A pulse is heard in the abdominal aorta. Causes of pulsating sensations in the abdomen

If the body gives sudden signals, this indicates the development of pathological processes. Disorders of the digestive tract can manifest themselves as sensations of pulsation in the stomach area. The symptom is not a frequent complaint and appears less often than heartburn, pain, nausea.

Description

When there is a sensation of pulsating flutter in the stomach, an experienced specialist will take into account the clinical symptom. Pulsation in the area of the projection of the stomach signals the beginning of the pathological process with frequent manifestation. The sensation of an increased pulse in the abdominal muscle extends to the anterior abdominal wall and brings discomfort to the person. An increased pulse appears in serious pathological conditions of the abdominal wall organs, and in completely healthy people of all age categories.

Pulsating pain can be of different intensity - from mild to sharp pains. Normally, sensations of involuntary contraction occur if you stay in one position for a long time, especially uncomfortable. Intense physical activity, sports are provocateurs of the development of discomfort.

Nervous strain is often accompanied by spasm of the muscles of the stomach walls and peritoneum.

A change in posture will relieve tension from the muscles and reduce pressure from the abdominal wall.

To solve the problem, it is enough to change the uncomfortable position and lie on your side, relax. These actions will relieve tension from the muscles and reduce pressure from the abdominal wall. If the measures brought a positive result, the pulsation passed without a trace, the condition is not a deviation or a symptom of a dangerous disease. If the upper abdomen pulsates constantly, the sensations gradually increase and are accompanied by pain, nausea, you should definitely consult a doctor for advice.

Pulsation after sporot exercises lasts longer, sensations are localized in one place. But the condition is normal. To make sure that this is not a consequence of pathology, you can use a light massage of the abdominal muscles. If after these actions the sensations have passed, consultation with a specialist is not required.

The abdomen pulsates in different places. Therefore, the location determines the pathology of a particular organ. If the work of the main digestive organ is disturbed, the pulse of the abdominal muscle is felt to the left, slightly above the navel. Violations of this organ and intestines are manifested by pulsations in the middle part of the abdomen. This location corresponds to pathological vasodilatation, which is typical for aortic aneurysms. The pathological state of the pancreas and its ducts is determined by vibrations in the paraumbilical zone on the right.

Causes of pulsation in the stomach

Pulsation of the stomach occurs with the development of many diseases of the gastrointestinal tract. But a symptom may appear with third-party pathologies that irradiate to the area of the projection of the stomach. Pulsation appears more often after eating and is accompanied by pain. The pains are sharp, shooting, periodic, constant, aching. Often the reasons are physiological in nature. Provoking factors:

Gastritis in acute or chronic exacerbated condition.
tumor processes. Often, the presence of an increased pulse at the top of the anterior abdominal wall suggests cancer.
vascular changes. With the narrowing of the aorta, which is often accompanied by atherosclerosis, the pressure inside the vessel rises, the blood flow is turbulent with an increase in pulse. At the same time, the walls of the vessel gradually lose their elasticity, which prevents them from maintaining normal blood flow pressure. As a result, a person begins to feel a strong pulse.
Formed aneurysm of the main vessel - the aorta. It is located in the retroperitoneal space. Aneurysm is characterized by persistent expansion with stretching of the walls of the aorta in one area. This happens due to morphological and functional changes in the walls. Aneurysms come in many shapes and sizes, most commonly saccular or fusiform. In this case, the age group of patients is 60 years and older. An aneurysm manifests itself as a pulsation in the middle part of the abdomen. Additionally, with an aneurysm, pain, belching, and swelling appear. The patient begins to lose weight.
Reducing the diameter of the abdominal aorta without the formation of an aneurysm. The reason is the hardening of the walls of the aorta, in which plaques appear, the pressure inside the blood vessels increases. When blood flows through a narrowed area under pressure, there is resistance to its flow. Therefore, there is a pulsation of the peritoneum.
Pancreatitis. Usually, an increased pulse in the upper part of the abdominal wall is accompanied by severe girdle pain, heaviness, and a change in the state of manifestations during defecation.
Pathology of the liver. The organ can pulsate with a visible increase, with the development of cirrhosis, hepatitis, cholestasis.
Dysfunctions of the heart muscle. The upper abdomen pulsates with persistent diffuse expansion or thickening of the wall of the right ventricle of the heart, which is located above the xiphoid process. Increased flutter is felt in the epigastric region.
Mental disorders, dysfunction of the central nervous system. Constant exposure to stress, psycho-emotional overstrain negatively affects the body, causing many pathological processes.

When overeating, the stomach works in an intensive mode, which causes pulsation.

In other cases, the reasons are physiological in nature:

Slim and tall. People of the asthenic type often feel a strong pulse in the upper abdomen due to the proximity of the aorta. This phenomenon is considered normal.
Prolonged stay in an uncomfortable position, physical activity with muscle strain. The symptom is removed by rest, light massage.
Binge eating. Excess food in the stomach cavity causes the organ to work in an intensive mode, which causes pulsation.
Hiccup. During shudders, sharp contractions of the diaphragm, sensations can be transmitted to the epigastric region.
Pregnancy in the early stages. During this period, strong changes occur in all organs and systems of the body, especially in the vessels. Therefore, pulsation can accompany a pregnant woman until delivery. But in most cases, the cause lies in hiccups and slight movements of the limbs of the fetus.

Sometimes it pulsates in the upper part of the peritoneum in the morning on an empty stomach. This may be caused by diaphragmatic spasm, which is similar in mechanism to hiccups. The etiology of the condition is explained by the reflux of stomach acid into the esophagus, passing through the diaphragm. The process is aggravated by the horizontal position. When a person wakes up and begins to move, there is a contraction of tissues irritated by acid. The duration of sensations depends on the time of exposure to the stimulus. Often the process is accompanied by heartburn or regurgitation.

Pulsating sensations occur due to cardiac arrhythmia when the body position changes during sleep. If at the same time pressure is exerted on the region of the heart, the pulsation can last several minutes and be given to the epigastric zone.

