predisposing factor for aneurysm dissection. The disease can also manifest itself in syphilis. Rarely, but the disease also occurs in Morphan syndrome.
Sometimes dissection of the aortic walls occurs after unsuccessful catheter insertion (during surgery or diagnostic studies).
Development mechanism
How does this disease develop? At the initial stage, the patient's blood pressure increases, which causes severe pressure in the aorta. Due to the pressure acting on the wall 
of the aorta, it is stretched and its inner layer is damaged. Subsequently, under the influence of pressure, the blood enters the middle layer. The layers separate, and a hematoma forms between them, which consists of accumulated blood. A further increase in pressure can lead to rupture of the third membrane of the aorta and, as a result, death.
There are cases when aortic dissection occurs in a distant direction. However, this happens even less frequently in the proximal direction. Subsequently, the patient will experience hemopericardium and severe arterial insufficiency. Also, these processes provoke separation of the aortic valve and occlusion of the arteries. As a result of dissection, a re-rupture of the aortic membrane sometimes occurs. As a rule, it occurs below the place where the initial delamination occurred.
Manifestation of aneurysm
In medical practice, there are three stages of development of an aortic aneurysm. The acute stage of the disease occurs within two days, and death often occurs within the first minutes or hours after the onset of dissection.
The subacute stage lasts from two weeks to a month. As for the chronic stage, the process of dissection can last for months or even years. It is during the chronic stage that there is a better scenario for the development of events, since during this time the patient can receive surgical assistance. At the acute stage, specialists simply will not have time to provide appropriate assistance to the patient.
Symptoms
The most striking and indicative symptom of a dissecting aneurysm is considered to be sharp pain in the chest area. The patient feels an unbearable, bursting pain that radiates from the chest to the back. Moreover, the pain does not stop, that is, it is constant and only increases over time if aortic dissection continues. A person may also feel pain in the heart, which will then radiate to the left hand. As for blood pressure, it usually decreases. Although there are cases when the pressure, on the contrary, increases.
Symptoms of the disease also include the absence, or rather the inability to feel, a pulse in the extremities. If, when the aorta ruptures, blood enters the lungs and bronchi, the patient may cough up blood. If blood enters the esophagus, bloody vomiting occurs.
Another symptom of dissection is shortness of breath, which indicates aortic regurgitation. Moreover, no changes are observed on the ECG. An x-ray taken during the progression of this pathology will show an expansion of the aortic shadow observed over several days.
With this diagnosis, a person has little chance; he dies instantly or within a few days. The main cause of death in such cases is considered to be internal bleeding.
Complications
If the patient does not die within the first minutes and hours, complications such as stroke or myocardial infarction may occur. In addition, the lower limbs may lose functional ability, this is due to a change in blood flow through the aerial arteries. Disruption of the blood supply to the spinal cord and damage to the walls of the vertebral arteries can impair the functions of the spinal cord. In addition, with this disease, pain is felt in the lower back and abdomen if blood flow in other vessels is blocked.
The most dangerous and life-threatening complication of the patient is considered to be rupture of the aortic wall and internal bleeding.
Diagnostics
To make a diagnosis, a patient with the symptoms described above is recommended to immediately consult a specialist for medical help. To diagnose this disease, the patient is prescribed a set of tests. First of all, the patient is given an ECG. It should be noted that ECG results are not always able to reflect the severity of the patient’s condition. Even if the patient complains of unbearable pain, 
a cardiogram may not reveal significant changes. It is this factor that indicates the development of an aortic aneurysm. However, there are cases when, during dissection of an aortic aneurysm, changes in the ECG are pronounced. In this situation, the study is unable to distinguish a dissecting aneurysm from an acute myocardial infarction.
Thanks to an X-ray examination of the chest organs, specialists can determine how dilated the aorta is and how its position has changed.
Another diagnostic method is cardiac ultrasound, which allows you to learn more about the condition of large vessels, as well as the patient’s heart. In addition, ultrasound can detect the place that was affected.
To examine the thoracic aorta, doctors use electrocardiography, which helps assess the degree of atherosclerosis and the condition of the aortic valve.
