The abdominal aorta is pulsating, what should I do? The abdominal aorta pulsates

This is the name of the pathological expansion of the aortic wall in the abdominal region. The disease is asymptomatic in a number of cases, only sometimes making itself felt by pain or strong pulsation, but if the aneurysm abdominal aorta ruptures and internal bleeding begins.

Aortic aneurysm is a pathological expansion of the aortic wall in the abdominal region

What is known about the disease

Localization of possible formation of aortic pathology is 12 thoracic – 5 lumbar vertebrae. At the same time, you need to know that it most often undergoes this kind of changes - up to 95% of all age-related and other painful changes in blood vessels occur in this particular aorta.

The aorta is one of the main blood vessels that runs through the entire body. According to the location of its passage, it can be divided into several sections; according to their names, the types of aortic aneurysms are classified:

• ascending
• aortic arch
• thoracic or descending
• abdominal.

An aneurysm can form in any of these sections, and not necessarily as independent disease, but also how associated complication with other pathological processes in the body.

An aneurysm can manifest itself in different ways; blood may partial rupture begin to move, as it were, along the second channel, between the layers. Often, a dissecting abdominal aortic aneurysm is a continuation of a thoracic aortic dissection. Very rarely, a complete rupture occurs inside the dissecting aorta itself, in which case self-healing occurs, but more often it quickly leads to death.

Aneurysm of the ascending aorta is a severe condition that forms insufficiency heart valve. With rapid development, it can provoke displacement of the aorta.

An aneurysm of the ascending aorta can be either a protrusion of the vessel wall (blood is thrown into the formed sac and begins to circle there, worsening the patient’s condition) or its dissection (blood begins to move along a new channel between the layers).

Aneurysm of the aortic arch is an expansion of the vessel in the space between the ascending and descending sections of the aorta. It appears in a hoarse voice, swelling of the face.

An abdominal aortic aneurysm may be combined with other pathologies that have arisen in different departments vessel.

Even if there are no symptoms of pathology, the aneurysm will progress - its size increases by 10% annually, which can ultimately lead to its rupture.

Treatment of aortic aneurysm is exclusively surgical - surgery must be performed. The damaged area is cut out, then the aorta is sutured, restoring it normal shape and sizes using synthetic transplants, or endoprosthetics are used. Mortality during operations is about 8.2%.

The endoprosthesis is a frame with a diameter the size of the vessel being operated on, made of material compatible with human tissue. It is securely fixed and helps to fully restore the functionality of the damaged area.

Contraindications to surgery may be:

• recently suffered myocardial
• pulmonary failure
• significant damage to the femoral and iliac arteries (in particular, their poor patency).

If there is a need to make an urgent decision to carry out surgical intervention the doctor proceeds from the patient’s general vital signs.

Important! If the aortic aneurysm grows slowly, drug treatment can be prescribed to control cholesterol formation and slow down its development, but in this case there is still a risk of a different outcome, the patient should be constantly monitored by a doctor.

How is it discovered?

If the presence of an abdominal aortic aneurysm is suspected, the following diagnostics are performed:

• X-ray of the abdominal area

• Doppler ultrasound – accurate modern method determining the condition of blood vessels, identifying blood flow disorders. Allows diagnostics in three modes, each of which fully illuminates everything possible deviations– from plaques on the walls of blood vessels to bulging walls of blood vessels and areas with impaired blood flow.
• X-ray contrast angiography is a method of monitoring the condition of blood vessels and blood flow using contrast agents that are injected into the blood. When colored blood passes through the area under study, all abnormalities are visible on the angiograph.

Since a developed aneurysm creates an area of ​​increased pulsation in the abdominal region, it can be detected by palpation. It is especially easy to detect in thin patients.

For what reason can the disease occur?

• One of the main reasons for the occurrence similar problem with vessels is almost 90% of cases.
• Less commonly, the appearance of aneurysms is associated with inflammatory processes during the development of diseases such as rheumatism, salmonellosis and others.

• The body may initially have conditions for the development of this pathology, for example, congenital inferiority of the walls of blood vessels - fibromuscular dysplasia.
• Possible formation of iatrogenic aneurysms as a result wrong actions doctors. This can happen if there are errors in angiography, and even after surgery to remove an aortic aneurysm.
• A traumatic aneurysm can occur when there is damage to the abdominal area or spine.
• Smoking in large quantities can contribute to the development of the disease, and the risk increases with age.
• Aneurysm rupture occurs more often in people with high blood pressure, as well as in the presence of chronic lung diseases.
• The risk of rupture depends on the shape of the aortic sac and the size of the aneurysm itself.

Symptoms of an aneurysm

If the disease develops without pronounced symptoms, it can only be detected by chance, during an ultrasound for another problem in the peritoneum. It can also be detected during examination of the abdominal area by palpation, laparoscopy, or X-ray examination, but always by accident.

• One of the main symptoms of an aortic aneurysm is dull It's a dull pain in the left side of the abdomen or under the stomach, sometimes in parallel there is pain in the lower back or groin area. Often, diagnoses are made: renal colic, and others.
• Instead of pain, a feeling of heaviness and fullness in the abdomen, sometimes very strong pulsation, may regularly appear. If the aneurysm begins to put pressure on the stomach or intestines, frequent belching, vomit, strong gas formation, other deviations in the gastrointestinal tract.
• on bladder leads to gradual urinary dysfunction. The kidney may also be displaced, which can cause hematuria (blood in the urine). Men may experience pain in the testicles as a result of compression of nearby veins and arteries.
• Increasing pressure on nerve endings and vertebrae can lead to various degrees of motor activity disorders, such as lower back pain, weakness of the lower extremities, etc. For example, lameness may appear, and alternately, or changes in the tissues of the extremities caused by deterioration of blood supply.

Signs of aortic rupture

Rupture of an abdominal aortic aneurysm is accompanied by symptoms of an acute abdomen - signs of catastrophic changes in the abdominal cavity requiring immediate surgical intervention. It appears as follows:

• abdominal pain
• tension in the anterior abdominal wall

• violation of peristalsis
• collapse.

Without emergency care leads to death.

Symptoms differ in the direction of the rupture - where there will be blood from a ruptured aneurysm:

• into the retroperitoneal space

This gap is characterized constant pain, which can radiate to the groin, perineum, thigh. Heart pain may occur. In this case, the blood loss is about 200 ml.

• into the intraperitoneal space

Coming state of shock, pallor, pain throughout the abdomen. Death occurs quickly.

• into the inferior vena cava

Shortness of breath, swelling of the lower extremities, etc. appear. An easily detectable pulsating mass forms in the abdomen. Staying in this state very quickly leads to severe pain.

• into the duodenum

In this case, the disease is incorrectly identified, since the symptoms exactly repeat the clinical picture of gastrointestinal bleeding: hematemesis, collapse, melena (bloody stool with a pungent odor).

Conclusion

Abdominal aortic aneurysm – insidious disease, the development of which threatens the patient’s life, so if symptoms appear that at least partially resemble the signs of aortic rupture described above, you should immediately call an emergency medical care. If there are signs of developing the disease, it is better to consult a doctor to rule out the presence of this pathology.

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Updated: 04.05.2017

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Aorta is the largest vessel in the human body. The aorta and its branches carry oxygenated blood from the left ventricle of the heart to all organs. This is the main highway in human blood circulation; it is conventionally divided into several sections: ascending aorta, aortic arch And descending aorta. The last section is divided into chest And abdominal Part. The most common disease of this vessel is. In three out of four cases of vascular disease, an abdominal aortic aneurysm occurs, and only in one is the localization occurs in.

Aneurysm– pathological expansion of the vessel, in places where its walls are weakened. Under the influence of high blood pressure, the vessel wall expands and, as a result, protrudes. According to their shape, aneurysms are divided into baggy And fusiform education. In both cases, blood flow is disrupted, which contributes to the occurrence. In some cases, calcium accumulates in the aneurysm sac and the vessel wall becomes calcified, making it brittle and predisposing it to rupture.

An abdominal aortic aneurysm is localized primarily below the origin of the renal arteries. Therefore, its complications are dangerous for the pelvic organs and lower extremities. What is the most common complication? . During its course, the thrombus spreads from the aneurysmal sac along the course of the vessel. The thrombus fragments, and its pieces spread through the bloodstream to the pelvic organs and extremities. Pieces of the blood clot can clog the arteries, leading to necrosis of the lower extremities. But the most dangerous thing for the patient’s life is the rupture of an aneurysm, which results in hemorrhage into the abdominal cavity.

Although there are no obvious symptoms of an abdominal aortic aneurysm, complications may arise. indirect signs, which will be discussed later, but first let’s look at the causes of the disease.

Causes of abdominal aortic aneurysm

The development of an aneurysm is caused by 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 dissection of the aortic wall, with the more fragile inner walls tearing and the outer wall bulging, forming dissecting aortic aneurysm. The causes of abdominal aortic aneurysm are also arterial hypertension, inflammatory diseases of the aortic wall, congenital diseases connective tissue, infectious diseases, in particular accompanied by damage to the aorta.

A predisposition to the development of an aneurysm is observed in men over 60 years of age, most often in those who smoke or have uncontrolled high blood pressure. blood pressure. Women are less predisposed to this disease. Hereditary factors and the presence of the disease in other family members also play a role. It has been proven that Marfan syndrome in parents greatly increases the likelihood of developing an aneurysm.

