How to recognize an abdominal aortic aneurysm. Surgical operations for aneurysm

The heart tirelessly pumps blood around the clock, delivering with its current nutrients and oxygen to the tissues of all internal organs. Sometimes it happens that the transport routes - the vessels - become thinner and can break at any moment. Especially often this happens in the retroperitoneal region. Find out why such a phenomenon is dangerous, how to diagnose and treat it.

What is an abdominal aortic aneurysm

Translated from Greek, aneurysm is an expansion. The blood that runs through the aorta presses on its walls. If the vessels have lost their elasticity, in some places they are stretched. In the place where this happened, a "bag" is formed, which is called an aneurysm. When diagnosing a degenerative process in the retroperitoneal space, this refers to the stretching of the aorta, located between the 12th thoracic and 4th lumbar vertebrae.

The abdominal aorta is considered the largest artery in the human body, and its damage in medical practice is very common. According to statistics, about 15% of men over 65 suffer from a latent form of this pathology. In children and adolescents, this disease is congenital. In general, such vascular defects are diagnosed in 5% of people worldwide.

Causes

Deformation can appear for many reasons. If we consider cases congenital pathology, it is worth paying attention to connective tissue diseases - Marfan's syndrome and fibromuscular dysplasia. They affect the tone of the vessels in the baby and reduce their strength. If the aneurysm is small, surgery is delayed until the child is older.

Another one common cause development of pathology - injuries of the abdominal space, chest or spine A. The following types of damage lead to the occurrence, and often to an instantaneous rupture:

penetrating wounds abdominal cavity with dissection of the aorta;
closed injuries of the spine;
chest or rib bruises;
consequences strong blows in the chest or abdomen.

The secondary type of causes of abdominal aneurysm include different infectious diseases. Some strains harmful microorganisms, bacteria, viruses or fungi can penetrate the retroperitoneal region with blood flow and provoke the development of aortitis - inflammation of the vessel. In response to such actions, the body begins to produce attacking antibodies. After the infection is neutralized, the walls of the aorta are partially destroyed or thinned. The following infectious diseases and microorganisms lead to the appearance of vascular pathologies of the abdominal cavity:

syphilis;
tuberculosis;
pathogenic staphylo- and streptococci;
cytomegalovirus infection;
herpes virus;
bacterial endocarditis;
streptococcal angina;
trophic diseases;
salmonellosis.

In the non-infectious course of the disease, the cause of damage to the walls of the aorta is not microbes, but the body's own antibodies. Among the diseases that provoke aneurysm are rheumatism, rheumatoid arthritis and some other systemic diseasesaffecting the density of connective tissue:

Bechterew's disease or ankylosing spondylitis;
Takayasu's disease - granulomatous inflammation of large vessels;
systemic vasculitis;
Wegener's granulomatosis;
thromboangiitis obliterans;
periarteritis nodosa;
lupus erythematosus;
Sharp's syndrome.

The most common cause of a defect is the development of atherosclerosis.. This is a chronic disease that occurs due to a violation fat metabolism substances in the body and deposition bad cholesterol on the walls of blood vessels. All this leads to the proliferation of connective tissues and a decrease in the elasticity of blood vessels. The risk of atherosclerosis increases:

with diabetes;
in overweight people;
with malnutrition, smoking;
in patients who are often nervous or who have recently experienced severe stress.

In some cases, an aortic aneurysm appears after surgery. This vascular pathology is much less common as a result of purulent processes, after peritonitis or mediastinitis. Most aneurysms are acquired, that is, they appear during life. Predisposing factors include:

Racial affiliation. Scientists have found that Caucasians are more likely to suffer from vascular pathologies.
Age. As life goes on age-related changes in blood vessels and connective tissues.
Floor. Statistically, pathology is more often diagnosed in men than in women. This is influenced by bad habits (smoking, alcohol), frequent stress, difficult working conditions.
hereditary predisposition. If there were already precedents in the family, the chance to get the pathology “inherited” increases significantly.
Hypertension. High blood pressure not only reduces the quality of life, but also has a bad effect on the state of blood vessels. Due to the constant pulsation of blood, they become thinner, lose their elasticity, and can exfoliate.