Pathological changes in the wall of large blood vessels are a common cause of death in patients. Abdominal aortic aneurysm is very dangerous: the symptoms of this condition are often mistaken for clinical manifestations of other diseases.

Inflammatory and destructive changes in the vascular wall lead to a decrease in elastin formation and excess collagen production.

An aneurysm of the abdominal aorta (ICD 10 - I71.4) is a pathological protrusion of the vascular wall, which can reach large sizes. The localization of the formation is the abdominal aorta (from the XII thoracic vertebra to the V lumbar).

Risk factors:

genetic(high risk of developing pathology in the closest male relatives, inferiority of the aortic wall in congenital fibromuscular dysplasia or Marfan's syndrome).
Cardiovascular. Patients with AAA (abdominal aortic aneurysm) often have such diseases as arterial hypertension, myocardial infarction, stenosis of the arteries of the lower extremities, heart failure.
Atherosclerotic.

There are iatrogenic aneurysms associated with errors in various surgical interventions (stenting of the aorta, removal of a blood clot). Another cause of the pathological process in the vascular wall is closed injuries of the abdominal cavity and spine.

Classification

Types of aneurysms:

Depending on the reason	Distinguish: acquired - inflammatory and non-inflammatory (traumatic, atherosclerotic); congenital (aneurysmal expansion of the abdominal aorta in diseases such as Marfan's syndrome, fibromuscular dysplasia).
By shape	Allocate: saccular; spindle-shaped.
Depending on localization	There are 4 types of ABA: infrarenal, there is a sufficient length of the distal and proximal isthmus; infrarenal aneurysm extending to the aortic bifurcation, there is a proximal isthmus sufficient in length; infrarenal AAA, involving the iliac arteries with aortic bifurcation in the pathological process. total defeat.
By diameter	There are: small (from 3 to 5 cm); medium (up to 7 cm); large (more than 7 cm); giant (with a diameter many times greater than the normal size of the aorta).
By clinical course	It happens: uncomplicated AAA; complicated (rupture); dissecting aneurysm of the abdominal aorta (a cavity connected to the lumen of the aorta is formed in the thickness of the vascular wall).
According to the structure of the wall	Distinguish: true (thinning and protrusion of the vascular wall develops); false (formed from a hematoma, around which connective tissue grows).

Clinical picture

Signs of an aneurysm of the abdominal aorta depend on the location of the pathological formation and its size.

Uncomplicated course

In this case, specific symptoms are often absent. The diagnosis is made by chance, during ultrasound, radiography or laparoscopy.

Typical manifestations:

Pain syndrome. The growing aneurysm presses on the retroperitoneal nerve plexuses. Dull aching pains in the middle part of the abdomen are characteristic, extending to the lower back, inguinal or sacral region. Sometimes pain medication is required.
Complaints of heaviness or pulsation in the abdomen.
With compression of the stomach and duodenum, the patient may complain of nausea, flatulence, or belching. Constipation often occurs.
Compression of the ureter or displacement of the kidney is often manifested by urological disorders and hematuria.
In case of compression of the testicular arteries and veins, varicocele may develop. Characterized by complaints of pain in the testicles.
The consequences of a large AAA are a chronic circulatory disorder of the lower extremities, which is manifested by the appearance of intermittent claudication and various trophic disorders.
Compression of the vertebrae or spinal roots is the cause of pain in the lumbar region, motor and sensory disorders.

Attention! Abdominal aortic aneurysm - the symptoms of this disease are often mistaken for renal colic, sciatica, or an attack of acute pancreatitis.

Complicated course

For a long time, the disease can be asymptomatic. But as the aneurysm grows, the development of pathological conditions associated with compression of various anatomical structures and circulatory disorders is possible.

Main problems

Aneurysm rupture	The price of late diagnosis is the death of the patient.
thrombus formation	In the cavity of the aneurysm, blood flow is disturbed, which creates favorable conditions for the formation of blood clots. After leaving the aorta, a thrombus can block vessels of smaller diameter. There is an acute violation of the blood supply.
Pneumonia	It develops if an aneurysm compresses the trachea or bronchi, which disrupts the excretion of sputum.
Obstruction of the bile ducts	Leads to the development of pancreatitis and cholecystitis. Even an experienced doctor can not always correctly determine the cause of the disease.

Gap

The walls of the aneurysm are thin and have low elasticity. Therefore, even a slight injury or a slight increase in blood pressure can lead to rupture and severe internal bleeding.

Factors that can provoke a break:

fall, blow to the stomach;
taking medicines that increase blood pressure;
severe stress.

Large fusiform and dissecting aneurysms are very dangerous. The clinic of the rupture depends on its location. In some patients, the signs of this formidable complication are very weak, which leads to frequent diagnostic errors.

Symptoms:

Retroperitoneal rupture	Characteristic signs: Excruciating pain in the abdomen or lumbar region (associated with compression of the nerve trunks by a growing retroperitoneal hematoma). With a low accumulation of blood, the pain radiates to the inguinal region and perineum, with a high accumulation - to the region of the heart. The absence of pronounced symptoms of peritoneal irritation, since the amount of blood in the abdominal cavity with this type of rupture does not exceed 200 ml. Blood is poured into the retroperitoneal space slowly, so the syndrome of acute blood loss is not expressed.
intraperitoneal rupture	Characterized by: The severity of symptoms of internal bleeding (pallor of the skin, cold sweat, tachycardia, lowering blood pressure). Hemorrhagic shock develops rapidly. The abdomen is swollen, on palpation there is pain in all departments. Symptoms of peritoneal irritation are determined. Abdominal percussion reveals free fluid in the abdominal cavity. The patient's condition is rapidly deteriorating.
Aneurysm rupture into the inferior vena cava	Symptoms: Complaints of shortness of breath and general weakness. Pain in the abdomen and lumbar region. Swelling of the legs and lower half of the body. On examination, a pulsating formation is determined in the abdomen. Gradually, severe heart failure develops.
AAA rupture into the duodenum	It is manifested by symptoms of severe gastrointestinal bleeding: Vomiting blood. Paleness of the skin, lowering blood pressure, tachycardia.