Diagnosis and symptoms of abdominal aortic aneurysm

In some cases, the disease is practically asymptomatic, which is why it is detected during the diagnosis of other diseases, but more often an abdominal aortic aneurysm can manifest itself as the presence of a pulsating formation. A pulsation is felt in the abdominal cavity in rhythm with heart contractions.

In some cases, periodic pain occurs caused by the pressure of the aneurysmal sac on the spinal roots - it gradually increases as the aneurysm develops. Pain can also occur after eating, due to embolism. The occurrence of severe sharp pain in the abdomen and lower back is a symptom of a ruptured aneurysm. In case of complications, there is pain in the legs, their pallor or cyanosis, which is caused by blockage of the arteries with pieces of blood clots.

So scant symptoms Abdominal aortic aneurysms make it difficult to diagnose the disease in the early stages. In 40% of cases, problems are discovered during instrumental examination, if other diseases are suspected. X-ray or ultrasound examination of the aorta gives a more accurate result, and it is with such studies that it is most often detected.

During examination, the doctor may suspect an aneurysm using a stethoscope. Pulsation and noise can be heard as blood flows in the area of ​​the aneurysmal formation. But such a diagnosis can only be made if the patient does not suffer from excess weight . If an aneurysm is suspected, a computed tomography scan is performed, which makes it possible to more accurately determine the size and shape of damage to the vessel, after which the doctor prescribes treatment for an abdominal aortic aneurysm. X-ray examination is less informative than others; it only makes it possible to detect an aneurysm by calcium deposits, but it is impossible to accurately determine its size or shape with such an examination.

The normal diameter of the aorta in the abdominal cavity is approximately two centimeters in diameter, aneurysmal dilatations can significantly exceed acceptable standards, reaching critical sizes. Dilations of less than 5 cm rarely cause 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 to prevent the development of an abdominal aortic aneurysm. Every six months it is carried out Ultrasound And CT to control the condition and size of the aneurysm. Blood pressure must be corrected and antihypertensive drugs are prescribed for this purpose. Only following all the doctor’s instructions and timely research can make it possible to monitor the patient’s condition and carry out surgical intervention in a timely manner.

Abdominal aortic aneurysm larger than 5 cm is treated only surgically. Such extensions are often complicated by rupture, which requires immediate surgical intervention, otherwise the rupture ends lethal. But even with immediate intervention, the mortality rate is 50%. Therefore, as soon as the symptoms of an abdominal aortic aneurysm are identified and the appropriate diagnosis is made, it is so important to be under observation, and in case of further dilation of the vessel, to 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, taking into account his condition, lifestyle and other factors. In both types surgical treatment It is based on the implantation of an artificial vessel to restore normal blood circulation through the damaged area of ​​the aorta.

Traditional surgical treatment of abdominal aortic aneurysm involves implantation of an artificial vessel made of plastic material inside the dilated aorta. The aorta seems to envelop the implant with its tissues. The entire operation is performed through an incision in the abdominal cavity and lasts about 6 hours. With radical treatment, 90% of operated patients have a favorable prognosis.

The second type of treatment is endovascular stent graft insertion, a special device with which the aneurysmal sac is isolated from the general bloodstream. In this way, a possible rupture of the thinned wall is prevented and a new way for blood flow. With this type of surgery, the implant is inserted through a puncture in the groin area. At the junction of the femoral vessels, a special catheter, through which the device is inserted directly into the aneurysm, where the stent graft opens and forms a channel for normal blood flow. This 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.

Prevention of the development of abdominal aortic aneurysm is the same as for coronary disease hearts. First of all, this is control over blood pressure, lifestyle correction, refusal bad habits, in particular from smoking. It is mandatory to conduct a series of studies every 3-6 months. Ultrasound readings will enable the doctor to accurately determine the need for surgical treatment and its method.

It should not be forgotten that aneurysm rupture, is dangerous due to severe bleeding, which damages internal organs and tissues, and even with successful urgent surgical intervention, it can develop renal failure during and after surgery, which greatly aggravates the patient’s condition. Without surgical care if a rupture occurs, the patient does not survive, and such a complication occurs in 90% of patients who refuse surgery in the early stages of the disease.

Abdominal aortic aneurysm is a serious pathological condition that occurs in approximately one in twenty people over 65 years of age. It is not so much the disease itself that is dangerous, but the consequences it can lead to. Aneurysm rupture is often fatal.

Aorta and aortic aneurysm

The aorta is the largest vessel in the human body, thanks to which almost all organs are supplied with blood.

The aorta is the largest vessel in the human body, feeding almost the entire body

The aorta itself consists of three layers:

1. The outer layer (adventitia) is tunica externa. Mainly formed by connective tissue for the mechanical strength of the vessel. It is in this layer that the so-called vasa vasorum are presented - the vessels that feed the wall.
2. The middle layer is tunica media. Consists of elastic and muscle fibers. This is necessary to stretch the walls during blood flow.
3. The inner layer is tunica intima. Represented by endothelium. Designed in such a way that it is able to pass nutrients to maintain the aorta.

The aorta consists of three layers - outer, middle and inner

Conditionally in anatomical structure The aorta has four parts:

1. Ascending aorta. Relatively short. The heart is nourished from the arteries that arise from this section.
2. Aortic arch. From here there is blood supply to the head and both arms.
3. Thoracic descending aorta. Takes place at level three or four thoracic vertebra right up to the diaphragm, along the way feeding all organs and formations located nearby.
4. Abdominal portion of the descending aorta. It begins after the artery of the diaphragm passes through a special opening. The length is approximately 15 cm. In the area of ​​the lumbar vertebrae, the aorta is divided into iliac arteries.

An aortic aneurysm is a sac-like protrusion of the aorta

An aneurysm is an anomaly in the lining of a vessel in which its wall bulges. Although it does not occur particularly often, it is still terrible for its complications.

Abdominal aortic aneurysm - video

Classification

Aneurysms should be classified, for example, to select further treatment tactics.

Depending on the layer in which the defect formed, it can be:

• true. The cavity is the directly expanded walls of the aorta, blood collects, and because of this, bulging occurs;
• false. Formed from the connective tissue that surrounds the aorta. The cavity of such a formation is filled with blood through a crack that has arisen in the wall of the aorta;
• exfoliating. This pathology develops when a cavity forms between the layers in the walls of the aorta. Refers to one of the most formidable forms.

Depending on the shape, aneurysms are divided into:

• saccular. Protrusion of the vessel wall on one side;
• fusiform. Protrusion occurs on all sides.

Examples various forms aneurysm

Depending on the size:

• small aneurysm, three to five centimeters in diameter;
• medium aneurysm, with a diameter of five to seven centimeters;
• large aneurysm with a diameter of more than seven centimeters;
• a giant aneurysm, the diameter is eight to ten times greater than the diameter of the aorta.

Regarding the course of the disease:

• asymptomatic course. The patient is not bothered at all, he does not even suspect the presence of an aneurysm;
• painless course. There are symptoms, but no pain;
• painful course. There is pain in the abdominal area.

Depending on the stage of development of the aneurysm:

• threatening rupture;
• delamination;
• aneurysm rupture.

Regarding location on the aorta:

• suprarenal. Occur when the upper border of the aneurysm is located above the origin of the renal (renal) artery;
• subrenal. Upper limit located below the origin of the renal artery;
• infrarenal. Develops in the lowest part of the aorta near the bifurcation (branching).

Causes and development factors

There are two key points in the formation of aortic aneurysm:

1. Firstly, there must be some kind of weak point in the vessel - a wall defect.
2. Secondly, a force is needed that will act on this very place. In the case of an aneurysm, this force is blood pressure, the level of which increases due to various reasons.

The formation of a defect can occur for the following reasons:

1. Congenital disorders. This could be, for example, Marfan syndrome (a defect in the development of connective tissue).
2. Various traumatic injuries:
   • penetrating wounds of the abdominal cavity, in which damage to the entire thickness of the aorta or only part of its wall is possible;
   • closed abdominal injuries, when an increase in intraperitoneal pressure may occur.
3. Infectious inflammations. For example:
   • tuberculosis;
   • dysentery;
4. Inflammations of a non-infectious nature. This includes various autoimmune diseases that occur due to inadequate reaction the body onto its own tissues. For example:
   • Bekhterev's disease;
   • nonspecific aortoarteritis.
5. Atherosclerosis. The risk of its development increases with:
   • smoking;
   • overweight;
   • elevated blood sugar levels;
   • hypercholesterolemia.
6. Complications arising after operations.

Example of a normal and diseased aorta

Risk factors include:

• smoking;
• ervopeoid race;
• increased blood cholesterol levels;
• old age;
• male gender;
• heredity;
• high blood pressure.

Signs and symptoms

In 25% of cases, the disease is completely asymptomatic. At the same time, the risk of death from a ruptured aneurysm is high, since the person is unaware of the disease and does not receive any treatment. Often, these types of formations are accidental findings during examination.

Typical symptoms will be:

• abdominal pain;
• pulsation in the abdomen.