Symptoms

The disease belongs to the category of especially dangerous, because in almost 90% of cases it is completely asymptomatic or the external signs are so insignificant that the patient does not consider it necessary to see a doctor. Characteristic manifestations aneurysms are:

Pain in the mesogastrium. Patients describe them as dull, aching. Sometimes the pain radiates to the back, lower back, femoral part. The intensity of discomfort increases with high pressure or after physical activity.
Pulsation of the abdominal aorta. In a liquid medium, which is blood and lymph, vibration is felt especially well. While the heart is contracting or relaxing, if you put your hand on the abdominal area, you can clearly feel the pulsation at one point.

If the pathology has reached large sizes, the vessels begin to come into contact with other organs. There is a violation of digestion, there is a compression of the ureters, nerve endings. In such cases, other symptoms of an abdominal aortic aneurysm appear:

abdominal - heartburn, progressive anorexia, stool disorders (constipation or diarrhea), nausea, vomiting, flatulence, belching;
urological - the appearance of blood impurities in the urine, discomfort during urination, heaviness in the lumbar region, renal colic, other dysuric disorders;
ischioradicular - pain in the lower back when turning the body, numbness of the legs, decreased sensitivity of the extremities, impaired body movements;
ischemia lower extremities- sensation of coldness in the legs, intermittent lameness, trophic ulcers, brittle nails, the appearance of rough skin.

Aneurysm classification

To prescribe proper treatment important role determines the type of abdominal aneurysm. Today, this defect is usually evaluated according to several criteria at once:

according to the location of the lesion:

subrenal or suprarenal (diffuse) - defects are located immediately below or above the renal arteries;
infrarenal - the defect extends to the iliac arteries;
interrenal - abdominal aortic aneurysm affects the arteries of the kidneys;
intervisceral - with the involvement of the intestine;
total - defects affect all parts of the abdominal aorta.

by diameter:

small - from 3 to 5 centimeters;
medium - 5-7 cm;
large - more than 7 cm;
huge - exceed the diameter of the vessel itself.

in the form:

saccular - deformation is only on one side of the vessel;
spindle-shaped - an aneurysm expands the aorta in all directions.

according to the nature of the pathology:

uncomplicated form - the disease progresses slowly, the risk of rupture of the walls of blood vessels is minimal;
complicated form - the vessel has bundles, large accumulations of blood clots, the risk of wall rupture is very high.

wall structure:

true - the aneurysm is formed with the involvement of all structures of the vessel (internal, middle and outer wall);
false - is scar tissue replacing the healthy walls of the vessel;
exfoliating - the pathology has formed between the walls of the aorta.

Rupture of the abdominal aorta

Dissecting aneurysm without proper treatment abdominal region aorta can lead to rupture and short time To lethal outcome. The condition can be provoked by: hypertensive crisis, abdominal trauma, severe stress, exercise stress. The symptom complex of the gap is characterized by a triad of signs:

pain in the abdomen and lumbar back;
collapse;
pronounced pulsation in the mesogastrium.

The presence of other signs and the intensity of their manifestations will depend on which area of \u200b\u200bthe abdominal space the gap is directed to:

A breakthrough into the retroperitoneal zone is characterized by acute, constant pain. Sometimes discomfort can give in the groin, perineum, thigh area. Due to the high location of the hematoma, the patient will complain of compression or pain in the heart. Internal bleeding is usually not too intense.
When the aorta breaks into the intraperitoneal space, hemoperitoneum syndrome develops: signs of hemorrhagic shock appear, the patient is in a semi-conscious state, the skin turns pale, and cold sweat. Often, against the background of an intra-abdominal rupture, hypotension develops, the pulse quickens, and bloating is noted. With this form of the disease, death can occur within a few minutes.
If the aneurysm ruptured into the inferior vena cava, weakness, shortness of breath, swelling of the lower extremities appear, and tachycardia develops. Sometimes patients complain about cutting, sharp pain in the abdomen and lower back. All signs increase over time, can lead to the development of a severe form of heart failure.
If a hemorrhage occurs in the duodenum, a sudden collapse develops, bloody vomiting appears, black semi-liquid stools.

