General information. Abdominal aortic aneurysm - what is this disease?
Aorta is the largest vessel in the human body. Through the aorta and its branches, oxygen-rich blood from the left ventricle of the heart enters all organs. This is the main highway in the blood circulation of a person, it is conditionally divided into several departments: ascending aorta, aortic arch and the descending part of the aorta. The last division is divided into chest and abdominal part. The most common disease of this vessel is aneurysm. In three of four cases of vascular disease, abdominal aortic aneurysms occur and only in one localization occurs in the thoracic region.
Aneurysm - pathological expansion of the vessel, in places of weakening of its walls. Under the influence of high blood pressure, the vessel wall expands and, as a consequence, its protrusion. In their form, aneurysms are divided into baggy and spindle-shaped education. In both cases, blood flow is disturbed, which contributes to thrombosis. In some cases, calcium accumulates in the aneurysmal sac and the vessel wall is calcified, which makes it brittle and predisposes to rupture.
Aneurysm of the abdominal aorta is localized mainly below the place of discharge of the renal arteries. Therefore, its complications are dangerous for the pelvic organs and lower extremities. As a complication most often occurs embolism. During its flow, a blood clot spreads from the aneurysmal sac along the course of the vessel. A thrombus is fragmented, and pieces of it spread through the bloodstream to the pelvic organs and limbs. Pieces of a blood clot may clog arteries, leading to lower limb necrosis. But the most dangerous for the patient’s life is a rupture of the aneurysm, as a result of which hemorrhage into the abdominal cavity occurs.
Although there are no obvious symptoms of abdominal aortic aneurysm, with complications there are some indirect signs, which will be discussed later, but first we will dwell on the causes of the disease.
Causes of abdominal aortic aneurysm
The development of aneurysm is due to several factors. Most often, the disease occurs due to atherosclerosis, in which the lumen of the vessel narrows, and its walls become fragile. This leads to stratification of the aortic wall, while the more fragile inner walls are torn, and the outer wall protrudes, forming stratified aortic aneurysm. The causes of abdominal aortic aneurysm are also arterial hypertension, inflammatory diseases of the aortic wall, congenital connective tissue diseases, infectious diseases, in particular syphilisaccompanied by damage to the aorta.
A predisposition to the development of aneurysm is observed in men over 60 years old, most often in smokers or who have uncontrolled high blood pressure. Women are less prone to this disease. The hereditary factor, the presence of the disease in other family members also plays a role. It is proved that Marfan syndrome in parents greatly increases the likelihood of developing aneurysm.
Diagnosis and symptoms of abdominal aortic aneurysm
In some cases, the disease is almost asymptomatic, which is why it is found in the diagnosis of other diseases, but more often the abdominal aortic aneurysm can manifest itself with a pulsating formation. In the abdominal cavity there is a pulsation in the rhythm of heart contractions.
In some cases, there is periodic pain caused by pressure of the aneurysmal sac on the spinal roots - it gradually increases, as the aneurysm develops. Pain can occur after eating, arises intermittent claudicationdue to embolism. The occurrence of severe sharp pain in the abdomen and lower back is a symptom of aneurysm rupture. With complications, there is pain in the legs, their pallor or cyanosis, which is caused by clogged arteries with pieces of blood clots.
Such meager symptoms of abdominal aortic aneurysm make it difficult to diagnose the disease in the early stages. In 40% of cases, problems are detected by instrumental examination, with suspected other diseases. X-ray or ultrasound examination of the aorta gives a more accurate result, it is with such studies and they find it most often.
On examination, the doctor may suspect an aneurysm with a stethoscope. The pulsation and noise that occurs during the flow of blood in the area of aneurysmal formation are heard. But such a diagnosis can only be if the patient does not suffer from excess weight. If aneurysm is suspected, computed tomography is performed, which makes it possible to more accurately determine the size and shape of the damage to the vessel, after which the doctor prescribes the treatment of abdominal aortic aneurysm. An X-ray examination is less informative than others, it only makes it possible to detect aneurysm by calcium deposits, but it is impossible to accurately determine its size or shape with such an examination.