Computed tomography, as well as magnetic resonance imaging, can 100% determine the presence or absence of a dissecting aneurysm. MRI can most accurately determine the location of the dissection.
Phonocardiography will allow you to evaluate murmurs in the heart and blood vessels, which will tell specialists about the presence of aortic insufficiency. Another research method, angiography, will allow you to find out the location of the dissection and its extent. This method is used for those patients who are being prepared for surgery.
The process of diagnosing dissecting aortic aneurysm is difficult because most of its symptoms are similar to those of myocardial infarction. Making a correct diagnosis is extremely important, since an aortic aneurysm should never be treated with anticoagulants and thrombolytics, which are used in the complex treatment of myocardial infarction.
Treatment
If aortic dissection is suspected, it is extremely important to immediately hospitalize the patient in a hospital, where complete monitoring of vital functions will be carried out. The treatment process for this disease primarily includes medications that reduce heart rate and lower blood pressure. Such drugs include:
Important! Blood pressure readings should not be higher than 100/60 mm Hg.
However, care should be taken to ensure that blood pressure does not become low to such an extent that it can lead to inhibition of the functioning of other organs.
The aorta damaged due to syphilis requires a course of treatment with antibiotics.
The treatment process is constantly accompanied by careful monitoring of blood pressure and heart rate. To monitor the process occurring in the aorta, the patient undergoes a chest x-ray every 12 hours. This measure is necessary in order to monitor the severity of the process. At the acute stage, surgery is extremely dangerous.
There are a number of indications for urgent surgery for this diagnosis. These include:
- threat of aortic rupture;
- progressive process of delamination;
- formation of a saccular aortic aneurysm.
Surgery is inevitable if the use of medications is ineffective or the pain does not stop.
Also, an indication for surgery is hemopericardium, that is, when blood enters the outer membrane of the myocardium. The help of surgeons is also required for uncontrolled hypertension, or in other words, in a condition in which it is impossible to reduce blood pressure and maintain it at certain levels.
Surgical intervention for dissection of the aortic walls involves plastic surgery using a synthetic prosthesis. In addition, endovascular prosthetics and stent installation are possible. The operation lasts from several to six hours. If the outcome of the operation is positive, the patient recovers and is observed in the hospital for another 10 days. During these days, the person must take medications to prevent high blood pressure.
Medical statistics indicate that 75% of patients with aortic dissection without surgery die within 14 days.
Aorta- This is the largest, most powerful blood vessel in the human body. Powerful, therefore, it seemed that nothing “took” him. However, aortic aneurysm is the scourge of modern cardiovascular surgery. In normal conditions, in adult women and men, the diameter of the lumen of the ascending aorta is about 3 cm, the descending part is 2.5 cm, the abdominal segment of this large vessel is even smaller - 2 cm. The diagnosis of an aneurysm is announced only if the diameter of the affected aorta increases by 2 or more times compared to the norm.
Aneurysm is an abnormal bulge that appears on the walls of the artery. The walls of the arteries are quite thick and strong, the muscle fibers of which they are composed allow them to withstand intense blood pressure. However, if there is a weak area in the artery wall, the pressure causes the area to bulge, thereby forming an aneurysm.
Aortic aneurysm can develop in two parts of this artery:
- the abdominal part passing through the lower part of the abdominal cavity is an abdominal aortic aneurysm;
- A thoracic aortic aneurysm developing in the chest cavity. This type of aneurysm is less common, but both types are equally dangerous to human health and life.
Depending on the appearance of the aneurysm, it may be:
1. fusiform
2. saccular.
Small aneurysms usually pose no threat. However, they can increase the risk of: the formation of atherosclerotic plaques at the site of the aneurysm, which cause further weakening of the artery walls; formation and separation of a blood clot, therefore increasing the risk of stroke; an increase in the size of the aneurysm, which means compression of nearby organs, which causes pain; aneurysm rupture.
The main complication of aneurysms of any location is their dissection followed by possible rupture (mortality rate - 90%).