Does an abdominal aortic aneurysm affect pregnancy?

A vascular defect poses a serious danger to patients of certain categories: the elderly, young children, people with chronic systemic diseases and pregnant women. In the latter case, there is a threat to the life and health of the mother. As the fetus grows, intra-abdominal pressure increases in pregnant women, which is fraught with rupture of the walls of blood vessels and massive hemorrhage.

In addition, the aneurysm compresses internal organs, disrupting their functionality, leads to poor blood supply to the kidneys, pelvic organs and limbs. If the defect has reached 5-7 cm in diameter, the risk of eclampsia and other complications of pregnancy and childbirth increases. In the early stages of diagnosis, pathology can be removed with the help of surgery. Abortion is recommended only when medically indicated surgical intervention impossible.

Diagnostics

collection of anamnesis, visual inspection patient and methods instrumental diagnostics help not only to determine the presence of an aneurysm, but also to collect the maximum amount of information necessary for the appointment of competent treatment. To clarify the diagnosis and prepare for surgery, the patient is prescribed:

Physical examination - a visual examination of the patient, including a set of procedures. The approximate location of the defect is determined by palpation of the abdomen, tapping and listening with a stethophonendoscope of the abdominal cavity. The doctor will additionally measure blood pressure and pulse.
Ultrasound examination (ultrasound) - procedure duplex scanning abdominal cavity. The method helps to visualize the expansion of the walls of blood vessels, determine the exact location of the defect, its size, assess the speed of blood flow, the presence of blood clots.
Angiography - the introduction of an iodine-based contrast agent into the aorta and an x-ray. The procedure is prescribed only when previous studies have not given a clear picture.
Radiography is one of the most informative ways to diagnose pathology. On the x-ray, you can see the swelling of the aorta, the length of the protrusion.
Spiral computed and magnetic resonance imaging (SCT, MRI) - are prescribed to assess the spread of pathology to other vessels or branches.
Electrocardiography is an analysis aimed at assessing the state of the heart. This method is necessary immediately before the operation.
Blood and urine tests. Standard Methods laboratory diagnostics help to establish the fact of leukocytosis, hematuria, hypercholesterolemia, to assess the rate of blood clotting.
Fibroesophagogastroduodenoscopy (FEGDS) - diagnostic procedure aimed at visual inspection of the upper sections gastrointestinal tract using an endoscope. The technique helps to assess the condition of the intestines, stomach, esophageal membrane, but does not provide data on the location of the aneurysm.

Treatment of an aneurysm of the abdominal aorta

This disease is fraught with the development of serious complications. If treatment is not started in time, dissection of the aortic walls may occur, which over time will lead to rupture of vascular tissues and massive internal hemorrhage. There are no drugs that can completely eliminate the problem. Medicines prescribed by a doctor are designed to prevent the development of complications - to prevent delamination of the walls of blood vessels and further rupture. The following groups of drugs are prescribed:

Antibiotics and antimycotics - are necessary to eliminate the inflammatory process caused by bacteria or fungi.
Cardiotropic drugs - normalize the level blood pressure, reduce the heart rate (Verapamil, Noliprel, Recardium).
Anticoagulants - normalize blood viscosity, prevent the formation of blood clots (Aspicor, Cardiomagnyl, Warfarin).
Lipid-lowering drugs - prevent the deposition of cholesterol plaques on the walls of the aorta (Torvacard, Atoris, Liprimar).
Non-steroidal anti-inflammatory drugs and corticosteroids - necessary for rheumatic lesion heart (Diclofenac, Prednisolone).

Classical surgical treatment

Complete elimination of the problem is carried out only surgically. Dissection is considered a classic operation. abdominal wall followed by aortic replacement. This treatment is preferred in emergency situations where doctors do not have complete picture about the patient's condition. The procedure is carried out under general anesthesia, sometimes with the connection of the victim to the apparatus cardiopulmonary bypass.