The patient's only chance for salvation is an emergency surgical operation.

How to make a diagnosis?

Examination instructions for suspected abdominal aortic aneurysm:

Inspection	In a thin patient, a pulsation can be detected in the region of the anterior abdominal wall. Percussion is not very informative, since the aorta is located on the back wall of the abdominal cavity. On palpation, a pulsating mass is found in the abdomen. By attaching a phonendoscope, you can hear a characteristic noise.
Ultrasound procedure	Advantages of the method: it is possible to determine the size and shape of the aneurysm; diagnosis of complications; With the help of Doppler, blood flow can be assessed and forming blood clots can be detected.
Electrocardiography	Helps to identify changes in the work of the heart (complications of the disease).
Computed and magnetic resonance imaging	It is used before a planned operation to remove an aneurysm and in difficult diagnostic situations. The use of contrast helps to obtain a three-dimensional image of the aorta and diagnose the threat of rupture.
Laboratory examination	It will help to identify the following changes: increased levels of cholesterol and triglycerides; changes in blood coagulability indicators with the onset of thrombus formation (increased fibrinogen levels, signs of hypercoagulability).

The collected information will help in the development of treatment tactics.

How to get rid of an aneurysm of the abdominal aorta?

Treatment without surgery is impossible: there is no such medicine that can restore the thinned vascular wall.

Before a planned surgical intervention, a complete examination and treatment of concomitant diseases is necessary. Sometimes patients have symptoms of coronary heart disease and coronary artery disease. In this case, revascularization of the cardiac muscle is indicated before reconstructive surgery.

Indications for emergency surgery:

severe pain syndrome, lowering blood pressure;
the threat of aneurysm rupture;
thromboembolism.

Surgical intervention for the removal of AAA can only be performed in specialized centers.

Operation types:

Abdominal aortic aneurysm resection

Complicated and traumatic surgery.

It is the removal of a pathologically altered area and its replacement with a special prosthesis.

Endoprosthetics

A stent graft is inserted through the femoral artery under X-ray control. This allows you to create a new channel for blood flow and prevent rupture.

Endovascular repair of an aneurysm of the abdominal aorta is a more benign method of treatment.

Advantages:

low trauma;
reducing the risk of postoperative complications;
speed of recovery.

Thanks to the latest examination methods, the number of diagnostic errors has decreased, which has saved the lives of many patients.

Prevention includes the following activities:

scheduled examinations of high-risk patients;
smoking cessation;
treatment of the underlying disease (CHD, arterial hypertension).

Photos and videos in this article will tell you about abdominal aortic aneurysm, diagnostic features and the most modern methods of treatment.

Frequently asked questions to the doctor

Is salvation possible?

Hello! Yesterday my father died. An operation was performed - an aneurysm of the abdominal aorta ... He died right on the table. Everything happened so quickly: his stomach hurt sharply, he fell down, became pale as a wall. The ambulance arrived immediately. The thought does not leave me: was everything as it should be? Maybe the doctors did something wrong?

Hello! Unfortunately, with an aortic rupture, there is little chance of saving the patient, even if it happened in a hospital.

How to make a diagnosis?

Hello! My stomach has been hurting for several days now. I think I have an abdominal aneurysm - the symptoms are the same, I read it in a medical reference book. What to do, where to run?

Good afternoon. Don't get upset ahead of time. Ultrasound is required to confirm the diagnosis.

Is an operation necessary?

Hello, Doctor! They found an aneurysm in my abdominal aorta. They say that you need to be operated on, it can burst. But I'm afraid! Maybe there are some pills to strengthen the blood vessels?

Hello! Aneurysm of the abdominal aorta - treatment is possible only surgically. It's good that the diagnosis was made on time.

An abdominal aortic aneurysm is a pathological expansion of the walls of this arterial vessel, which can lead to its rupture as a result of thinning. The danger of vascular disease lies in the likelihood of asymptomatic course and death as a result of dissection of the abdominal aorta and subsequent bleeding.

The reasons

An aneurysm is understood as a protrusion of the walls of the vessel and the acquisition of the shape of a bag by it. The formation of an aneurysm of the abdominal aorta and the causes that caused it are due to the influence of various factors. The main ones are:

atherosclerosis;
a defect in a local area of the vascular wall;
jumps in blood pressure;
inflammatory processes in the aorta.

When the wall of the vessel is thinned and weakened, a rupture of the abdominal aorta is possible, the causes of which are also due to the above factors.

Symptoms

Approximately ¼ of all patients diagnosed with an abdominal aortic aneurysm do not feel any symptoms of the disease. Not only are there no complaints, but the examination does not always reveal signs of pathology. This course is the most dangerous, since it is not possible to control the likelihood of an aneurysm rupture.

There are cases when the rupture of the aortic artery is the first manifestation of the disease. This situation is fraught with a quick death. But in most cases, the pathology can be recognized before such a complication. The asymptomatic type of the disease is more often detected on ultrasound or during abdominal surgery for other pathologies.

The typical symptoms of an abdominal aortic aneurysm are as follows:

Pain in the groin and abdomen of varying severity, in most cases dull and aching. More often localized in the mesogastrium and epigastrium. Appears after eating or exercise. Increases with movement and gives to the lower back or sacrum.
Pulsation in abdomen. It can be intense and resemble a contraction of the heart muscle. This sensation is always present or resumes after physical work.
dyspepsia. Nausea, vomiting, bloating act as secondary signs that appear as a result of compression of the abdominal organs.

All signs of aortic aneurysm are combined into groups according to the nature of manifestations: abdominal, ischioradicular, urological.

When the aneurysm reaches a large size, the blood supply to the digestive tract worsens, the stomach and duodenum are compressed, which manifests itself in indigestion and symptoms such as nausea, heartburn and belching, stool instability and rapid weight loss.

Ischioradicular symptoms are caused by compression of the nerve roots of the lumbar spine. These include:

violation of the sensitivity of the skin on the legs;
sensation of numbness of the lower extremities;
intermittent lameness;
lower back pain.