Causes and risk factors
The main causes of aneurysm are diseases and conditions that reduce the strength and elasticity of the vascular wall:
- atherosclerosis of the aortic wall (according to various sources, from 70 to 90%); inflammation of the aorta (aortitis) of a syphilitic, giant cell, mycotic nature;
- traumatic injury;
- congenital systemic connective tissue diseases (for example, Marfan or Ehlers-Danlos syndrome);
- autoimmune diseases (nonspecific aortoarteritis);
- iatrogenic causes caused by medical manipulations (reconstructive operations on the aorta and its branches, cardiac catheterization, aortography).
Risk factors for the development of atherosclerosis and aneurysm formation:
- male gender (the incidence of aneurysms in men is 2-14 times higher than in women);
- smoking (during screening diagnostics of 455 people aged 50 to 89 years in the Department of Vascular Surgery of the Moscow Regional Research Clinical Institute, it was revealed that 100% of patients with abdominal aortic aneurysms had a smoking history of more than 25 years, and as a result of the Whitehall study it was proven that life-threatening complications of aneurysms occur 4 times more often in smokers than in non-smokers);
- age over 55 years;
- family history;
- long-term arterial hypertension (blood pressure above 140/90 mm Hg);
- physical inactivity;
- excess body weight;
- increased blood cholesterol levels.
They also talk about a dissecting aneurysm, which is formed as a result of rupture of the inner membrane with its subsequent dissection and the formation of a second false channel for blood flow.
Depending on the location and extent of the dissection, 3 types of pathology are distinguished:
1. Dissection begins in the ascending aorta and moves along the arch (50%).
2. Dissection occurs only in the ascending aorta (35%).
3. Dissection begins in the descending aorta and moves down (more often) or up (less often) along the arch (15%).
Depending on the duration of the process, a dissecting aneurysm can be:
acute (1-2 days from the appearance of the endothelial defect);
subacute (2-4 weeks);
chronic (4-8 weeks or more, up to several years).
SYMPTOMS OF AN AORTIC ANEURYSM
Aortic aneurysm manifests itself in different ways - it mainly depends on the size of the aneurysmal sac and its location (below is a visual clinical picture using the example of an aneurysm of the sinus of Valsalva). In some cases, no symptoms are observed at all (in particular, before the aneurysm ruptures, but this will be a different diagnosis), which makes early diagnosis difficult.
The most common complaints from patients with an aneurysm of the ascending aorta are:
pain in the chest (in the area of the heart or behind the sternum) - due to the fact that the aneurysmal protrusion puts pressure on nearby organs and tissues, as well as due to the pressure of the blood flow on a thin and weak wall; shortness of breath, increasing over time; feeling of palpitations (“As if something is pounding in the chest” - a comment from patients); dizziness; with large aneurysms, attacks of headaches, swelling of the soft tissues of the face and upper half of the body are disturbing - due to the development of the so-called superior vena cava syndrome (because the aneurysm presses on the superior vena cava).
An aortic arch aneurysm is characterized by:
- difficulty swallowing (due to pressure on the esophagus);
- hoarseness of the voice, sometimes coughing - if the aneurysm puts pressure on the recurrent nerve, which is “responsible” for the voice;
- suddenly increased salivation and slow pulse - if pressure spreads to the vagus nerve, which controls salivation and pulse rate;
- strained breathing, and later shortness of breath if the trachea and bronchi are compressed by a huge aneurysm;
- unilateral pneumonia - if an aneurysm, pressing on the root of the lung, interferes with its normal ventilation, then, as a result, congestion occurs in the lungs, which, when an infection is attached, develops into pneumonia.
With an aneurysm of the descending aorta, the following appear:
- pain in the left hand (sometimes up to the fingers) and shoulder blade;
- with pressure on the intercostal arteries, a lack of oxygen supply to the spinal cord may develop, which is why paresis and paralysis are inevitable;
- in case of constant long-term pressure of a large aneurysm on the vertebrae, they may even be displaced;
- in milder cases, due to pressure on the intercostal nerves and arteries - pain, as with radiculitis or neuralgia.