The surgeon applies clamps to the protrusion of the aorta and excised the damaged area. Healthy abdominal arteries are not affected. The damaged area is replaced with a synthetic tube, which takes root well in the human body. The operation takes about three hours. The main advantages of the classic surgical treatment:

the ability to operate on a patient in an emergency situation, without additional instrumental preparation;
wide surgical access to the damaged area;
reliable fixation of an artificial prosthesis;
the ability to analyze the state of other organs and establish the presence of similar pathologies;
the ability to remove excess blood if an artery rupture occurs.

To disadvantages traditional way treatments include:

invasiveness of the procedure (after surgery, a large scar remains on the patient's abdomen);
the need to use general anesthesia;
the presence of a risk of injury to neighboring organs, arteries;
the need to temporarily stop the normal flow of blood through the artery;
the duration of the operation;
increased risk of complications in the rehabilitation period.

Endovascular surgery

A more modern method of surgical intervention is endovascular prosthetics.. The procedure does not involve cutting the peritoneum with a scalpel. The operation is performed using a shunt inserted into the body through femoral artery. This method of prosthetics requires detailed preparation, therefore, if necessary, emergency measures are not carried out.

The operation is performed under local or general anesthesia and lasts no longer than three hours. The prosthesis is inserted over or inside the protrusion. The main advantages of endovascular surgery:

no need to use general anesthesia;
the operation is fast;
minimum level of trauma;
no risk of divergence of seams;
the rehabilitation period is easier for the patient and ends faster;
the chance of introducing an infection into the abdominal cavity is minimal;
the surgeon does not stop the flow of blood in the damaged aorta.

After endovascular prosthetics, the patient is observed in the hospital for 3-5 days, after which he is discharged. The technique of complete resection of the protrusion is not used, which speeds up the rehabilitation period. With so many advantages, the procedure still has a number of disadvantages, which include:

lack of opportunity visual diagnostics internal organs of the patient and adjacent arteries;
there is no possibility of prosthetics of large or exfoliating aneurysms;
in case of complications during the procedure, you still have to enter the abdominal cavity.

Recovery period after surgery

After the operation, the patient is forbidden to lift weights or play sports for the next six months. During the first 12 months after discharge, you must visit a doctor every 30 days, then every six months and once a year. Before and after the procedure, the patient must strictly adhere to the recommendations of the doctor, be sure to take the prescribed drugs. To prevent the risk of complications, you must adhere to the following simple rules:

Refuse bad habits(tobacco, alcohol).
Eat right and control obesity. From the menu it is necessary to completely exclude food rich in cholesterol, fatty, fried, spicy. It is not recommended to eat animal fats, confectionery, flour. It is better to cook dishes by steaming, boiling or baking.
Control the level of cholesterol, blood glucose with the help of tests, if necessary, take statins.
Correct symptoms of comorbidities ( diabetes, kidney disease, heart disease, etc.). Regularly visit a doctor, take prescribed medications.

Complications after surgery

In general, any operation goes well, and complications in the rehabilitation period are extremely rare. . In less than 4% of cases, the following unforeseen situations may occur:

swelling of the lungs or brain;
kidney failure;
divergence of postoperative sutures;
bleeding;
blood clotting disorder;
prosthesis infection;
departure of the prosthesis;
vein thrombosis;
sexual dysfunction;
postoperative hernia.

Forecast

After the operation, the patient fully recovers, the chances of aortic rupture are minimized. Without medical care or if patients do not comply with the prescribed norms, the prognosis is very unfavorable:

the mortality of patients with small protrusions is 5% per year, with average or more - 75%;
fatal outcome in the detection of large or giant aneurysms in the first two years is 50%;
when an artery ruptures and massive hemorrhage, about 90% of patients die before surgery and 80% of patients after the procedure;
after a planned excision of the artery, followed by replacement with a prosthesis, the survival rate of patients is 75-89%.

Prevention

With a genetic predisposition or the presence of other factors provoking vascular diseases, the patient is advised to adhere to the following rules of prevention:

Follow a healthy lifestyle. Give up bad habits, eat right. The diet should be high in plant food, fresh fruit, fiber.
It is necessary to regularly monitor blood pressure, cholesterol levels in the blood. If the pressure rises, you should contact a cardiologist for an appointment. antihypertensive therapy.
Avoid intense motor activity, avoid physical exertion, heavy lifting, stress.
Control body weight.