Depending on the location of the aneurysm, the following symptoms may occur:

1. Symptoms related to the digestive tract:
   • rapid weight loss;
   • heartburn;
   • nausea;
   • constipation or diarrhea;
   • increased gas formation.
2. Symptoms associated with the genitourinary system:
   • heaviness in the lumbar region;
   • various urinary disorders;
   • renal colic;
   • blood in the urine.
3. Symptoms associated with compression of the nerve roots:
   • pain in the lumbar region, which intensifies when bending or turning;
   • sensory disturbances in the lower extremities;
   • weakness in the legs.
4. Symptoms associated with insufficient blood circulation in the lower extremities:
   • intermittent claudication;
   • trophic ulcers;
   • lack of hair on the lower extremities;
   • cold feet.

Rupture of an abdominal aortic aneurysm is a life-threatening condition

Characteristic signs of rupture will be typical for any internal bleeding:

• abdominal pain;
• pallor skin;
• thready pulse;
• very fast heartbeats;
• throbbing in the abdomen;
• loss of consciousness.

Diagnostics

1. Ultrasound examination. It is preferred due to its simplicity and fairly good information content. You can measure the diameter of the vessel in its various parts.
2. Angiography. The bottom line is that during the study, a contrast agent containing iodine is injected into the patient through a special probe, then its distribution throughout the vessels is observed.
3. Radiography. The method was used earlier when there were no other visualization methods. Due to its low information content, it is rarely used.
4. Computed tomography (CT). Allows you to detect on images the expansion at the site of aneurysm formation. Is one of the most precise methods diagnostics
5. Spiral computed tomography (SCT). With this method, volumetric modeling of the entire organism occurs. A very informative diagnostic method that allows you to project a model of the formation on the equipment.

Treatment: drug therapy

Drug therapy for abdominal aortic aneurysm is often only preparatory stage to the operation. It is aimed at reducing the impact various factors risk. Can be used:

• beta blockers (Coronal);
• statins (Lovastatin);
• angiotensin-converting enzyme inhibitors (Captopril);
• anticoagulants (Warfarin).

Medicines: Coronal, Lovastatin and others - gallery

Coronal is a drug used to treat arterial hypertension
Lovastatin - a drug to lower cholesterol levels
Lovastatin is a drug used to treat high blood pressure.
Warfarin is a drug that prevents blood clots

Surgical intervention: resection, endoprosthetics and other methods

Surgery is the main treatment method for aortic aneurysm.

Indications for surgery

Today, the indications for surgical treatment of aneurysms are:

• aneurysm diameter more than 55 mm;
• saccular form of aneurysm;
• various kinds of complications;
• gap

Stages of surgery

The steps of the operations are generally similar, regardless of the type of intervention. The only exceptions are intravascular manipulations. With open options:

• the patient is put under anesthesia;
• access the aortic aneurysm and isolate it along its entire length;
• they clamp the vessels and perform resection of the artery, followed by prosthetics or installation of an aorto-iliac shunt;
• Afterwards, the wound is sutured in layers.

Rehabilitation after surgery

The recovery period after surgery largely depends on the method that was chosen as treatment. At open methods rehabilitation takes several weeks, it consists of preventing bleeding, blood clots, and infection. With the endovascular option, the patient is in the hospital for only two to three days. Subsequently, he needs to return to his doctor in a month to check the stent graft.

Reviews from doctors and patients

There is quite detailed information on the topic of stenting an abdominal aortic aneurysm. This type of operation is indeed tolerated by patients (especially old age) is significantly easier than open prosthetic surgery. At the same time, stenting an abdominal aortic aneurysm has quite a few limitations (i.e., it cannot be performed on every patient); In addition, this is a very, very expensive procedure.

Anna Evgenievna Udovichenko

https://forums.rusmedserv.com/showthread.php?t=35842

It is not enough to survive an aneurysm; you also need to undergo surgery to remove it. The risk of surgery for a thoracic aortic aneurysm, which I experienced, is very high. The highest operative mortality rate is for aneurysms of the ascending section and aortic arch and, according to various authors, ranges from 20 to 75%.

6% live without surgery for 10 years, then no longer live, and after surgery, a maximum of 40% reach 5 years. It turns out that, for some reason, I was lucky, there is a chance next year that I will reach the 10-year mark of living without surgery. After all, I have two aneurysms, one was operated on and the other was not. When I was examined 2 years ago in Novosibirsk, where I had my first operation, I learned that everyone who had a similar operation at the same time as me, everyone died, except me and one other guy. And that guy is generally great, he even removed his disability and lives an ordinary life. But he has one advantage over me, he had one aneurysm, only in the thoracic region.

http://golodanie.su/forum/showthread.php?t=9557&page=4

Today I talked with colleagues - leading specialists in Russia in aortic replacement. Their experience is the greatest in the country. At the same time, we discussed physical activity after surgery. The verdict is as follows: when limited physical activity within reason this means one thing. Any physical activity associated with enlargement intra-abdominal pressure, blood pressure, and exercises that can directly or indirectly injure the abdominal (or thoracic) cavity are strictly contraindicated. This means skiing, snowboarding, rock climbing, skating and roller skating, parachuting and diving, wrestling and other martial arts, game types sports (except chess and checkers 🙂) and so on. (The list can be deepened and supplemented...) are categorically contraindicated. The world medical literature describes cases of displacement and dislocation of the stent and rupture of aneurysms even when straining in the toilet with chronic constipation. We must not forget that an aneurysm of the abdominal and/or thoracic aorta is a deadly disease with a very high mortality rate. If an aneurysm ruptures, no more than 20 percent of patients survive (only one in five!!!). In the distant postoperative period(after arthroplasty) the mortality rate is 5 to 10 percent. A patient, even with a successfully prosthetic aortic anerism, unfortunately remains a sick person, who, with the help of modern technologies, has been somewhat protected from sudden death from a ruptured aneurysm, but it cannot be completely cured. The patient must be wise in choosing physical activity in order to move on with LIVING.

http://forum.tetis.ru/viewtopic.php?f=17&t=92573

Diet

It is worth excluding foods that increase gas formation and accelerate peristalsis, which contribute to an increase in blood cholesterol and blood pressure.

You can give preference to:

• oatmeal;
• cottage cheese with sour cream;
• boiled fish.

You need to refuse:

• fried meat;
• smoked meats;
• foods containing large amounts of salt.

Permitted and prohibited products - photo gallery

Oatmeal is a good source of complex carbohydrates
Cottage cheese with sour cream is a source of proteins necessary for the recovery of the patient
Boiled fish contains a large amount of polyunsaturated fatty acids, which helps reduce cholesterol levels
Fried meat contains a large amount of harmful fatty acids, which is a risk factor for the development of atherosclerosis
Smoked meat is a source of large amounts of polysaturated acids and salts, which is contraindicated in case of aortic aneurysm
Pickles contain a lot of salt, which increases blood pressure

Folk remedies

On initial stages diseases can be used folk remedies that can prevent further development pathology and reduce the risk of complications:

1. Dill infusion:
   • finely chop the dill leaves and leave in 500 ml of boiling water;
   • drink three times a day throughout the day.
2. Hawthorn infusion:
   • take hawthorn berries, dry them and grind them into powder;
   • 3 tbsp. pour 400 ml of water over the resulting product and leave for half an hour;
   • consume thirty minutes before meals three times a day.
3. Infusion of gillyflower jaundice:
   • take three tablespoons of the plant, pour 250 ml of hot water;
   • consume 20 ml every four to five hours.
4. Elderberry decoction:
   • take the root of the plant and throw it into boiling water;
   • leave for fifteen to twenty minutes;
   • Take a tablespoon of the decoction half an hour before meals three times a day.

Treatment prognosis and possible complications

If there is no adequate surgical therapy, then the mortality rate is 90%, with treatment the probability of death is up to 30%.

Complications are:

• aneurysm dissection;
• gap;
• thrombus formation;
• the occurrence of infections.

Prevention

1. Refusal of heavy physical activity.
2. A diet that avoids foods that increase gas formation and enhance peristalsis.
3. Blood pressure control.
4. Controlling cholesterol levels.
5. Visit the doctor once a year.

Abdominal aortic aneurysm: symptoms and causes - video

Do not underestimate an aortic aneurysm. The absence of symptoms in no way indicates the severity of the condition. Must be completed annually preventive observations from specialists so as not to miss the development of such formidable pathologies.

An abdominal aortic aneurysm is a pathological expansion of the abdominal aorta in the form of a protrusion of its wall in the area from the XII thoracic to the IV-V lumbar vertebrae. In cardiology and angiosurgery, abdominal aortic aneurysms account for up to 95% of all aneurysmal changes in blood vessels. Among men over 60 years of age, abdominal aortic aneurysm is diagnosed in 2-5% of cases. Despite the possible asymptomatic course, abdominal aortic aneurysm is prone to progression; on average, its diameter increases by 10% per year, which often leads to thinning and rupture of the aneurysm with a fatal outcome. In the list of the most common causes of death, abdominal aortic aneurysm ranks 15th.

Classification of abdominal aortic aneurysm

Of greatest clinical value is anatomical classification abdominal aortic aneurysms, according to which infrarenal aneurysms are distinguished, located below the origin of the renal arteries (95%) and suprarenal aneurysms with localization above the renal arteries.