Manifestations of a urological nature are provoked by compression of the ureter and displacement of the kidneys from an anatomically correct position. The patient complains of heaviness in the lumbar region and impaired urination. Blood may be present in the urine. The possibility of developing renal colic is not excluded.

Diagnostics

A set of examinations aimed at identifying an aortic aneurysm includes a general examination and instrumental diagnostic methods. Pathology can be suspected by palpation and auscultation of the abdominal region. So, signs of a violation are: increased pulsation, felt through the anterior abdominal wall, and systolic murmur.

The most accessible instrumental method for diagnosing the pathology under consideration is plain radiography. With it, you can visualize the shadow of the aneurysm and detect pathological expansion due to calcification of the walls of this artery.

Modern methods include ultrasound with duplex scanning of the main artery and aortic branches. Ultrasound examination allows to identify the defect of the vascular wall with maximum accuracy. In particular, parameters such as:

prevalence of aneurysm and its localization;
condition of the walls of the main artery;
the presence and location of the break.

It will be possible to determine the rupture of an aneurysm of the abdominal aorta or a threatening condition using computed multislice tomography of the abdominal aorta.

Treatment

Given that aortic rupture can occur suddenly, when it is first detected, a decision is made to remove the damaged area. Expansion of the abdominal aorta is treated only with surgical methods.

Medical

Medical treatment of an abdominal aortic aneurysm focuses only on strengthening the walls of the artery to prevent it from rupturing. If there is a weak spot in the vessel, then the aneurysm cannot disappear on its own. It will gradually stretch under the influence of high pressure in the aorta. Such a defect is corrected only by surgery.

No medicine can reduce this pressure, because it is physiologically provided and necessary for pumping blood in the body. Drug treatment is used as a preventive measure to eliminate diseases that can weaken the walls of the aorta. In addition, for the purpose of prevention, medications are taken:

to normalize blood pressure;
to lower blood cholesterol;
to eliminate the severity of autoimmune processes;
to control blood clotting disorders;
for the treatment of chronic pathologies that are a contraindication to surgical correction of an aneurysm.

Surgical

Surgical treatment will allow you to completely get rid of the aneurysm by removing the defective part of the vessel. Therefore, an operation is indispensable. It is performed through abdominal surgery or with the use of endovascular surgery.

If it was possible to identify the expansion of the aorta in the abdominal region, then the operation is performed in a planned manner and the patient must first prepare for the intervention. If a rupture occurs or a dissecting aneurysm is to be removed, then medical manipulation is carried out on an emergency basis.

During the abdominal operation, the abdominal wall is dissected and direct access to the site of damage is provided. The deformed part is cut, and a special tube is inserted into the cavity, which will subsequently prevent rupture.

In this way, an aneurysm of any size and shape is removed.

The use of endovascular surgery allows the operation to be performed without dissection of the abdominal wall. Manipulations are carried out through the femoral artery. This method has a number of advantages over the abdominal method: there is no risk of suture separation and infection, a short rehabilitation period, and blood flow in the aorta does not stop. But it is carried out only in a planned manner, it is not suitable for emergency cases, since it requires careful preparation of the patient.

Forecasts

Being a severe pathology, aortic aneurysm in the absence of timely medical care leads to death. This occurs as a result of rupture and massive bleeding. Since it is impossible to predict this vascular pathology, an unfavorable outcome occurs in 80% of cases.

The following factors influence the course of the disease and outcome:

the shape and size of the aneurysm;
reasons for education;
patient's age;
the presence of chronic pathologies;
compliance with the doctor's recommendations.

Because aneurysms are difficult to predict, regular check-ups are recommended to reduce the risk of rupture in people with a predisposition to the condition and a tendency to form blood clots. It is important to give up bad habits.

In contact with

If any of the primary signs of an abdominal aortic aneurysm are present, it is urgent to contact a specialist.

People of the older age category (from 60 years old) need to regularly visit a doctor and undergo a preventive examination. Men who smoke between the ages of 65 and 75 should have an abdominal ultrasound every year. Such an examination is also carried out for men with a family history of abdominal aneurysm.

To be checked, you need to contact a therapist who will refer you for examinations and, if necessary, to a narrow specialist.

Diagnosis of aneurysms of the abdominal aorta

How to diagnose an aneurysm of the abdominal aorta and is it possible to determine its possibility by complaints? The survey algorithm looks like this:

Complaints. Paroxysmal or persistent pain in the umbilical region, lower back. Episodes of hypertension, visible pulsation of the anterior abdominal wall. The general condition is not broken. Most abdominal aortic aneurysms are asymptomatic and are discovered incidentally.
Inspection. Forced position with bent knees. Paleness, swelling of the legs.
Physical Data. Painful palpation in the projection of education. Frequent soft pulse, arterial hypertension. Auscultatory - in the projection of the aneurysm vascular noise.
Laboratory examination. With the involvement of the renal arteries - an increase in the level of creatinine, low urine density.
. Tachycardia, concomitant heart disease are detected.
X-ray in oblique projection helps to identify limited protrusion associated with the aorta, as well as calcifications, but does not allow for differential diagnosis.
Ultrasound of the abdominal aorta is the "gold standard" for diagnosing aneurysms. A liquid rounded formation or diffuse expansion of the aortic lumen more than 3 cm, thinning of the vascular wall, parietal thrombus are detected.
Computed tomoangiography (CTA), MRI. Expansion of the lumen and thinning of the wall of the abdominal aorta, double channel of blood flow, deformity of the contour of the renal arteries, parietal hematoma, blood clots, local edema, compression of the nerve trunks. The methods are recommended for emergency diagnosis.
Transcatheter aortography. The method allows to determine the expansion of the lumen of the aorta in the absence of thrombus formation. In the presence of blood clots, the results become false negative.

Differential Diagnosis

The disease is differentiated from:

pancreatitis;
pancreatic cyst;
Perforation of gastric and duodenal ulcers;
diverticulitis;
Renal colic;
intestinal bleeding;
Colon cancer.