Video

Pulsation in the abdominal aorta can only mean one thing - it's an aneurysm of the abdominal aorta. The process is pathological, characterized by persistent saccular expansion of the largest artery in the body - the aorta due to the thinning of its walls. Aneurysm of the abdominal aorta is the most common pathology of this vessel. It can be diagnosed in any part of the aorta, but in 90% of all cases it is found in the abdominal part.

The aneurysm itself is a serious danger. It may rupture or split, the result of which is massive bleeding. Also an aneurysm is disposing factor to the development of thromboembolism.

Clinic

With pulsation of the abdominal aorta, two scenarios are possible. The pathological process can proceed completely painlessly, and the disease will be detected by chance during an ultrasound scan for another problem. Or the aneurysm will have pronounced clinical signs, delivering a large number of problems.

The most common clinical signs of abdominal aortic pulsation or aneurysm include:

persistent pain in the abdomen (mainly in umbilical region and left side of the abdomen). Sometimes the pain radiates to groin or lumbar spine;
feeling of "beating pulse" in the abdomen. The feeling of pulsation is like a heartbeat;
feeling of heaviness, fullness of the stomach;
the appearance of pallor in the lower extremities, sometimes their sensitivity is disturbed, there are sensations of tingling and "creeping goosebumps";
in some cases it appears abdominal syndrome(belching, vomiting, lack of appetite). Constipation or diarrhea, sudden weight loss are possible.

Treatment

The main treatment for an aortic aneurysm is surgery. If the diameter of the aneurysm does not exceed 5 cm, then surgical treatment may not be indicated. In this case, doctors recommend starting an intensive conservative therapy which is essentially a preventive measure. They are aimed at preventing complications of the disease.

Conservative treatment in this case involves healthy lifestyle life, smoking cessation and alcoholic beverages, treatment arterial hypertension, lowering cholesterol levels in the blood. It also requires regular examination and constant monitoring of the condition of the aneurysm.

Surgical intervention

Most often, open surgery is performed. In this case, the surgical access is exposed along the midline of the abdomen or through the chest (performing side cut). After penetrating into the abdominal cavity and exposing the aneurysm, surgeons proceed to clamping and sewing the prepared special synthetic material to the aorta at the site of the incision in its wall. Prostheses from this material do not tend to be rejected; they contribute to the preservation of the main functions of the aorta throughout the life of the patient. The prognosis for the treatment of abdominal aortic pulsation using this technique is favorable in 90% of cases.

Endovascular surgery is less common. Main advantage this method- it does not require opening the abdominal cavity. The essence of the endovascular technique is the placement of a special synthetic prosthesis in the area of the aneurysm through a small incision in the groin. The stent is delivered through the femoral artery to the aneurysm under mandatory constant x-ray control. A big plus of this operation is a low degree of invasiveness. The postoperative rehabilitation period rarely exceeds three days, but it is worth remembering that in the near future postoperative period will need to be regularly x-ray examination about the functioning of the implanted stent. This operation is contraindicated in persons with kidney pathologies.

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

Strong enough walls of the aorta allow to withstand blood pressure. However, if under the influence of certain diseases or due to congenital features walls weaken, blood accumulates in various departments vessel, forming protrusions. This is how an aortic aneurysm develops - a formidable pathology, which is fraught with many complications up to the death of a person.

A bag of trouble

A protrusion of the aorta in the abdominal or thoracic cavity looks like a vascular sac or resembles a spindle in its appearance, but no matter what it looks like, it is always a potential source of serious danger.

Comparison of a normal aorta and with an aneurysm

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

Aneurysm can be either congenital or acquired with age. There are also true and false aneurysms.

A true aortic aneurysm affects all layers of the walls of the vessel, however, the fibers of the middle membrane undergo the greatest destruction. Remains fibrous tissue are strongly 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 is formed in the abdominal or thoracic cavity against the background of a long-term course of the following diseases:

Atherosclerosis of the 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 of the abdominal cavity, chest area, which resulted in a rupture of the middle layers of the wall. individual sections aorta. In this case, there is also a weakness vascular wall and the formation of an aneurysmal sac. It is interesting that an aneurysm can develop for years after an injury and be diagnosed 10-20 years later, when all its other consequences have long been experienced.