Based on the shape of the protrusion of the vessel wall, saccular, diffuse fusiform and dissecting aneurysms of the abdominal aorta are distinguished; according to the structure of the wall - true and false aneurysms.

Taking into account the etiological factors, abdominal aortic aneurysms are divided into congenital and acquired. The latter can have a non-inflammatory etiology (atherosclerotic, traumatic) and inflammatory (infectious, syphilitic, infectious-allergic).

According to the clinical course, an abdominal aortic aneurysm can be uncomplicated or complicated (dissecting, ruptured, thrombosed). The diameter of the abdominal aortic aneurysm allows us to speak of a small (3-5 cm), medium (5-7 cm), large (over 7 cm) and giant aneurysm (with a diameter 8-10 times higher than the diameter of the infrarenal aorta).

Based on the prevalence of A.A. Pokrovsky et al. There are 4 types of abdominal aortic aneurysm:

• I – infrarenal aneurysm with a sufficiently long distal and proximal isthmus;
• II - infrarenal aneurysm with a proximal isthmus of sufficient length; extends to the aortic bifurcation;
• III - infrarenal aneurysm involving the bifurcation of the aorta and iliac arteries;
• IV – infra- and suprarenal (total) aneurysm of the abdominal aorta.

Causes of abdominal aortic aneurysm

According to research, the main etiological factor aortic aneurysms (aortic arch aneurysms, thoracic aortic aneurysms, abdominal aortic aneurysms) is atherosclerosis. Among the causes of acquired aortic aneurysms, it accounts for 80-90% of cases of the disease.

The more rare acquired origin of abdominal aortic aneurysms is associated with inflammatory processes: nonspecific aortoarteritis, specific vascular lesions in syphilis, tuberculosis, salmonellosis, mycoplasmosis, rheumatism.

A prerequisite for the subsequent formation of an abdominal aortic aneurysm may be fibromuscular dysplasia - a congenital defect of the aortic wall.

The rapid development of vascular surgery in recent decades has led to an increase in the number of iatrogenic abdominal aortic aneurysms associated with technical errors during angiography and reconstructive operations (aortic dilatation/stenting, thromboembolectomy, prosthetics). Closed damage abdominal cavity or spine can contribute to the occurrence of traumatic aneurysms of the abdominal aorta.

About 75% of patients with abdominal aortic aneurysm are smokers; Moreover, the risk of developing an aneurysm increases in proportion to the length of smoking and the number of cigarettes smoked daily. Age over 60 years, male gender and the presence of similar problems in family members increase the risk of developing an abdominal aortic aneurysm by 5-6 times.

The likelihood of rupture of an abdominal aortic aneurysm is higher in patients suffering from arterial hypertension And chronic diseases lungs. In addition, the shape and size of the aneurysmal sac is important. It has been proven that asymmetric aneurysms are more susceptible to rupture than symmetric ones, and when the aneurysm diameter is more than 9 cm, mortality from rupture of the aneurysmal sac and intra-abdominal bleeding reaches 75%.

Pathogenesis of abdominal aortic aneurysm

Inflammatory and degenerative atherosclerotic processes in the aortic wall play a role in the development of abdominal aortic aneurysm.

An inflammatory reaction in the aortic wall occurs as an immune response to the introduction of an unknown antigen. At the same time, infiltration of the aortic wall with macrophages, B- and T-lymphocytes develops, the production of cytokines increases, and proteolytic activity increases. The cascade of these reactions, in turn, leads to degradation of the extracellular matrix in the middle layer of the aortic membrane, which is manifested in an increase in collagen content and a decrease in elastin. In place of smooth muscle cells and elastic membranes, cyst-like cavities are formed, as a result of which the strength of the aortic wall decreases.

Inflammatory and degenerative changes are accompanied by thickening of the walls of the aneurysmal sac, the occurrence of intense perianeurysmal and postaneurysmal fibrosis, fusion and involvement of the organs surrounding the aneurysm in the inflammatory process.

With an uncomplicated course of an abdominal aortic aneurysm, there are no subjective symptoms of the disease. In these cases, an aneurysm can be diagnosed accidentally by palpation of the abdomen, ultrasound, radiography of the abdominal cavity, diagnostic laparoscopy for other abdominal pathology.

The most typical clinical manifestations of an abdominal aortic aneurysm are constant or periodic aching, dull pain in the mesogastrium or left half of the abdomen, which is associated with the pressure of the growing aneurysm on nerve roots and plexuses in the retroperitoneal space. Pain often radiates to the lumbar, sacral or groin area. Sometimes the pain is so intense that analgesics are required to relieve it. Pain syndrome can be regarded as an attack renal colic, acute pancreatitis or radiculitis.

Some patients, in the absence of pain, note a feeling of heaviness, fullness in the abdomen or increased pulsation. Due to mechanical compression of the abdominal aorta of the stomach and duodenum by the aneurysm, nausea, belching, vomiting, flatulence, and constipation may occur.

Urological syndrome with an abdominal aortic aneurysm can be caused by compression of the ureter, displacement of the kidney and is manifested by hematuria and dysuric disorders. In some cases, compression of testicular veins and arteries is accompanied by the development of a pain symptom complex in the testicles and varicocele.

The ischioradicular symptom complex is associated with compression of the nerve roots of the spinal cord or vertebrae. It is characterized by lower back pain, sensory and motor disorders in the lower extremities.

An abdominal aortic aneurysm may develop chronic ischemia lower extremities, occurring with symptoms of intermittent claudication and trophic disorders.

Isolated dissecting abdominal aortic aneurysm is extremely rare; more often it is a continuation of dissection of the thoracic aorta.

Symptoms of a ruptured aneurysm

Rupture of an abdominal aortic aneurysm is accompanied by an acute abdomen and can lead to a tragic outcome in a relatively short time.

The symptom complex of abdominal aortic rupture is accompanied by a characteristic triad: pain in the abdomen and lumbar region, collapse, increased pulsation in the abdominal cavity.

The clinical features of a ruptured abdominal aortic aneurysm are determined by the direction of the rupture (into the retroperitoneal space, free abdominal cavity, inferior vena cava, duodenum, bladder).

Retroperitoneal rupture of an abdominal aortic aneurysm is characterized by persistent pain. When a retroperitoneal hematoma spreads to the pelvic area, pain radiates to the thigh, groin, and perineum. High location hematomas can simulate cardiac pain. The amount of blood spilled into the free abdominal cavity during a retroperitoneal rupture of an aneurysm is usually small - about 200 ml.

With intraperitoneal localization of the rupture of the abdominal aortic aneurysm, a clinical picture of massive hemoperitoneum develops: the phenomena rapidly increase hemorrhagic shock- severe pallor of the skin, cold sweat, weakness, threadlike, rapid pulse, hypotension. There is severe bloating and pain in the abdomen in all parts, and a diffuse Shchetkin-Blumberg symptom. Percussion determines the presence free liquid in the abdominal cavity. Death with this type of rupture of an abdominal aortic aneurysm occurs very quickly.

A rupture of an abdominal aortic aneurysm into the inferior vena cava is accompanied by weakness, shortness of breath, and tachycardia; swelling of the lower extremities is typical. Local symptoms include pain in the abdomen and lower back, a pulsating formation in the abdomen, over which a systole-diastolic murmur is heard. These symptoms increase gradually, leading to severe heart failure.

When an abdominal aortic aneurysm ruptures into the duodenum, a clinical picture of profuse gastrointestinal bleeding develops with sudden collapse, hematemesis, and melena. From a diagnostic point of view, this type of rupture is difficult to distinguish from gastrointestinal bleeding of other etiologies.

Diagnosis of abdominal aortic aneurysm

In some cases, a general examination, palpation and auscultation of the abdomen allows one to suspect the presence of an abdominal aortic aneurysm. To identify familial forms of abdominal aortic aneurysm, it is necessary to obtain a thorough medical history.

When examining thin patients in the supine position, increased pulsation of the aneurysm through the anterior abdominal wall can be detected. On palpation, a painless pulsating dense elastic formation is revealed in the upper abdomen on the left. On auscultation, a systolic murmur is heard over the abdominal aortic aneurysm.

Most accessible method Diagnosis of an abdominal aortic aneurysm is performed by plain radiography of the abdominal cavity, which allows one to visualize the shadow of the aneurysm and calcification of its walls. Currently, ultrasound is widely used in angiology, duplex scanning abdominal aorta and its branches. The accuracy of ultrasound detection of abdominal aortic aneurysm approaches 100%. Using ultrasound, the condition of the aortic wall, the extent and location of the aneurysm, and the location of the rupture are determined.

CT or MSCT of the abdominal aorta allows you to obtain an image of the lumen of the aneurysm, calcification, dissection, intrasaccular thrombosis; identify a threat of rupture or an accomplished rupture.

In addition to these methods, aortography is used in the diagnosis of abdominal aortic aneurysm, intravenous urography, diagnostic laparoscopy.

Detection of an abdominal aortic aneurysm serves absolute indication to surgical treatment. A radical type of operation is resection of an abdominal aortic aneurysm followed by replacement of the resected area with a homograft. The operation is performed through a laparotomy incision. When the iliac arteries are involved in the aneurysm, bifurcation aorto-iliac replacement is indicated. The average mortality rate for open surgery is 3.8-8.2%.

