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Abdominal Aortic Aneurysm
Overview
An aneurysm of the abdominal aorta is an expansion and thinning of the walls of the most important vessel in the human body. This formidable disease at first does not manifest itself in any way. With the progression of the disease and the lack of timely treatment, aortic rupture may occur, and as a result, massive bleeding, which often ends in death. Timely access to a specialist, high-quality advisory, diagnostic and surgical care can prevent the progression of the disease and ensure the prevention of a life-threatening complication - aneurysm rupture.
What is an aorta?
The aorta is the largest vessel in the human body that carries blood away from the heart to organs and limbs. The upper aorta runs inside the chest, this section is called the thoracic aorta. The lower part is located in the abdominal cavity and is called the abdominal aorta. It delivers blood to the lower body. In the lower abdomen, the abdominal aorta divides into two large vessels - the iliac arteries, which carry blood to the lower extremities.
The wall of the aorta consists of three layers: inner (intima), middle (media), outer (adventitia).
Abdominal aortic aneurysm
Abdominal aortic aneurysm is a chronic degenerative illness with potentially fatal consequences. An aneurysm of the abdominal aorta is defined as an increase in diameter of more than 50% over normal or local wall bulging. The aorta may expand or bulge due to the pressure of the blood flowing through this conduit. A normal aorta in the abdominal area is around 2 cm in diameter. The aorta may be dilated to 7 cm or more at the location of an aneurysm.
Why is aortic aneurysms dangerous?
Aortic aneurysms are extremely dangerous because they can burst. Massive internal bleeding brought on by a burst aneurysm might result in shock or even death.
Additional major health issues might result from an abdominal aortic aneurysm. Often, blood clots (thrombi) develop in the aneurysm sac or portions of the aneurysm detach, and they travel with the blood flow via the aortic branches to the internal organs and extremities. A blocked blood vessel can result in excruciating discomfort, organ death, or the amputation of a lower limb. Fortunately, aortic aneurysms may be treated quickly, safely, and effectively if they are detected early.
Types and classification of the disease
According to the anatomical parameters, there are infrarenal and suprarenal aneurysms. The first is diagnosed if the protrusion of the vessel wall is located below the renal artery, the second - when the expansion of the aorta is above.
Abdominal aortic aneurysm is classified according to its shape:
• Saccular - rounded on a stem, which generally resembles a mushroom;
• Diffuse fusiform - protrusion of the aortic wall occurs evenly along its entire circumference;
• Exfoliating - when one or more layers of the artery wall are exfoliated, as a result of which blood accumulates and stagnates behind them.
According to the structure of the artery wall, true (thinning of the soft tissue of the vessel wall) and false (formed from connective tissue) forms of pathology are distinguished. According to the etiology, aneurysm can be congenital or acquired. The second is also divided into 2 types: non-inflammatory (a consequence of trauma, atherosclerosis) and inflammatory ( a consequence of infection, syphilis, allergic reactions).
According to the nature of the course, there are aneurysms without complications and complicated:
• with bundle;
• with a gap;
• with thrombosis.
By size, 4 forms of pathology are distinguished:
• small - an increase in the diameter of the artery up to 3-5 cm;
• medium - expansion up to 7 cm;
• large - more than 7 cm;
• hyperlarge - when the lumen is increased 10 times the normal diameter of the artery.
Symptoms
A small aneurysm of the abdominal aorta without complications can go unnoticed for a long time. Gradually increasing in size, it causes unpleasant discomfort, which soon develops into pronounced symptoms:
• dull arching pain that pulls the stomach and causes a feeling of constant tension;
• a feeling of heaviness appears to the left of the navel;
• a slight pulsation is felt in the peritoneum, which intensifies in certain positions of the body;
• digestive tract dysfunctions: nausea, upset, belching, lack of hunger;
• pain radiating to the lumbar region, which is accompanied by coldness of the legs.
With an aneurysm of the abdominal aorta, symptoms rarely cause particular discomfort in the patient, especially in the early stages of development. Therefore, the diagnosis of pathology, as a rule, is carried out late, when treatment with conservative methods is ineffective.
Causes
The formation of aortic aneurysms can be due to various reasons. A prerequisite for the subsequent formation of an aneurysm of the abdominal aorta may be fibromuscular dysplasia - a congenital inferiority of the aortic wall. Among the acquired factors, the most important are:
• Atherosclerosis of the vessels. According to studies, the main etiological factor of aortic aneurysms (aneurysms of the aortic arch, aneurysms of the thoracic aorta , aneurysms of the abdominal aorta) is atherosclerosis . In the structure of the causes of acquired aortic aneurysms, it accounts for 80-90% of cases.