Complex differential diagnosis is performed using imaging methods - ultrasound, CT, aortography. Methods of objective and laboratory research are not effective.

Treatment: choice of tactics

Therapy begins from the moment the diagnosis is made, the tactics depend on the size of the formation. Surgery is mainly performed, however, if the aneurysm is small (up to 50 mm), the course is asymptomatic (or the symptoms do not interfere with a full life), then the patient can be offered the method of "active waiting", which consists in the regular behavior of ultrasound and control over the patient's condition .

Indications for treatment without surgery:

Diameter less than 50mm;
Absence of a clinic;
Presence of contraindications to surgery;
The period of exacerbation of chronic diseases (bronchial asthma, COPD).

Means of drug therapy:

beta blockers;
Statites;
Fibrates;
Nitrates;
Aspirin;
According to indications - diuretics, ACE inhibitors.

Indications for surgery and surgical tactics

Indications for surgery:

Diameter over 55 mm;
Presence of symptoms;
Progressive growth of more than 10 mm per year or more than 6 mm in six months;
Gap;
The appearance of child aneurysms;
thrombus formation;
Bag-shaped;
intestinal ischemia;
Involvement of the renal arteries.

Relative contraindications to surgery:

Cerebral circulation disorders.

The threat of rupture is an absolute indication for open surgery in all patients. In other patients, in the presence of contraindications, drug and symptomatic therapy is carried out, aimed at controlling the dynamics of the process, the level of pressure, cholesterol in the blood.

The operation is most often performed by one of two methods:

Traditional operation. During this operation, the patient is under general anesthesia. The surgeon makes an incision from the obvious process of the sternum to the navel. The damaged area of the vessel is excised, and an artificial prosthesis is implanted in its place. The procedure lasts 3-5 hours. The period of postoperative stay in a hospital is about a week.
Endovascular method. The procedure is usually performed under epidural anesthesia. The surgeon makes a small incision in the groin area, through which a stent graft is brought to the aneurysm using a special catheter. Having brought the device to the designated place, the surgeon opens it and places it in the aneurysmal area. After the opening of the stent graft, a channel is formed through which the normal movement of blood occurs. The duration of the procedure is 3-5 hours, and postoperative hospitalization does not exceed 5 days.

Possible Complications

Operational mortality in planned patients reaches 12%, emergency - 78%.

Possible complications after surgery in case of resection of an aneurysm of the abdominal aorta:

Injury to the renal arteries;
Rupture of the ureters;
secondary infection;
heart attack;

Complications during endovascular intervention occur in 1.2-5% of patients:

stent thrombosis;
Rupture of the anastomosis;
Displacement of parts of the stent inside the vessel;
secondary infection.

The prognosis is unfavorable. For small aneurysms of the abdominal aorta, the survival rate in the first year is 75%, within 5 years - 50%. If the aneurysm is larger than 6 cm, then the rates are reduced to 50% and 6%, respectively.

Primary and secondary prevention

Primary prevention is aimed at preventing the development of pathology. It includes:

BP control.
To give up smoking.
Treatment of concomitant diseases.
Exclusion of stress, traumatism.
Maintaining a body mass index within 18.5-24.9.

Secondary prevention aims to slow the progression and prevent complications. It includes:

Observation by the surgeon, ultrasound - 2 times a year.
Duplex scanning - at least 1 time per year.
Dispensary account.
Control of lipid and glucose levels in the blood - 4 times a year.
Taking statins, aspirin, beta-blockers and ACE inhibitors.
Patients who have undergone endovascular intervention are recommended aortography once a year to monitor the condition of the stent.

Abdominal aortic aneurysm is an insidious and unpredictable disease. Growth is impossible to predict, so it is important to see a specialist at the first symptoms and undergo regular medical examinations if diagnosed.

Useful video

For more details about the disease, see the video:

Abdominal aortic aneurysm is a pathological expansion of the abdominal part of the 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 vascular changes. Among men older than 60 years, 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

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

According to the shape of the protrusion of the vessel wall, saccular, diffuse fusiform and exfoliating 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 variant of the clinical course, abdominal aortic aneurysm can be uncomplicated and complicated (stratified, ruptured, thrombosed). The diameter of the abdominal aortic aneurysm allows us to talk about small (3-5 cm), medium (5-7 cm), large (over 7 cm) and giant aneurysms (8-10 times 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 sufficient length of the distal and proximal isthmus;
II - infrarenal aneurysm with sufficient length of the proximal isthmus; 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 studies, the main etiological factor of aortic aneurysms (aneurysms of the aortic arch, aneurysms of the thoracic aorta, aneurysms of the abdominal aorta) is atherosclerosis. In the structure of the causes of acquired aortic aneurysms, it accounts for 80-90% of cases.

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

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

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

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

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

The pathogenesis of an aneurysm of the abdominal aorta

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

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 by macrophages, B- and T-lymphocytes develops, the production of cytokines increases, and proteolytic activity increases. The cascade of these reactions, in turn, leads to the degradation of the extracellular matrix in the middle layer of the aortic membrane, which manifests itself in an increase in the content of collagen 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.

In an uncomplicated course of aneurysm of the abdominal aorta, there are no subjective symptoms of the disease. In these cases, an aneurysm can be diagnosed by chance during abdominal palpation, ultrasound, abdominal radiography, diagnostic laparoscopy for other abdominal pathology.

The most typical clinical manifestations of an abdominal aortic aneurysm are persistent or recurrent aching, dull pain in the mesogastrium or the left side of the abdomen, which is associated with the pressure of the growing aneurysm on the nerve roots and plexuses in the retroperitoneal space. Pain often radiates to the lumbar, sacral or inguinal region. Sometimes the pain is so intense that pain relief requires the appointment of analgesics. Pain syndrome can be regarded as an attack of renal colic, acute pancreatitis or sciatica.

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

Urological syndrome in abdominal aortic aneurysm can be caused by compression of the ureter, displacement of the kidney and is manifested by hematuria, dysuric disorders. In some cases, compression of the testicular veins and arteries is accompanied by the development of a painful 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 low back pain, sensory and movement disorders in the lower extremities.