Contraindications to elective surgery include recent (less than 1 month) myocardial infarction, stroke (up to 6 weeks), severe cardiopulmonary failure, renal failure, widespread occlusive lesions of the iliac and femoral arteries. In case of a tear or rupture of an abdominal aortic aneurysm, resection is performed for life-saving reasons.

To modern low-traumatic methods Abdominal aortic aneurysm surgery involves endovascular aneurysm replacement using an implantable stent graft. Surgical procedure performed in the cath lab through a small incision in the femoral artery; The progress of the operation is monitored by X-ray television. Installation of a stent graft allows you to isolate the aneurysmal sac, thereby preventing the possibility of its rupture, and at the same time creates new channel for blood flow. The advantages of endovascular intervention are minimal trauma, lower risk of postoperative complications, and rapid recovery. However, according to the literature, distal migration of endovascular stents is observed in 10% of cases.

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Abdominal aorta examination

Abdominal aorta (Fig. 362). The abdominal aorta is the most accessible section for physical examination. The examination of the patient should begin with an assessment of the color of the skin of the lower extremities, the state of trophism of their skin and muscles. In healthy people, the skin color of the lower extremities does not differ from the skin color of other parts of the body. The trophism of the skin (skin pattern, hair), trophism of the nails, and muscles of the lower extremities has no deviations.

Rice. 362. Abdominal aorta and its branches.

1 - abdominal aorga,
2 - hepatic artery,
3 - right renal artery;
4 - bottom mesenteric artery,
5 - right common iliac artery;
6 - right intrailiac artery,
7 - right external iliac artery;
8 - gastric artery,
9 - splenic auria,
10 - left renal artery,
11 - superior mesenteric artery,
12 - left common iliac artery;
13 - middle sacral artery,
14 - left internal iliac artery,
15 - left external iliac artery

For pathology of the abdominal aorta with a violation of its patency, pallor appears, thinning of the skin, hair loss on the legs, impaired trophism of the nails (thinning, fragility), the appearance trophic ulcers on the feet, atrophy of the leg muscles. Feet become cold to the touch.

Visible pulsation of the abdominal aorta is often observed in completely healthy individuals, especially in at a young age in asthenic patients with reduced nutrition, with a weak abdominal wall after excitement and physical activity, in excitable subjects with empty stomach and intestines. Ripple is usually visible when the patient is in an upright position, but is better when the patient is in a horizontal position. It disappears when the abdominal muscles are tense. The severity of such pulsation is not significant.

Pronounced visible pulsation observed in patients with a hyperkinetic type of hemodynamics, with an increased stroke volume of the heart - NCD, arterial hypertension, thyrotoxicosis, as well as in aortic valve insufficiency. In these cases, pulsation of varying intensity is usually visible from the xiphoid process to the navel.

Limited pulsatile bulge in the projection of the aorta is characteristic of a large aortic aneurysm. Only a bulging, but not pulsating tumor above the aorta is possible - this happens when the aneurysm thromboses.

Palpation of the abdominal aorta

Palpation of the abdominal aorta is of very great diagnostic value. It is held in horizontal position patient with maximum relaxation of the abdominal muscles (Fig. 363).

Rice. 363. Palpation of the abdominal aorta.
The patient is lying on his back, the doctor's fingers are located on the white line of the stomach across the axis of the aorta.
Upon reaching the posterior part of the abdominal cavity, as the patient exhales, a sliding movement is made with a roll through the aorta.
The abdominal aorta is examined from the xiphoid process to the navel and slightly below.

The examination begins from the xiphoid process and ends at the navel. It must be borne in mind that a hypersthenic upper third epigastric region is filled with the left lobe of the liver, so palpation should begin lower than in asthenics and normosthenics.

Palpation of the aorta is carried out in the same way as deep palpation belly. The doctor's palm is placed on the abdominal wall below the xiphoid process perpendicular to the axis of the aorta so that the terminal phalanges of the II, III, IV fingers are on the white line of the abdomen. Further, with each exhalation of the patient, they plunge into the abdominal cavity all the way to the back wall, that is, until the moment when pulsation appears under the fingers. Having reached it, the fingers calmly make a sliding movement across the aorta on the next exhalation. The manipulation is repeated 2-3 times. Then the fingers are placed in a similar manner slightly lower and palpation is carried out.

This way the entire abdominal aorta is examined from the sword to the navel or just below. U healthy person, if the aorta is palpated, then it is perceived as an elastic, moderately pulsating, even, smooth tube with a diameter of 2-3 cm. If the abdominal wall is weak, the stomach and intestines are not full and not swollen, palpation is easy even from the first immersion of the hand.

With developed muscles, a thick fat layer, and a full stomach and intestines, palpation is difficult. The aorta must be palpated along its entire length. The abdominal aorta is best palpated in asthenics, in women who have given birth many times, when the abdominal muscles diverge.

Increased pulsation abdominal aorta is observed during excitement, after physical exertion, which is associated with an increase in stroke volume of the heart.

In pathology, the following palpation deviations are possible: when examining the abdominal aorga:

Increase or decrease in pulsation;
- detection of limited aortic bulge
- aneurysms;
- detection of a limited non-pulsating compaction (thrombosed aneurysm),
- thickening and curvature of the aorta.

A pronounced pulsation of the abdominal aorta along its entire length is observed in patients with a hyperkinetic type of hemodynamics (NCD, arterial hypertension), with insufficient aortic valves, and with thyrotoxicosis

Weakened aortic pulsation throughout its entire length is determined in acute cardiac and vascular insufficiency(fainting, collapse, shock, myocarditis, acute myocardial infarction), with aortic stenosis, coarctation of the aorta, aortoarteritis, external compression of the aorta above the level of palpation.

Limited pulsatile aortic bulge- an aneurysm, can be of different sizes - from several centimeters to the size of the head. An aneurysm can have a round, oval, or sac-like shape. The surface of the aneurysm is smooth and has a densely elastic consistency. When it thromboses, it becomes denser, its pulsation is insignificant or absent. If an aneurysm is detected, palpation is carried out carefully, without excessive pressure and sliding movements on its surface. This is dangerous, as a blood clot can break off with serious consequences. The abdominal aorta, which is compacted throughout or in certain places, occurs with atherosclerotic lesions. A localized lump is sometimes mistaken for a tumor.

Thrombosis of the aortic trunk or its branches is accompanied by ischemia of the lower extremities (pale, cold legs, lack of pulsation in the vessels, gangrene). The slow development of thrombosis is manifested by a decrease in vascular pulsation, the development of collaterals and muscle atrophy. The pulsation of such an aorta is reduced, the zone of localization of the thrombus is compacted.

Ascultation of the abdominal aorta

Ascultation of the abdominal aorta is carried out along the white line of the abdomen from the xiphoid process to the navel (Fig. 364).

The phonendoscope is gradually immersed into the abdominal cavity, taking into account the patient’s breathing: as you exhale, the device goes down, while inhaling, it is held at the immersion level, resisting being pushed out by the abdominal muscles.

Depending on the development of the muscles, the aorta can be reached in 1 or 3 dives. Listening is carried out while exhaling with breath holding. This is how the phonendoscope moves from the sword to the navel. We draw attention to the inadmissibility strong pressure and compression of the aorta, which can cause a stenotic noise.

In adults, young and middle-aged people, no noise is heard during auscultation of the abdominal aorta. Only in children and adolescents can a quiet, short systolic murmur be detected in the middle of the distance between the navel and the xiphoid process.

Systolic murmur above the abdominal aorta of varying intensity is heard with aortic atheromatosis, aortitis, aneurysm and aortic compression. When assessing the results of auscultation of the abdominal aorta, one must keep in mind that the noise heard at the xiphoid process may be due to stenosis of the thoracic aorta, as well as stenosis or compression of the celiac trunk. Noise in the navel area occurs with increased blood flow in the umbilical and paraumbilical veins, in the dilated saphenous veins of the abdominal wall with non-union umbilical vein and cirrhosis of the liver.

In order to diagnose diseases of the abdominal aorta, as well as the thoracic aorta, it is necessary to measure and compare blood pressure in the arms and legs. Normal blood pressure in the legs is 20 mmHg. higher than on the hands. If the patency of the thoracic and abdominal aorta is impaired (coarctation, aortitis, thrombosis, external compression), the pressure in the legs will be reduced.

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What is the abdominal aorta

The aorta is the first vessel into which the heart pumps blood. It stretches in the form of a large tubular formation with a diameter of 1.5–2 cm to 2.5–3 cm through the chest, starting from the aortic-cardiac junction, and the entire abdominal cavity to the level of the articulation of the spine with the pelvis. This is the largest and most important vessel in the body.

Anatomically, it is important to divide the aorta into two sections: thoracic and abdominal. The first one is located in chest above the level of the diaphragm (the muscular strip that carries out breathing and separates the abdominal and thoracic cavities). The abdominal region is located below the diaphragm. Arteries emerge from it that supply blood to the stomach, small and large intestines, liver, spleen, pancreas, and kidneys. The abdominal aorta ends after bifurcation into the right and left common iliac arteries, which bring blood to the lower extremities and pelvic organs.