The most common complaints with an aneurysm of the abdominal aorta:
- a feeling of fullness in the stomach and heaviness in the epigastrium (upper floor of the abdomen), which the patient initially tries to explain by overeating or stomach pathology;
- belching;
- in some cases, reflex vomiting (appears as a reaction to the pressure of the aortic aneurysm on nearby organs and tissues);
- When palpated, a tense, tumor-like pulsating formation is felt. Sometimes patients can independently detect this pulsation.
DIAGNOSIS OF AORTIC ANEURYSMS AND ITS COMPLICATIONS
An aortic aneurysm in the period before rupture has rather meager clinical manifestations: murmurs that are heard on auscultation; the doctor listens not only to the chest, but also to the abdominal cavity; a tumor-like pulsating formation, which is found with deep but careful palpation (sometimes it is actually regarded as a tumor, since it is quite dense to the touch); incomprehensible discomfort at the site of aneurysmal protrusion formation.
Therefore, to clarify the pathology before it “gives birth” to dangerous complications, instrumental diagnostic methods are used: fluoroscopy and radiography of the chest and abdominal cavity - they visualize a tumor-like formation (its pulsation is visible during fluoroscopy); echocardiography - if an aneurysm of the ascending aorta is suspected; Doppler ultrasound (USDG) - for signs of aneurysm in other parts of the aorta; CT and MRI.
TREATMENT AND SURGERY FOR AORTIC ANEURYSM
If an aneurysm is diagnosed, but its progression is not observed, doctors adopt conservative tactics: further careful observation by a vascular surgeon and cardiologist - monitoring the general condition, blood pressure, pulse, repeated electrocardiography and other more informative methods to monitor the possible progression of the aneurysm and notice in time the prerequisites for complications of an aneurysm; antihypertensive therapy - in order to reduce blood pressure on the thinned wall of the aneurysm; anticoagulant treatment - to prevent the formation of blood clots and possible subsequent thromboembolism of medium and small vessels; reducing the amount of cholesterol in the blood (using both drug therapy and diet). Surgical intervention is resorted to in the following cases: large aneurysms (at least 4 cm in diameter) or with a rapid increase in size (by half a centimeter in six months); complications that threaten the patient’s life - aneurysm rupture and others; complications that, although not critical in terms of death, sharply reduce the patient’s quality of life - for example, pressure on nearby organs and tissues, which causes pain, shortness of breath, vomiting, belching and similar symptoms.
PROGNOSIS FOR AORTIC ANEURYSM
Aortic aneurysm is a nosology that should be constantly under close monitoring by doctors. The reason is possible complications, which in most cases threaten human life. Over time, the aneurysm progresses morphologically (the altered wall becomes thinner and thinner, the protrusion increases). The life and health of a patient can be saved only through careful monitoring of the course of the disease and, if necessary, immediate surgical intervention.
PREVENTIVE MEASURES
Prevention, thanks to which it is possible to prevent the occurrence of aortic aneurysm in healthy people, is nonspecific (that is, effective not only in the case of this pathology) and includes: complete cessation of smoking; reducing alcohol standards to the level of “only for holidays”, or better yet, a complete refusal; physical education and sports; elimination of factors that cause a rise in blood pressure (stress, kidney disease); treatment and prevention of pathology that contributes to the formation of aortic aneurysm (atherosclerosis); immediate alertness in the event of a sudden, at first glance inexplicable appearance of interruptions in the functioning of the heart, gastrointestinal tract and respiratory system and immediate examination by specialized specialists to exclude an aortic aneurysm; regular, high-quality, not just for show, medical examinations with a vascular surgeon and cardiologist. If an aortic aneurysm is already present, preventive measures are indicated in order to prevent complications of this disease: well-chosen anticoagulant therapy to prevent the formation of blood clots in the lumen of the aneurysm; a significant reduction in physical activity - otherwise they can cause overstrain of the thinned wall of the aneurysm, which will result in its rupture; sometimes a complete refusal of physical activity is necessary until the doctor clarifies the diagnosis and assesses the risk; antihypertensive treatment - thanks to it, it is possible to avoid an increase in the pressure of the blood flow on the thinned wall of the aneurysm, which can rupture at any moment; careful psychological control - in some patients, even minor stressful situations pushed the aortic aneurysm to rupture.
Loading...