If as a result of injury or long course hypertensive disease, intimal tear occurs in the ascending or descending sections, develops special form pathology - exfoliating aortic aneurysm.

A bit of anatomy

The aorta consists of three sections - ascending, descending and arch. From ascending department located behind the pulmonary trunk, the coronary arteries of the heart depart. 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, for which they received the corresponding names.

Abdominal aneurysms

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

Most often, the disease affects older men over 50 years of age who have developed hypertension or various heart diseases for many years. exacerbates the situation and hereditary predisposition, as well as addiction to tobacco, which has an extremely negative effect on the tone and condition of the vascular walls.

An aneurysm of the abdominal aorta that was not detected in time progresses - its diameter increases by about half a centimeter a 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 symptom of aneurysmal vascular lesions is the absence of a bright severe symptoms for many years. Just 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. varying degrees intensity.

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

Diagnostics

Abdominal aortic aneurysm is usually discovered incidentally - 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: their specialist detects them in the epigastric region. Aneurysms are especially well palpable in lean patients.

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

Forecast

An aneurysm of the abdominal aorta is high probability sudden rupture and thrombosis of the affected area of the vessel. This outcome depends on a number of factors:

growth rate of the aneurysm
Degrees of atherosclerotic lesions of blood vessels and heart

Normally, the diameter of the aortic lumen is about 30 mm, but a developing aneurysm can reach an impressive size - six centimeters or more. The larger its size, the more likely a sudden rupture of the vessel at the site of the bulge: 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 form of a spindle-shaped 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 causes of the development of this type of disease include hypertension and heart disease.

Symptoms

The intensity of the manifestation of the symptoms of the disease is affected by the size of the aneurysm: small bulging of the aorta does not bother in any way, 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 corresponding sensations:

Cough, hoarseness of voice (with pressure of the neoplasm on nerve endings larynx)
Dyspnea
Diffuse chest pain
Swallowing disorders (if an aneurysm has formed near the esophagus)
Pulsation in the chest

There is also specific symptoms, which appears when the nerves of the autonomic nervous system: It is called Horner's syndrome.

In patients with the aforementioned syndrome, a constricted pupil, half-drooped eyelids are clearly visible, and severe sweating is noted.

People at highest risk of developing the disease include:

smokers
Elderly patients (over 50 years old) with pre-existing diseases of the heart, blood vessels
Those with high levels of bad cholesterol
obese people
Patients with a family history of aneurysms

aortic aneurysm in thoracic region detected using X-ray and ultrasound research methods, as well as on MRI. Specialists evaluate the condition of the walls of the aneurysm, its size, and make a decision on the advisability of surgical intervention.

If there was a break

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

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

The picture of an intraperitoneal rupture is characterized by a swollen abdomen, a thready pulse and a Shchetkin-Blumberg symptom. Percussion in the abdominal cavity is determined by free fluid.

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

Pills or surgery?

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

The sex of patients also has a certain value.

Surgery

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

In men, large neoplasms that have reached 5.5 cm and above are removed, while women are shown surgical treatment even with smaller aneurysms.

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

Medical treatment

In some cases, only medical treatment of an aortic aneurysm is performed. It is recommended for its small size and slow growth.

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

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

Lifestyle and diet

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

An aneurysm of the abdominal aorta is a local expansion of the lumen of the abdominal part of the aorta, which develops as a result of a pathological change in its walls or anomalies in their development. Among all aneurysmal lesions of blood vessels, abdominal aortic aneurysm is 95%. The disease is diagnosed in every twentieth man over the age of 60, women suffer less often.

Expansion of the lumen of the abdominal part of the aorta with aneurysm

An aneurysm of the abdominal aorta in most cases is asymptomatic, but it gradually increases in volume (by about 10-12% per year). Over time, the walls of the vessel stretch so much that they are ready to burst at any moment. An aneurysm rupture is accompanied by massive internal bleeding and death of the patient.

Abdominal aortic aneurysm ranks 15th in the list of diseases leading to death.

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.

In the absence of timely surgical treatment of abdominal aortic aneurysm about 90% of patients die within the first year of diagnosis.