What happens during the disease and what is its danger

An abdominal aortic aneurysm is the following pathological change in this vessel:

• Outwardly it looks like an expansion, protrusion, an increase in the total diameter and internal lumen of the aorta section in comparison with the overlying and underlying sections.
• Located below the diaphragm (in any segment from the diaphragm to the level of separation) along the abdominal cavity - in the abdominal section.
• It is characterized by thinning and weakening of the walls of the vessel in the area of ​​protrusion.

All these pathological changes carry within themselves great danger in connection with:

There is debate among specialists regarding the criteria for diagnosing an abdominal aortic aneurysm. If previously it was believed that only an expansion of more than 3 cm was a reliable symptom of the disease, recent studies have shown the relative reliability of this information. This is due to the fact that many additional factors must be taken into account:

• gender – in men, the abdominal aorta is on average 0.5 cm wider in diameter than in women;
• age – with age, there is a natural expansion of the abdominal aorta (on average by 20%) due to weakening of its wall and increased blood pressure;
• section of the abdominal aorta - the lowest sections are normally 0.3–0.5 cm smaller in diameter than the upper ones.

Therefore, expansion of the aorta in the abdominal region of more than 3 cm is a correct, but not the only sign of the disease. This is because under no circumstances should a healthy aorta have a larger diameter. Due to the variability of the normal diameter of the aorta, experts classify even dilations of less than 3 cm as aneurysms if there is:

Types of aortic aneurysms

Based on the location of the abdominal aortic aneurysm, it is important to divide it into two types:

By type and shape, abdominal aneurysms are:

Small aneurysms

Experts identify a group of small aortic aneurysms - any enlargement with a diameter of up to 5 cm. The expediency of this is due to the fact that they are often recommended to be observed rather than operated on. If there is a rapid increase in size of more than 0.5 cm in 6 months, this indicates a threat of rupture. Such aneurysms require surgical treatment, despite their small size. Statistically, they rupture equally often compared to large aneurysms, but the number of postoperative complications and failures is much lower.

Causes of the disease

There are four main reasons for the development of abdominal aortic aneurysms:

1. The role of atherosclerosis

Atherosclerosis is the main cause of 80–85% of aneurysms. Cholesterol plaques both in the aorta itself and in the underlying sections - the arteries of the lower extremities - they destroy the vascular wall, reduce its strength, promote the formation of blood clots, and increase blood pressure in the aorta. Against this background, its expansion or protrusion is formed. It has been noted that with atherosclerosis, spindle-shaped aneurysms predominantly arise, prone to gradual dissection.

2. The importance of genetic and congenital factors

A hereditary association of abdominal aortic aneurysms among men between first-line relatives (parents and children) has been proven. If a father has this disease, the chance of his son developing it is about 50%. This is due to defects in genetic material, gene structure and chromosome anomalies (mutations). At a certain point, they disrupt the functioning of enzyme systems responsible for the production of substances that are the basis for the strength of the aortic wall.

Congenital structural features of blood vessels in the form of abnormal narrowings, dilations, angiodysplasias (branching disorders, wall structure) can also cause the formation of an aneurysm. This happens with Marfan syndrome and arterial-aortic fibromuscular dysplasia.

3. Inflammatory processes

Depending on the causes, an abdominal aortic aneurysm can be non-inflammatory (atherosclerotic, genetic, traumatic) or inflammatory. The reason and mechanism of formation of the second is a sluggish chronic inflammatory process.

It can occur both directly in the aortic wall and in the surrounding fatty tissue. In the first case, an aneurysm occurs due to destruction vascular wall inflammation, replacement of normal tissues with weak scar tissues. In the second, the aorta is secondarily involved in inflammation, stretched into different sides and expands as a result of the formation of dense adhesions between it and the surrounding tissues.

The inflammatory process is possible when:

• Aorto-arteritis is an autoimmune process, a breakdown of the immune system, in which immune cells destroy the aortic wall, perceiving its tissue as foreign.
• Syphilis and tuberculosis. Such aneurysms are called specific infectious. They occur when these diseases persist for a long time (years, decades).
• Any infections (intestinal, herpetic, cytomegalovirus, chlamydial). This happens very rarely (no more than 1–2%) with individual hypersensitivity to a specific pathogen and also for immunodeficiencies.

4. What injuries provoke an aneurysm?

Direct traumatic damage to the wall of the abdominal aorta is possible with:

All these factors weaken the vessel wall, which can subsequently cause aneurysmal expansion in the damaged area.

Importance of risk factors

Factors that by themselves are not capable of causing an aneurysm, but aggravate its course, are risk factors:

• male gender;
• age from 50 to 75 years;
• severe arterial hypertension (increased blood pressure);
• smoking and alcohol abuse;
• obesity and diabetes.

Characteristic symptoms

The table shows typical symptoms and possible options for the course of an abdominal aortic aneurysm:

In an uncomplicated painful course, there are symptoms, but they are nonspecific only for the aneurysm and do not affect the general condition (25–30%).

In case of a painful complicated course, the symptoms sharply disturb general condition, indicate a rupture of an aneurysm and threaten the patient’s life (40–50%).

Click on photo to enlarge

Pain syndrome

Pain of various nature and severity are noted by about 50–60% of patients with aortic aneurysm in the abdominal cavity. It often accompanies both complicated and uncomplicated forms caused by atherosclerosis, and can be:

Pulsating tumor

About 20–30% of patients with large abdominal aortic aneurysms (more than 5 cm) independently discover a dense tumor-like formation in their abdomen. Its characteristic features:

• located in the abdomen at the level of the navel on the left, slightly above or below it;
• pulsates, has unclear boundaries;
• fixed in one position and does not move to the sides with your fingers;
• moderately painful when pressed;
• When listening with a phonendoscope, a blowing noise is detected above the tumor, synchronous with pulsation and heartbeat.

Changes in blood pressure

More than 80% of patients with an aneurysm are hypertensive. Over the course of many years, they have had a constant increase in blood pressure that is resistant to drug treatment. The formation of an aneurysm itself leads to arterial hypertension. Both of these violations mutually reinforce each other (vicious circle). If in a patient with an abdominal aneurysm the pressure begins to spontaneously decrease below the usual or normal values ​​(less than 100/60 mm Hg), this may indicate a threat of rupture or dissection of the aorta.

Changes in blood pressure can lead to aortic dissection

Symptoms of impaired blood supply to internal organs and lower extremities

In 35–40%, an abdominal aortic aneurysm is hidden under the guise of other diseases. This is due to impaired blood circulation in the arteries emanating from it, which supply blood to the internal organs and lower extremities. There are four variants of the manifestation of the disease:

All these forms of the disease are highlighted because it is precisely because of additional, and not the main symptoms of aortic aneurysm, that patients often turn to doctors of various specialties (neurologists, gastroenterologists, therapists, urologists, general surgeons) and unsuccessfully treat a non-existent pathology. While the true disease remains unrecognized.

How to Diagnose the Problem

Based on complaints and general examination, an aortic aneurysm can only be suspected. Help to reliably determine it:

How to cure the disease and how possible it is

A reliably diagnosed abdominal aortic aneurysm is a serious reason for consultation and lifelong monitoring with a vascular surgeon or cardiac surgeon. The only one radical method treatment is surgery. But even this cannot always be accomplished (only 50–60%). This is due to:

The main thing in treatment is to choose the right tactics and not cause harm through your actions. General Tips about this:

• Small aneurysms (up to 5 cm), which, according to ultrasound or other research methods, do not increase, or the increase does not exceed 0.3 cm in 6 months, do not need to be operated on. Constant monitoring is carried out.
• Large (6–10 cm or more) and abdominal aortic aneurysms, increasing at a rate of 0.5 cm in 6 months, it is advisable to operate as quickly as possible. High risk of rupture.
• It is better not to operate on aneurysmal enlargements located above the renal arteries without significant indications (rapid enlargement of the aneurysm in young people and people under 55–65 years of age without concomitant pathology).
• People over 70–75 years of age, especially those with severe concomitant diseases It is very dangerous to operate on any aneurysms. Conservative-observational tactics are more appropriate.

The essence of the operation

The classical technique involves an incision in the abdomen, excision of the aneurysm, and replacement of the resulting defect with an artificial prosthesis. If it is impossible to perform such a volume of intervention, perform:

In the presence of an operated or unoperated aortic aneurysm in the abdominal cavity:

Forecast

The rupture of any aneurysm (both small and large), despite the operation performed, dooms the patient to death (no more than 3% survive up to 3 months). After planned operations for small unruptured dilations (up to 5 cm), about 75% survive, and for large aneurysms and aneurysms located above the renal arteries, no more than 45%. About 30% of small aneurysms do not increase in size and do not require surgical treatment if treatment recommendations are followed.

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Forms of the disease

Most often, clinicians use the classification of abdominal aortic aneurysms, based on the characteristics of the anatomical location of pathological extensions:

• infrarenal aneurysms, i.e. localized below the branches of the renal arteries (observed in 95% of cases);
• suprarenal aneurysms, i.e. located above the origin of the renal arteries.

Based on the structure of the sac wall, abdominal aortic aneurysms are divided into false and true.

According to the shape of the protrusion:

• exfoliating;
• fusiform;
• diffuse;
• saccular.