With an aneurysm of the abdominal aorta, chronic ischemia of the lower extremities can develop, occurring with symptoms of intermittent claudication, trophic disorders.

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

Symptoms of a ruptured aneurysm

The rupture of an aneurysm of the abdominal aorta is accompanied by a clinic of 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, and increased pulsation in the abdominal cavity.

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

Retroperitoneal rupture of an aneurysm of the abdominal aorta is characterized by a pain syndrome of a permanent nature. With the spread of retroperitoneal hematoma in the pelvic area, irradiation of pain in the thigh, groin, perineum is noted. The high location of the hematoma can simulate cardiac pain. The amount of blood poured into the free abdominal cavity during retroperitoneal aneurysm rupture is usually small - about 200 ml.

With intraperitoneal localization of the rupture of the abdominal aortic aneurysm, a clinic of massive hemoperitoneum develops: the phenomena of hemorrhagic shock increase rapidly - a sharp pallor of the skin, cold sweat, weakness, thready, frequent pulse, hypotension. There is a sharp swelling and soreness of the abdomen in all departments, a diffuse symptom of Shchetkin-Blumberg. Percussion determines the presence of free fluid in the abdominal cavity. The lethal outcome in this type of rupture of the abdominal aortic aneurysm occurs very quickly.

The breakthrough of an aneurysm of the abdominal aorta into the inferior vena cava is accompanied by weakness, shortness of breath, tachycardia; edema of the lower extremities is typical. Local symptoms include pain in the abdomen and lower back, a pulsating mass in the abdomen, over which a systolic-diastolic murmur is heard. These symptoms increase gradually, leading to severe heart failure.

When an aneurysm of the abdominal aorta ruptures into the duodenum, a clinic of profuse gastrointestinal bleeding develops with a sudden collapse, bloody vomiting, and chalk. In diagnostic terms, this rupture variant is difficult to distinguish from gastrointestinal bleeding of another etiology.

Diagnosis of an aneurysm of the abdominal aorta

In some cases, the presence of an aneurysm of the abdominal aorta can be suspected by a general examination, palpation and auscultation of the abdomen. To identify familial forms of abdominal aortic aneurysm, it is necessary to take a thorough history.

When examining lean patients in the supine position, increased pulsation of the aneurysm through the anterior abdominal wall can be determined. Palpation in the upper abdomen on the left reveals a painless pulsating dense elastic formation. A systolic murmur is heard on auscultation over an aneurysm of the abdominal aorta.

The most accessible method for diagnosing an aneurysm of the abdominal aorta is a survey radiography of the abdominal cavity, which allows visualizing the shadow of the aneurysm and calcification of its walls. Currently, ultrasound, duplex scanning of the abdominal aorta and its branches is widely used in angiology. The accuracy of ultrasound detection of abdominal aortic aneurysm approaches 100%. With the help of ultrasound, the condition of the aortic wall, the prevalence and localization of the aneurysm, and the place of rupture are determined.

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

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

Identification of an aneurysm of the abdominal aorta is an absolute indication for surgical treatment. A radical type of operation is resection of an aneurysm of the abdominal aorta, 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 aortoiliac prosthesis is indicated. The average mortality in open surgery is 3.8-8.2%.

Contraindications to elective surgery are 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 tear or rupture of an aneurysm of the abdominal aorta, resection is performed according to vital indications.

Modern low-traumatic methods of abdominal aortic aneurysm surgery include endovascular aneurysm replacement using an implantable stent graft. The surgical procedure is performed in an X-ray operating room through a small incision in the femoral artery; The course of the operation is monitored by X-ray television. The installation of a stent graft allows isolating the aneurysmal sac, thereby preventing the possibility of its rupture, and at the same time creates a 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 noted in 10% of cases.

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Examination of the abdominal aorta

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

Rice. 362. Abdominal aorta and its branches.

1 - abdominal aorga,
2 - hepatic artery,
3 - right renal artery;
4 - inferior mesenteric artery,
5 - right common iliac artery;
6 - right internal iliac artery,
7 - right external iliac artery;
8 - gastric artery,
9 - splenic aryuria,
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

With pathology of the abdominal aorta with a violation of its patency, pallor, thinning of the skin, hair loss on the legs, a violation of the trophism of the nails (thinning, brittleness), the occurrence of trophic ulcers on the feet, and atrophy of the muscles of the legs appear. Feet become cold to the touch.

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

Pronounced visible pulsation noted 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 pulsating bulge in the projection of the aorta is characteristic of a large aortic aneurysm. Only a protruding, but not pulsating tumor over the aorta is possible - this happens when an aneurysm is thrombosed.

Palpation of the abdominal aorta

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

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

The study starts from the xiphoid process and ends at the navel. It must be borne in mind that in hypersthenics, the upper third of the 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 performed in the same way as deep palpation of the abdomen. The doctor's palm is placed on the abdominal wall below the xiphoid process perpendicular to the aortic axis 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 up to the back wall, that is, until the moment when a pulsation appears under the fingers. Having reached it, the fingers on the next exhalation calmly make a sliding movement across the aorta. Manipulation is repeated 2-3 times. Then the fingers are set in a similar way a little lower and palpate.

So the entire abdominal aorta is examined from the sword to the navel or just below. In a 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 crowded and swollen, palpation is easy even from the first immersion of the hand .

With developed muscles, a thick fat layer, a filled stomach and intestines, palpation is difficult. The aorta must be felt along its entire length. The abdominal aorta is best palpated in asthenics, in many women who have given birth, with a divergence of the abdominal muscles.

Ripple amplification of the abdominal aorta is noted during excitement, after physical exertion, which is associated with an increase in the stroke volume of the heart.