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

Numerous studies have shown that the main etiological factor aneurysms of the abdominal aorta, 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 abdominal aortic aneurysms 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 (prosthetics, thromboembolectomy, stenting or dilatation of the aorta) or angiography.

Factors that increase the risk of developing an aneurysm of the abdominal aorta 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, abdominal aortic aneurysm proceeds without any clinical signs and is diagnosed incidentally during a plain radiography of the abdominal cavity, ultrasound, diagnostic laparoscopy or routine abdominal palpation performed in connection with other abdominal pathology.

An aneurysm of the abdominal aorta in most cases is asymptomatic, but it gradually increases in volume (by about 10-12% per year).

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

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, in connection with which 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;
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 also develops varicocele.

Compression spinal roots 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 disorder blood supply 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. Clinical symptoms this state 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.

Peculiarities clinical picture rupture of an aneurysm of the abdominal aorta is determined by the direction of bleeding (bladder, duodenum, inferior vena cava, free abdominal cavity, retroperitoneal space). Retroperitoneal bleeding is characterized by persistent pain syndrome. 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 symptoms acute abdomen when an aortic aneurysm ruptures, symptoms of hemorrhagic shock occur and rapidly 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;
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 gastric and duodenal ulcers.

Diagnostics

In 40% of cases, abdominal aortic aneurysms are an incidental diagnostic finding during clinical or x-ray examination on a different occasion.

It is possible to assume the presence of the disease on the basis of data obtained during the collection of anamnesis (indication of family cases of the disease), general inspection 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 with great accuracy. pathological expansion. In addition, according to the data computed tomography doctor can evaluate mutual arrangement aneurysms of the abdominal aorta and other visceral blood vessels, to identify possible anomalies 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, and 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.

In case of rupture of an aneurysm of the abdominal aorta, the operation is performed according to vital indications in urgent order.

Abdominal aortic aneurysm ranks 15th in the list of diseases leading to death.

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 with aneurysm of the abdominal aorta, it is characterized by minimal morbidity, 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 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, end in death in 50-60% of cases.

Prevention

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

An important role in the prevention of the formation of aneurysm is smoking cessation, active treatment infectious and systemic inflammatory diseases.

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Article publication date: 12/18/2016

Article last updated: 12/18/2018

From this article you will learn: what is an abdominal aortic aneurysm, and why is it dangerous. The reasons, how this disease is manifested and diagnosed, how it is possible to cure it, and what is needed for this.

With an aneurysm of the abdominal aorta, there is an excessive increase in diameter and expansion of the lumen of the largest vessel of the body (aorta), located in its abdominal region. The wall of the altered abdominal aorta, from which the arteries emanate, bringing blood to the internal organs, becomes thinner and becomes weakened. The result of such changes is the threat of a spontaneous break with heavy bleeding, violation of the blood supply to the abdominal organs. This pathology, although relatively rare (no more than 1% of the population is ill), is very dangerous (more than 90% of patients with aortic aneurysm die from its complications).

The insidiousness of the disease in an asymptomatic course - for years, an aneurysm of the abdominal aorta does not manifest itself in any way and is discovered by chance during examinations for various diseases. Only 30% of patients turn to doctors about early minor complaints caused by this pathology (pain, pulsating swelling in the abdomen). More than 40% of patients are urgently admitted to the hospital in severe, life threatening condition due to a sudden severe complication of an aortic aneurysm - rupture or dissection.

The disease is treated by vascular surgeons and cardiac surgeons. The only option for successful therapy is surgery to replace the altered portion of the aorta with an artificial prosthesis. But even it is either only for a while (months, years, decades), or partially relieves the patient of the problem due to the high risk postoperative complications and the need for lifelong medication.

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 chest, based on 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 cavity). 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. Ends abdominal aorta after bifurcation into the right and left common iliac arteries, bringing 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 separation) 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 are great danger in connection with:

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 latest research showed 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 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, 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:

an increase in the diameter of the abdominal region below the level of the renal arteries by more than 50% compared with the region above these vessels;
any spindle-shaped dilatation 0.5 cm larger than the diameter of the normal aorta;
focal limited expansion in the form of a bag-like protrusion of any size and extent.