Depending on the cause, abdominal aortic aneurysms can be congenital (associated with abnormalities in the structure of the vascular wall) or acquired. The latter, in turn, are divided into two groups:

1. Inflammatory (infectious, infectious-allergic, syphilitic).
2. Non-inflammatory (traumatic, atherosclerotic).

According to the presence of complications:

• uncomplicated;
• complicated (thrombosed, ruptured, dissecting).

Depending on the diameter of the area of ​​expansion, abdominal aortic aneurysms are small, medium, large and giant.

A. A. Pokrovsky proposed a classification of abdominal aortic aneurysms, based on the prevalence of the pathological process:

1. Infrarenal aneurysm with long proximal and distal isthmuses.
2. Infrarenal aneurysm, located above the level of bifurcation (bifurcation) of the abdominal aorta, having a long proximal isthmus.
3. Infrarenal aneurysm extending to the area of ​​the bifurcation of the abdominal aorta, as well as the iliac arteries.
4. Total (infrarenal and suprarenal) aneurysm of the abdominal aorta.

Causes and risk factors

The results of numerous studies have shown that the main etiological factor of abdominal aortic aneurysm, as well as other localizations of this pathological process (thoracic aorta, aortic arch), is atherosclerosis. In 80-90% of cases, the development of the disease is caused by it. Much less frequently, the development of acquired abdominal aortic aneurysms is associated with inflammatory processes (rheumatism, mycoplasmosis, salmonellosis, tuberculosis, syphilis, nonspecific aortoarteritis).

Often, an abdominal aortic aneurysm forms in patients with congenital defects in the structure of the vascular wall (fibromuscular dysplasia).

Causes of traumatic aneurysm of the abdominal aorta:

• spinal and abdominal injuries;
• technical errors when performing reconstructive operations (prosthetics, thromboembolectomy, stenting or aortic dilatation) or angiography.

Factors that increase the risk of developing an abdominal aortic aneurysm are:

• smoking – smokers make up 75% of all patients with this pathology; the longer the smoking history and the number of cigarettes smoked daily, the higher the risk of developing an aneurysm;
• age over 60 years;
• male gender;
• the presence of this disease in close relatives ( hereditary predisposition).

Rupture of an abdominal aortic aneurysm most often occurs in patients suffering from chronic bronchopulmonary diseases and/or arterial hypertension. In addition, the size and shape of the aneurysm influence the risk of rupture. Symmetrical aneurysmal sacs rupture less frequently than asymmetrical ones. And giant dilations, reaching 9 cm in diameter or more, rupture in 75% of cases with massive bleeding and rapid death of patients.

Symptoms of an abdominal aortic aneurysm

In most cases, an abdominal aortic aneurysm occurs without any clinical signs and is diagnosed incidentally during plain abdominal radiography, ultrasound, diagnostic laparoscopy, or routine palpation of the abdomen performed in connection with other abdominal pathology.

In other cases, the clinical symptoms of an abdominal aortic aneurysm may be:

• abdominal pain;
• feeling of fullness or heaviness in the abdomen;
• feeling of pulsation in the abdomen.

Pain is felt in the left half of the abdomen. Its intensity can range from mild to unbearable, requiring injections of painkillers. Often the pain radiates to the inguinal, sacral or lumbar region, in connection with which the diagnosis of radiculitis, acute pancreatitis or renal colic is erroneously made.

When a growing abdominal aortic aneurysm begins to have mechanical pressure on the stomach and duodenum, this leads to the development of dyspeptic syndrome, which is characterized by:

• nausea;
• vomit;
• belching air;
• flatulence;
• tendency to chronic constipation.

In some cases, the aneurysmal sac displaces the kidney and compresses the ureter, thereby leading to the formation of a urological syndrome, which is clinically manifested by dysuric disorders (frequent, painful, difficult urination) and hematuria (blood in the urine).

If an abdominal aortic aneurysm compresses the testicular vessels (arteries and veins), the patient experiences pain in the testicular area and also develops varicocele.

Compression of the spinal roots by the increasing protrusion of the abdominal aorta is accompanied by the formation of an ischioradicular symptom complex, which is characterized by persistent pain in the lumbar region, as well as motor and sensory disorders in the lower extremities.

An abdominal aortic aneurysm can cause chronic disruption of blood supply in the lower extremities, which leads to trophic disorders and intermittent claudication.

When an abdominal aortic aneurysm ruptures, the patient experiences massive bleeding, which can lead to death in a few seconds. Clinical symptoms of this condition are:

• sudden intense pain (so-called dagger pain) in the abdomen and/or lower back;
• a sharp drop in blood pressure, up to the development of collapse;
• feeling of strong pulsation in the abdominal cavity.

Features of the clinical picture of a ruptured abdominal aortic aneurysm are determined by the direction of bleeding (bladder, duodenum, inferior vena cava, free abdominal cavity, retroperitoneal space). Retroperitoneal bleeding is characterized by persistent pain. If the hematoma increases towards the pelvis, then the pain radiates to the perineum, groin, genitals, and thigh. High localization of the hematoma often manifests itself under the guise of a heart attack.

Intraperitoneal rupture of an abdominal aortic aneurysm leads to the rapid development of massive hemoperitoneum, severe pain and bloating are noted. The Shchetkin-Blumberg symptom is positive in all areas. Percussion determines the presence of free fluid in the abdominal cavity.

Simultaneously with the symptoms of an acute abdomen when an aortic aneurysm ruptures, symptoms of hemorrhagic shock arise and quickly intensify:

• sharp pallor of the mucous membranes and skin;
• severe weakness;
• cold clammy sweat;
• lethargy;
• thread-like pulse (frequent, low filling);
• pronounced decrease in blood pressure;
• decrease in diuresis (amount of urine excreted).

With intraperitoneal rupture of an abdominal aortic aneurysm, death occurs very quickly.

If a breakthrough of the aneurysmal sac into the lumen of the inferior vena cava occurs, this is accompanied by the formation of an arteriovenous fistula, the symptoms of which are:

• pain localized in the abdomen and lower back;
• formation of a pulsating tumor in the abdominal cavity, over which systole-diastolic murmurs can be heard well;
• swelling of the lower extremities;
• tachycardia;
• increasing shortness of breath;
• significant general weakness.

Heart failure gradually increases, which becomes the cause of death.

Rupture of an abdominal aortic aneurysm into the duodenum leads to sudden massive gastrointestinal bleeding. The patient's blood pressure drops sharply, bloody vomiting occurs, weakness and indifference to the environment increases. Bleeding with this type of rupture is difficult to diagnose from gastrointestinal bleeding due to other causes, for example, peptic ulcer of the stomach and duodenum.

Diagnostics

In 40% of cases, abdominal aortic aneurysms represent an incidental diagnostic finding during a clinical or radiological examination for another reason.

The presence of the disease can be assumed based on data obtained from collecting anamnesis (indication of family cases of the disease), general examination of the patient, auscultation and palpation of the abdomen. In thin patients, it is sometimes possible to palpate a pulsating, painless formation in the abdominal cavity that has a densely elastic consistency. During auscultation over the area of ​​this formation, a systolic murmur can be heard.

The most accessible and cheapest method for diagnosing an abdominal aortic aneurysm is plain radiography of the abdominal cavity. The X-ray image shows the shadow of the aneurysm, and in 60% of cases, calcification of its walls is noted.

Ultrasound examination and computed tomography make it possible to accurately determine the size and location of pathological expansion. In addition, according to computed tomography data, the doctor can assess relative position aneurysms of the abdominal aorta and other visceral blood vessels, identify possible anomalies vascular bed.

Angiography is indicated for patients with arterial hypertension with severe or unstable angina, significant stenosis of the renal arteries, patients with suspected mesenteric ischemia, as well as patients with symptoms of occlusion (blockage) of the distal arteries.

If indicated, other methods may be used instrumental diagnostics, for example, laparoscopy, intravenous urography.

Treatment of abdominal aortic aneurysm

The presence of an abdominal aortic aneurysm in a patient is an indication for surgical treatment, especially if the size of the protrusion increases by more than 0.4 cm per year.

The main operation for an abdominal aortic aneurysm is aneurysmectomy (excision of the aneurysmal sac) followed by plastic surgery of the removed area. blood vessel a prosthesis made of Dacron or other synthetic material. Surgical intervention is performed through laparotomy (an incision in the abdominal wall). If the iliac arteries are also involved in the pathological process, then bifurcation aorto-iliac replacement is performed. Before, during and on the first day after the operation, monitor the pressure in the heart cavities and the value cardiac output using a Swan–Gantz catheter.

Contraindications to performing elective surgery for abdominal aortic aneurysm are:

• acute cerebrovascular accidents;
• fresh myocardial infarction;
• end-stage chronic renal failure;
• severe degree of cardiac and respiratory failure;
• widespread occlusion of the iliac and femoral arteries (partial or complete blockage of blood flow through them).

If an abdominal aortic aneurysm ruptures, the operation is performed for life-saving reasons on an emergency basis.

Currently vascular surgeons prefer minimally invasive methods of treating abdominal aortic aneurysm. One of them is endovascular prosthetics of the area of ​​pathological expansion using an implantable stent graft (a special metal structure). The stent is installed so that it completely covers the entire length of the aneurysmal sac. This leads to the fact that the blood stops putting pressure on the walls of the aneurysm, thereby preventing the risk of its further enlargement, as well as rupture. This operation for abdominal aortic aneurysm is characterized by minimal trauma, a low risk of complications in the postoperative period, and a short rehabilitation period.