• Inflammatory changes in the vascular wall. A more rare acquired origin of abdominal aortic aneurysms is associated with inflammatory processes: nonspecific aortoarteritis , specific vascular lesions in syphilis , tuberculosis, salmonellosis, mycoplasmosis , rheumatism .
• Aortic injury. The rapid development of vascular surgery in recent decades has led to an increase in the number of iatrogenic aneurysms of the abdominal aorta associated with technical errors in performing angiography, reconstructive operations (dilatation/stenting of the aorta, thromboembolectomy , prosthetics). Closed injuries to the abdominal cavity or spine can contribute to the occurrence of traumatic aneurysms of the abdominal aorta.
People at risk are:
• men (in the stronger sex, aneurysm is diagnosed 2 times more often than in women);
• older than 50 years, when natural structural changes occur in the vessels, a decrease in their elasticity;
• with a hereditary predisposition, when an aneurysm of the abdominal aorta was diagnosed in close relatives;
• having bad habits: nicotine destroys the vascular walls and increases blood pressure, and alcohol makes the walls of the arteries weaker and less elastic;
• with diabetes, since glucose has a devastating effect on blood vessels and contributes to the development of atherosclerosis;
• with hypertension , when high pressure in the arteries can cause their walls to bulge;
• with high cholesterol levels, which at times increases the risk of atherosclerosis, and with it aneurysms.
Prevention
With an aneurysm, the patient should unquestioningly follow the doctor's prescriptions, take medications to support the condition and prevent complications. Preventive measures are recommended in combination with drug therapy:
• Maintaining normal weight;
• Organizing a proper diet and avoiding foods that can increase cholesterol and blood sugar levels;
• Suppression of signs of hypertension, taking drugs that lower the level of pressure;
• Giving up bad habits;
• Moderate physical activity;
• Treatment of existing diseases that can aggravate the course of the aneurysm
Treatment
With an aneurysm of the abdominal aorta, drug therapy is prescribed to support the general condition of the patient, but it is impossible to cure the pathology with drugs alone. The doctor may prescribe funds:
• Cardiotropic to support cardiac activity: Recardium, Verapamil;
• Antithrombotic drugs: Cardiomagnyl, Aspicor;
• Anti-lipid to stabilize cholesterol levels: Atorvastatin, Rosuvastatin;
• Antibiotic, antifungal drugs to suppress inflammatory processes in the vessels;
• Non-steroidal anti-inflammatory drugs for rheumatic pathologies: Prednisolone, Diclofenac;
• Preparations to stabilize sugar levels for diabetic patients.
The greatest effect in the treatment can only be achieved by surgery. The intervention of the surgeon can be planned (if the abdominal aortic aneurysm reaches 5 cm in width) or carried out in an emergency mode with a stratifying form of the pathology or rupture of the vessel.
The surgical operation involves the installation of an artificial prosthesis at the site of the aneurysm, through which normal blood flow will be restored. This is a tube made of synthetic material, the service life of which is unlimited. The postoperative period of rehabilitation of the patient under the supervision of doctors is 7 days. For about a month, the patient needs to be regularly observed by a cardiologist.
Tests Required for Diagnosis
If there are no symptoms with an abdominal aortic aneurysm, it can be detected by chance during an examination related to the diagnosis of pathologies of the gastrointestinal tract, kidneys and other organs located in the abdomen. If the patient has complaints similar to the clinical picture with protrusion of the artery wall, then he is sent for a comprehensive examination. Diagnostics can be carried out in one or several ways at once.
Methods of instrumental visualization:
• Ultrasound together with duplex scanning determines the location of the aneurysm, the degree of development, the extent of the aortic lesion, the presence of cholesterol deposits;
• Computer or magnetic resonance imaging allows you to visualize the structure of the artery and nearby tissues, assess their condition and choose the right treatment tactics;
• Angiography involves the introduction of contrast into the aorta, after which an x-ray is taken and the diameter of the lumen of the vessel is estimated;
• Radiography provides information about the presence of calcium deposits in the vessels.
Laboratory diagnostics involves:
• Clinical analysis of blood and its biochemistry;
• A study that determines the level of sugar and cholesterol;
• Rheumatological tests and others.