Types of aortic aneurysms

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

Located above the level of the renal arteries, they are very dangerous, since they affect all the large arteries that supply blood to the internal organs. Therefore, they are difficult to operate.
Those located below the renal arteries are less dangerous, since they affect only the aorta, which facilitates the operation.

By appearance and shape, abdominal aneurysms are:

Focal (limited, saccular) - have the appearance of a limited protrusion of all walls, or one of them (an area several centimeters long), which is clearly separated from the overlying and underlying sections of normal diameter.
Diffuse (total, widespread, fusiform) - the length of the protrusion occupies all or most of the abdominal aorta in the form of a general expansion without clear boundaries - the entire aorta is evenly expanded.

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:

genetic and congenital factors;
inflammatory processes in the aorta;
injury and damage.

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, 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 secondarily involved in inflammation, stretches into different sides 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 in immunodeficiencies.

4. What injuries provoke an aneurysm

Immediate traumatic injury wall of the abdominal aorta is possible with:

closed injuries and wounds of the abdomen (gunshot, knife) affecting the aorta;
implementation open operations on the organs of the retroperitoneal space;
endovascular (intraluminal) interventions and manipulations on the aorta.

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 typical symptoms And possible options course of 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 violate general state, indicate a rupture of the aneurysm, threaten the life of the patient (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:

by localization - in the abdomen in the navel, slightly to the left of it.
by nature - aching, pulsating, burning, stabbing.
in severity - from weak, barely perceptible to strong, acute, unbearable.
by time - chronic periodic, associated with a load or increase in pressure, constant, sudden onset.
by irradiation (where it gives off) - to the lower back, upper abdomen and chest, to the interscapular region, inguinal folds and hips.

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 a patient with abdominal aneurysm 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.

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:

abdominal - pain in the stomach, vomiting, nausea, constipation or diarrhea. simulate symptoms of peptic ulcer, gastric stenosis, enterocolitis.
urological - pain in the lower back and lateral sections of the abdomen, frequent urination the presence of blood in the urine. simulate a clinic renal colic, pyelonephritis, urolithiasis.
ischioradicular (vertebral) - pain in the spine, lower back, along the intercostal space, gives to the leg, buttock. simulates the clinic of radiculitis, intervertebral hernias.
ischemia of the lower extremities - pain in the legs and feet when walking and at rest, pallor and coldness of the skin of the legs, lack of pulsation at the level of the feet. simulates an atherosclerotic process in the lower extremities.

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:

Ultrasound (usual study of the abdominal cavity including the aorta, and special with Doppler or duplex angioscanning). The method is simple, good, suitable for monitoring patients. But it does not provide comprehensive information about the state of the aorta, which is important for making a decision on surgical treatment.
Tomography. Both computed and magnetic resonance imaging of the abdominal cavity and retroperitoneal space are informative. A more informative method, but more difficult compared to ultrasound.
Aorto-angiography. A catheter inserted through the femoral artery injects a contrast agent into the aorta. Examined under the x-ray screen internal structure modified vessel. The method is the main one in solving tactical issues regarding aneurysms.

How to cure the disease, and as far as possible

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

high trauma and technical complexity of the intervention;
high degree of operational risk, frequency of postoperative complications and mortality;
predominantly older age group patients and the presence of severe concomitant diseases (heart, brain, internal organs);
almost 95–99% mortality in patients with ruptured aneurysms;
high cost of the operation.

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

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 gap.
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:

strengthening of the aorta with a prosthesis from the outside in the area of the aneurysm without its excision;
reinforcement with a prosthesis inner surface aorta from the side of its lumen. such an endovascular (intravascular) operation is less traumatic and has more indications.

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

rule out heavy physical work and stress;
sleep at least 8 hours a day, get plenty of rest;
control blood pressure, do not allow it to increase;
exclude salt, animal fats from the diet, limit liquid;
take drugs against atherosclerosis (atoris) and blood thinners (warfarin, plestazol, clopidogrel);
visit a specialist, conduct an ultrasound every 3 months.

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 planned operations about small unruptured extensions (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.