Possible consequences and complications

The main complications of an abdominal aortic aneurysm are:

• rupture of the aneurysmal sac;
• trophic disorders in the lower extremities;
• intermittent claudication.

Forecast

In the absence of timely surgical treatment of abdominal aortic aneurysm, about 90% of patients die within the first year from the moment of diagnosis. Operative mortality during elective surgery is 6–10%. Emergency surgical interventions performed against the background of a rupture of the aneurysm wall result in death in 50-60% of cases.

Prevention

For timely detection of abdominal aortic aneurysm, patients suffering from atherosclerosis or having a burdened history of this vascular pathology are recommended to systematically medical supervision with periodic instrumental examination (radiography of the abdominal cavity, ultrasound).

Mesenteric thrombosis

The aorta is the largest vessel human body: its diameter is up to 30 mm. Its main function is to supply the organs with oxygenated blood, so the walls of the aorta constantly bear significant loads created by the blood flow.

The fairly strong walls of the aorta allow it to withstand blood pressure. However, if under the influence of certain diseases or due to congenital features the walls weaken, blood accumulates in various parts of the vessel, forming protrusions. This is how an aortic aneurysm develops - a formidable pathology that is fraught with many complications, including the death of a person.

Bag of Trouble

A protrusion of a section of the aorta in the abdominal or thoracic cavity looks like a vascular sac or resembles a spindle in appearance, but whatever its appearance, it is always a potential source of serious danger.

Comparison of a normal aorta and with an aneurysm

The danger of a developed aneurysm is the high probability of a sudden rupture and, as a consequence, massive bleeding, which is almost impossible to stop: the person dies in a matter of minutes even before the medical team arrives.

Aneurysm can be either congenital or acquired with age. A distinction is also made between true and false aneurysms.

A true aortic aneurysm affects all layers of the vessel walls, but the fibers of the tunica media undergo the greatest destruction. Leftovers fibrous tissue are greatly stretched, resulting in an increase in the lumen of the vessel. As the pathology progresses, the risk of vascular sac rupture increases.

A true aneurysm forms in the abdominal or thoracic cavity against the background of a long-term course of the following diseases:

• Atherosclerosis of blood vessels of the heart and other organs
• Syphilis
• Inflammation of the aorta - aortitis due to infection or the development of autoimmune processes

The situation is slightly different with a false aneurysm. It appears as a result of injuries to the abdominal cavity and chest area, resulting in rupture of the middle layers of the wall of individual sections of the aorta. In this case, weakness of the vascular wall and the formation of an aneurysmal sac are also observed. It is interesting that an aneurysm can develop after an injury for years and be diagnosed 10-20 years later, when all its other consequences have long been experienced.

If as a result of injury or long term In hypertension, a tear in the intima occurs in the ascending or descending sections, and a special form of pathology develops - dissecting aortic aneurysm.

A little anatomy

The aorta consists of three sections - ascending, descending and arch. From the ascending department located behind pulmonary trunk, depart coronary arteries hearts. The descending section consists of the thoracic and abdominal sections, separated aortic orifice diaphragm.

Arteries depart from the thoracic and abdominal aorta - intercostal, esophageal, pericardial, celiac trunk, renal and others.

Aneurysms develop in the abdominal or thoracic aorta, which is why they received the corresponding names.

Abdominal aneurysms

The abdominal region is most susceptible to the development of aneurysms, and in every tenth patient, examination reveals multiple lesions of the largest vessel in the body. An abdominal aortic aneurysm occurs in the region of the renal arteries.

Most often, the disease affects elderly men over 50 years of age who have developed hypertension or various diseases hearts. The situation is aggravated by hereditary predisposition, as well as addiction to tobacco, which has an extremely negative effect on the tone and condition of the vascular walls.

An abdominal aortic aneurysm that is not detected in time progresses - its diameter increases by about half a centimeter per year. If the pathology is not detected in time and adequate treatment is not carried out, the risk of rupture of the walls of the aneurysm is almost inevitable.

Symptoms

A common sign of aneurysmal vascular lesions is the absence of pronounced symptoms for many years. Only on late stages disease, patients may complain of pressing pain in the places where the aneurysm has formed.

This is explained by the fact that the bulging section of the aorta compresses neighboring organs and disrupts blood circulation in them, which can cause a feeling of pressure and pain of varying degrees of intensity.

How does an abdominal aortic aneurysm manifest? It all depends on the size of the aneurysmal sac: if it is small, then there are no symptoms at all. When the aneurysm grows very significantly, patients begin to experience dull pain in the abdomen and lower back, which is why these people consult a doctor.

Diagnostics

An abdominal aortic aneurysm is usually discovered by chance, for example, during an examination for hypertension or heart disease.

A routine medical examination without the use of hardware diagnostic methods reveals only fairly large neoplasms: a specialist detects them in the epigastric area. Aneurysms are especially easily palpable in thin patients.

Also, to assess the size and growth dynamics of a neoplasm, radiographic and ultrasonic methods, which allow you to accurately determine the location of aneurysms, the thickness of their walls, and the presence of blood clots.

Forecast

Abdominal aortic aneurysm is fraught with high probability sudden rupture and thrombosis of the affected area of ​​the vessel. This outcome depends on a number of factors:

• Aneurysm growth rate
• Degrees of atherosclerotic damage to blood vessels and heart

Normally, the diameter of the aortic lumen is about 30 mm, but a developing aneurysm can reach impressive sizes - six centimeters or more. The larger its size, the more likely a sudden rupture of the vessel at the site of the bulge is: for example, a six-centimeter aneurysm ruptures in half of the cases.

Aneurysm in the thoracic aorta

An aneurysm formed in the thoracic part of the aorta has the appearance of a fusiform thickening and is located at the origin of the left subclavian artery. The main reason for the appearance of bulging is the same atherosclerosis. Also, the reasons for the development of this type of disease include hypertension and heart disease.

Symptoms

The intensity of the symptoms of the disease is influenced by the size of the aneurysm: small bulges of the aorta do not bother anyone, so people may not notice any symptoms for many years.

When a thoracic aneurysm increases significantly in size and begins to compress the surrounding organs, patients experience the following sensations:

• Cough, hoarseness (due to pressure of the tumor on the nerve endings of the larynx)
• Dyspnea
• Generalized chest pain
• Swallowing problems (if the aneurysm has formed near the esophagus)
• Pulsation in the chest area

There is also a specific symptom that appears when the nerves of the autonomic nervous system are compressed: it is called Horner's syndrome.

In patients with the above-mentioned syndrome, a constricted pupil, drooping eyelids are clearly visible, and severe sweating is noted.

Among the people most susceptible high risk development of the disease include:

• Smokers
• Elderly patients (over 50 years old) with existing heart and vascular diseases
• Those with high scores bad cholesterol
• Obese people
• Patients with a family history of aneurysm

Aortic aneurysm in thoracic region detected using radiographic and ultrasound methods, as well as MRI. Specialists evaluate the condition of the walls of the aneurysm, its size, and decide on the advisability of surgical intervention.

If there is a break

A ruptured aneurysm is a life-threatening condition: very, very few people are lucky enough to receive timely medical attention and survive after the vessel suddenly bursts.

Symptoms of aneurysm rupture and their intensity depend on the location. Most often, rupture occurs in the retroperitoneal space and in the free abdominal cavity.. Less often - in the intestines.

The picture of intraperitoneal rupture is characterized by a distended abdomen, thread-like pulse and Shchetkin-Blumberg sign. Free fluid is determined by percussion in the abdominal cavity.

Any diagnostic measures and attempts to provide emergency surgical care are pointless here: death occurs inevitably - after a few minutes.

Pills or surgery?

The basic rule that guides specialists when choosing treatment tactics for the disease concerns the size of the formed aneurysm and its pressure on nearby organs.

The gender of the patients also has a certain significance.

Surgical treatment

Already formed aneurysms of large sizes - over 5.5 cm - are subject to removal. It is also recommended to remove small protrusions that tend to rapid growth: such aneurysms increase in size by 0.5 cm every six months. Compression of the internal organs by the aneurysm, which causes symptoms on their part, is also important.

In men, large tumors that reach 5.5 cm and above are removed, while in women surgical treatment is indicated for smaller aneurysms.

The question of the appropriateness of the operation is decided taking into account the severity of concomitant diseases and the risk of complications from diseased organs.

Drug treatment

In some cases, only medication is used to treat an aortic aneurysm. It is recommended for small sizes and slow growth.

Such patients are prescribed drugs to control blood pressure and cholesterol levels in order to slow down the progression of atherosclerosis of the blood vessels and heart.

However, the effect of drug therapy has not been proven, but it significantly improves the quality of life of people with aneurysmal tumors in the aorta.

Lifestyle and diet

Aortic aneurysm is a pathology directly related to the lifestyle and nutrition of patients. People who abuse fatty, spicy and fried foods, as well as strong drinks and tobacco, increase the level of bad cholesterol, so treating the disease without revising personal habits and taste preferences is impossible.