Treatment of abdominal aortic aneurysm
The normal diameter of the aorta in the abdominal cavity is about two centimeters in diameter, aneurysmal enlargements can significantly exceed permissible norms, reaching critical sizes. Extensions of less than 5 cm are rarely fraught with rupture, so surgery is not necessary. But it should be noted that this disease does not go away on its own, in most cases, surgical intervention is required over time.
In order for the disease to progress and the aneurysmal expansion not to grow in size, the patient must be under the supervision of a doctor, namely the prevention of the development of abdominal aortic aneurysm. Every six months held Ultrasound scan and CT to control the condition and size of the aneurysm. Correction of blood pressure is necessarily carried out, for this antihypertensive drugs are prescribed. Only the fulfillment of all the doctor’s prescriptions and timely studies can make it possible to monitor the patient’s condition and conduct surgery on time.
Treatment of aneurysms of the abdominal aorta with sizes from 5 cm is carried out only promptly. Such enlargements are often complicated by rupture, which requires immediate surgical intervention, otherwise the rupture ends lethally. But even with immediate intervention, mortality is 50%. Therefore, as soon as the symptoms of abdominal aortic aneurysm are identified and an appropriate diagnosis is made, it is important to be monitored, and in case of further expansion of the vessel, perform the operation in a timely manner.
Today, there are two types of surgical treatment, but only a doctor can decide which one is more suitable for the patient, given his condition, lifestyle and other factors. In both types of surgical treatment, the basis is the implantation of an artificial vessel to restore normal blood circulation through the damaged aorta.
The traditional surgical treatment of abdominal aortic aneurysms involves the implantation of an artificial vessel of plastic material inside the dilated aorta. The aorta, as it were, envelops the implant with its tissues. The entire operation is performed through an incision in the abdominal cavity and lasts about 6 hours. With a radical method of treatment, 90% of operated patients have a favorable prognosis.
The second type of treatment is endovascular stent count, a special device with which an aneurysmal sac is isolated from the general bloodstream. Thus, the possible rupture of the thinned wall is prevented and a new path is created for blood flow. With such surgical intervention, the implant is implanted through a puncture in the inguinal region. At the junction of the femoral vessels, a special catheter, through which the device is inserted directly into the aneurysm, where the stent graph opens and forms a channel for normal blood flow. Such an operation takes from 2 to 5 hours and is a good alternative to the traditional method, especially for patients with a high risk of complications during surgery. But such treatment is contraindicated in patients with pathology of the arteries of the kidneys and other organs. Endoprosthetics It has no contraindications for age, and is much easier to tolerate by elderly patients than open surgery.
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Prevention of abdominal aortic aneurysm and the postoperative period during treatment
With traditional surgical intervention, the hospitalization period is from 5 to 8 days, after which constant monitoring is not required, complications arise in very rare cases. With endovascular intervention, hospitalization takes from 2 to 5 days, but observation and multiple CT scans are required. This is necessary for continuous monitoring of the state of the stent graph. In some cases, its lumen may narrow and the operation has to be repeated.
Prevention of the development of abdominal aortic aneurysm is the same as with coronary heart disease. First of all, it is control over blood pressure, lifestyle correction, refusal of bad habits, in particular from smoking. It is mandatory to conduct a series of studies every 3-6 months. Ultrasound indications will enable the doctor to accurately determine the need for surgical treatment and its method.
Do not forget that aneurysm rupture, It is dangerous by severe bleeding, in which internal organs and tissues are damaged, and even with a successful emergency surgery, kidney failure can develop during and after surgery, which greatly aggravates the patient's condition. Without rupture, the patient does not survive the rupture, and this complication occurs in 90% of patients who refuse to operate in the early stages of the disease.
Diet, nutrition for abdominal aortic aneurysm
Diet for cleansing blood vessels for diseases of the cardiovascular system
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Diet for atherosclerosis of blood vessels
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List of sources
- Outpatient angiology. A guide for doctors / Edited by A. I. Kiriyenko, V. M. Koshkin, V. Yu. Bogachev. - M .: Litera, 2007 .-- 327 p.
- Angiology. Ed. M.V. Ivanov - F48 M .: Medicine, 1981. - 674 p.
- Evdokimov A. G., Topolyansky V. D. Diseases of arteries and veins. - M .: Medicine, 2006 .-- 254 p.