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

Strengthening or weakening of the pulsation;
- detection of limited bulging of the aorta
- aneurysms;
- detection of a limited non-pulsating seal (thrombosed aneurysm),
- compaction 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 insufficiency of the aortic valves, with thyrotoxicosis

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

Limited pulsatile bulging of the aorta- aneurysm, can be of different sizes - from a few centimeters to the size of the head. The aneurysm may be round, oval, sac-shaped. The surface of the aneurysm is smooth, densely elastic consistency. When it is thrombosed, it becomes more dense, its pulsation is insignificant or absent. If an aneurysm is detected, its palpation is carried out carefully., without excessive pressure and sliding movements on its surface. This is dangerous, since a blood clot can break off with serious consequences. The abdominal aorta compacted throughout or in some places occurs with atherosclerotic lesions. Limited compaction 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 area of localization of the thrombus is sealed.

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 in the abdominal cavity, taking into account the patient's breathing: on exhalation, the device goes down, on inspiration it is held at the level of immersion, resisting expulsion by the abdominal muscles.

Depending on the development of the muscles, it is possible to reach the aorta in 1 or 3 dives. Listening is carried out on exhalation with a breath hold. So the phonendoscope moves from the sword to the navel. We draw attention to the inadmissibility of strong pressure and clamping of the aorta, which can cause the appearance of 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 over the abdominal aorta of varying intensity is heard with aortic atheromatosis, aortitis, aneurysm and aortic compression. When evaluating the results of auscultation of the abdominal aorta, it must be borne in mind that in the xiphoid process, the auscultated noise may be due to stenosis of the thoracic aorta, as well as stenosis or compression of the celiac trunk. Noise in the umbilical region occurs with increased blood flow in the umbilical and paraumbilical veins, in dilated saphenous veins of the abdominal wall with non-closure of the umbilical vein and cirrhosis of the liver.

In order to diagnose diseases of the abdominal aorta, as well as the chest, it is necessary to measure and compare blood pressure in the arms and legs. Normal blood pressure in the legs is 20 mm Hg. higher than on hand. In case of violation of the patency of the thoracic and abdominal aorta (coarctation, aortitis, thrombosis, compression from the outside), the pressure on the legs will be reduced.

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What is the abdominal aorta

The aorta is the first vessel into which the heart ejects 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. It 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 is located in the chest above the level of the diaphragm (the muscular strip that carries out breathing and separates the abdominal and chest cavities). The abdominal region is located below the diaphragm. Arteries depart from it, which supply blood to the stomach, small and large intestines, liver, spleen, pancreas, 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 with the disease, and what is its danger

An aneurysm of the abdominal aorta is called such a pathological change in this vessel:

Outwardly, it looks like an expansion, protrusion, an increase in the total diameter and internal lumen of the aortic section compared to the overlying and underlying sections.
It is located below the diaphragm (in any segment from the diaphragm to the level of division) along the abdominal cavity - in the abdominal region.
It is characterized by thinning, weakening of the walls of the vessel in the area of protrusion.

All these pathological changes carry a great danger due to:

There are discussions among specialists about the criteria for the diagnosis of an abdominal aortic aneurysm. If earlier it was believed that only an expansion of more than 3 cm is a reliable symptom of the disease, then 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, a regular expansion of the abdominal aorta occurs (on average by 20%) due to the weakening of its wall and high 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, the 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 due to the fact that under no circumstances should a healthy aorta have a larger diameter. Due to the variability in the size of the normal aortic diameter, experts refer to aneurysms even expansions of less than 3 cm, if there is:

Types of aortic aneurysms

According to the localization of the abdominal aortic aneurysm, it is important to divide into two types:

By appearance and shape, abdominal aneurysms are:

Small aneurysms

Specialists distinguish a group of small aortic aneurysms - any expansion with a diameter of up to 5 cm. The expediency in this is due to the fact that they are more 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 causes 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 destroy the vascular wall, reduce its strength, contribute to 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 in atherosclerosis predominantly spindle-shaped aneurysms occur, which are prone to gradual dissection.

2. Significance of genetic and congenital factors

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

Congenital features of the structure of blood vessels in the form of abnormal narrowing, expansion, angiodysplasia (violations of branching, 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, abdominal aortic aneurysm can be non-inflammatory (atherosclerotic, genetic, traumatic) and inflammatory. The reason and mechanism for the formation of the second is a sluggish chronic inflammatory process.

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

The inflammatory process is possible with:

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

4. What injuries provoke an aneurysm

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

All these factors weaken the vessel wall, which can later 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 pressure);
smoking and alcohol abuse;
obesity and diabetes.

Characteristic symptoms

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

In uncomplicated pain, there are symptoms, but they are not specific only for an aneurysm and do not disturb the general condition (25–30%).

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

Click on photo to enlarge

Pain syndrome

Pain of various nature and severity is 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 find a tumor-like dense 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 fuzzy boundaries;
fixed in one position and does not move with fingers to the sides;
moderate pain when pressed;
when listening with a phonendoscope over the tumor, a blowing noise is determined, synchronous with pulsation and heartbeat.

Drops in blood pressure

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

Blood pressure fluctuations can lead to aortic dissection

Symptoms of impaired blood supply to internal organs and lower extremities

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

All these forms of the disease are singled out because it is precisely for additional, rather than the main symptoms of aortic aneurysm, patients often turn to doctors of various specialties (neurologists, gastroenterologists, general surgeons, general surgeons) and unsuccessfully treat a non-existent pathology. While the true disease remains unrecognized.

How to Diagnose a Problem

Based on complaints and general examination, aortic aneurysm can only be suspected. Reliably determine it helps:

How to cure the disease, and as far as possible

A reliably diagnosed aneurysm of the abdominal aorta is a serious reason for consultation and lifelong follow-up with a vascular surgeon or a cardiac surgeon. The only radical treatment is surgery. But even it cannot always be fulfilled (only in 50-60%). It's connected with:

The main thing in treatment is to choose the right tactics and not harm with your actions. General advice on this is as follows:

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, you can not operate. 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 desirable to operate as quickly as possible. High risk of rupture.
It is better not to operate on aneurysmal expansions located above the renal arteries without significant indications (rapid increase in aneurysm in young people and people up to 55-65 years old without concomitant pathology).
In people over the age of 70–75 years, especially in the presence of severe concomitant diseases, it is very dangerous to operate for any aneurysms. More appropriate conservative-observational tactics.

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 an amount of intervention, perform:

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

Forecast

The rupture of any aneurysm (both small and large), despite the operation, dooms the patient to death (no more than 3% survive up to 3 months). After elective operations for small unruptured dilatations (up to 5 cm), about 75% survive, and with volumetric 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 medical recommendations are followed.

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Forms of the disease

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

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

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

According to the shape of the protrusion:

exfoliating;
spindle-shaped;
diffuse;
saccular.

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

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

According to the presence of complications:

uncomplicated;
complicated (thrombosed, torn, exfoliating).

Depending on the diameter of the site of expansion, abdominal aortic aneurysms are classified as small, medium, large, and giant.

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

Infrarenal aneurysm with long proximal and distal isthmuses.
Infrarenal aneurysm located above the level of bifurcation (bifurcation) of the abdominal aorta, having a long proximal isthmus.
Infrarenal aneurysm extending to the bifurcation of the abdominal aorta, as well as the iliac arteries.
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 due to it. Much less often, the development of acquired aneurysms of the abdominal aorta is associated with inflammatory processes (rheumatism, mycoplasmosis, salmonellosis, tuberculosis, syphilis, nonspecific aortoarteritis).

Often an aneurysm of the abdominal aorta is formed in patients with congenital inferiority of 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 (prosthesis, thromboembolectomy, stenting or dilatation of the aorta) or angiography.

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

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

Rupture of an aneurysm of the abdominal aorta most often occurs in patients suffering from chronic bronchopulmonary diseases and/or arterial hypertension. In addition, the size and shape of the aneurysm also affect the risk of rupture. Symmetric aneurysmal sacs rupture less frequently than asymmetric ones. And giant extensions, 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 an abdominal radiography, ultrasound, diagnostic laparoscopy, or routine abdominal palpation performed in connection with another abdominal pathology.

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

pain in the abdomen;
feeling of fullness or heaviness in the abdomen;
feeling of throbbing in the abdomen.

Pain is felt in the left side of the abdomen. Its intensity can be from mild to unbearable, requiring the appointment of injections of painkillers. Often the pain radiates to the inguinal, sacral or lumbar region, and therefore the diagnosis of sciatica, acute pancreatitis or renal colic is erroneously made.

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

nausea;
vomit;
belching with 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 aneurysm of the abdominal aorta compresses the testicular vessels (arteries and veins), the patient has pain in the testicles, and a varicocele develops.

Compression of the spinal roots by an 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.

Abdominal aortic aneurysm can cause chronic circulatory disorders in the lower extremities, which leads to trophic disorders and intermittent claudication.

When an aneurysm of the abdominal aorta ruptures, the patient experiences massive bleeding that can lead to death in a few seconds. The 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 rupture of an aneurysm of the abdominal aorta are determined by the direction of bleeding (bladder, duodenum, inferior vena cava, free abdominal cavity, retroperitoneal space). For retroperitoneal bleeding, the occurrence of persistent pain is characteristic. If the hematoma increases towards the small pelvis, then the pain radiates to the perineum, groin, genitals, thigh. High localization of the hematoma often manifests under the guise of a heart attack.

Intraperitoneal rupture of an aneurysm of the abdominal aorta leads to the rapid development of massive hemoperitoneum, there is a sharp pain and bloating. The Shchetkin-Blumberg symptom is positive in all departments. Percussion determine 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 appear and quickly increase:

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

With an intraperitoneal rupture of an aneurysm of the abdominal aorta, a lethal outcome occurs very quickly.

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

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

Gradually, heart failure increases, which causes death.

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

Diagnostics

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

It is possible to assume the presence of the disease on the basis of data obtained during the collection of an anamnesis (an indication of family cases of the disease), a general examination of the patient, auscultation and palpation of the abdomen. In lean patients, it is sometimes possible to palpate in the abdominal cavity a pulsating, painless mass with a densely elastic consistency. During auscultation over the area of this formation, you can listen to a systolic murmur.

The most accessible and cheapest method for diagnosing an aneurysm of the abdominal aorta is a survey radiography of the abdominal cavity. On the radiograph, the shadow of the aneurysm is visualized, and in 60% of cases, calcification of its walls is noted.

Ultrasound examination and computed tomography allow to determine the size and localization of the pathological expansion with great accuracy. In addition, according to computed tomography, the doctor can assess the relative position of the aneurysm of the abdominal aorta and other visceral blood vessels, and identify possible anomalies in the vascular bed.

Angiography is indicated in patients with arterial hypertension with severe or unstable angina pectoris, 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 there are indications, other methods of instrumental diagnostics can be used, for example, laparoscopy, intravenous urography.

Treatment of an aneurysm of the abdominal aorta

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 aneurysm of the abdominal aorta is an aneurysmectomy (excision of the aneurysmal sac) followed by plasty of the removed portion of the blood vessel with a prosthesis made of Dacron or other synthetic material. Surgical intervention is performed through laparotomy access (incision of the abdominal wall). If the iliac arteries are also drawn into the pathological process, then bifurcation aorto-iliac prosthesis is performed. Before, during and on the first day after the operation, the pressure in the cardiac cavities and the value of cardiac output are monitored using a Swan-Ganz catheter.

Contraindications to elective surgery for abdominal aortic aneurysm are:

acute disorders of cerebral circulation;
fresh myocardial infarction;
terminal stage of chronic renal failure;
severe degree of heart and respiratory failure;
widespread occlusion of the iliac and femoral arteries (partial or complete blockage of blood flow through them).

In case of rupture of an aneurysm of the abdominal aorta, the operation is performed according to vital indications on an emergency basis.

Currently, vascular surgeons prefer minimally invasive methods for the treatment of abdominal aortic aneurysms. One of them is endovascular prosthesis of the site 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 ceases to exert 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 morbidity, 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 lameness.

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. Operational mortality during elective surgery is 6-10%. Emergency surgical interventions performed against the background of rupture of the aneurysm wall are fatal in 50-60% of cases.

Prevention

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

mesenteric thrombosis