The abdominal aorta pulsates what to do. Pulsating abdominal aorta

This is the name of the pathological expansion of the wall of the aorta in the abdominal region. The disease is asymptomatic in some cases, only sometimes it makes itself felt with pain or strong pulsation, but if the abdominal aortic aneurysm ruptures, internal bleeding begins.

An aortic aneurysm is an abnormal expansion of the aortic wall in the abdominal region.

What is known about the disease

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

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

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

An aneurysm can form in any of these departments, and not necessarily as an independent disease, but also as a concomitant complication in other pathological processes in the body.

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

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

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

An aortic arch aneurysm is an enlargement of a vessel between the ascending and descending aorta. Manifested, hoarse voice, puffiness of the face.

Aneurysm of the abdominal aorta can be combined with other pathologies that have arisen in different parts of the vessel.

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

The treatment of an aortic aneurysm is exclusively surgical - an operation must be performed. The damaged area is excised, then the aorta is sutured, restoring its normal shape and size with the help of synthetic grafts, or endoprosthesis replacement is used. Mortality during operations is about 8.2%.

An endoprosthesis is a frame with a diameter corresponding to the size of the operated vessel, made of a material compatible with human tissue. It is securely fixed and contributes to the complete restoration of the functionality of the damaged area.

Contraindications to surgery may be:

• recently transferred myocardial
• pulmonary insufficiency
• significant lesions of the femoral and iliac arteries (in particular, their poor patency).

If it becomes necessary to make an urgent decision to conduct an operative intervention, the doctor proceeds from the general vital signs of the patient.

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

How is it discovered

If an aneurysm of the abdominal aorta is suspected, the diagnosis is made:

• abdominal x-ray

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

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

What causes the disease

• One of the main causes of such a problem with the vessels is - almost 90% of cases.
• Less often, the appearance of aneurysms is associated with inflammatory processes during the development of diseases, such as rheumatism, salmonellosis and others.

• In the body, there may initially be conditions for the development of this pathology, for example, congenital inferiority of the walls of blood vessels - fibromuscular dysplasia.
• Perhaps the formation of iatrogenic aneurysms as a result of incorrect actions of doctors. This can happen with errors in angiography, and even after surgery to remove an aortic aneurysm.
• Traumatic aneurysm can occur when there is damage to the abdominal cavity or spine.
• Heavy smoking can contribute to the development of the disease, with the risk increasing with age.
• Aneurysm rupture occurs more often in people with high blood pressure, as well as in the presence of chronic lung diseases.
• The degree of risk of rupture depends on the shape of the aortic sac and the size of the aneurysm itself.

Aneurysm symptoms

If the development of the disease proceeds without severe symptoms, it can only be detected by chance, during an ultrasound scan for another problem in the peritoneum. It can also be detected when examining the abdominal region by palpation, with laparoscopy, with an x-ray examination, but always by chance.

• One of the main symptoms of an aortic aneurysm is a dull aching pain in the left side of the abdomen or under the stomach, sometimes pain in the lower back or groin occurs in parallel. Often, diagnoses are made:, renal colic, and others.
• Instead of pain, a feeling of heaviness and fullness in the abdomen may regularly appear, sometimes a very strong pulsation. If the aneurysm begins to put pressure on the stomach or intestines, frequent belching, vomiting, severe gas formation, and other abnormalities in the gastrointestinal tract may occur.
• on the bladder leads to a gradual disorder of urination. The kidney may also be displaced, which can cause hematuria (blood in the urine). Men may experience pain in the testicles as a result of compression of nearby veins and arteries.
• The growing pressure on the nerve endings and vertebrae can lead to motor activity disorders of varying degrees, such as lower back pain, weakness of the lower extremities, etc. There may be, for example, lameness, and alternating, or changes in the tissues of the limbs caused by a deterioration in blood supply.

Signs of an aortic rupture

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

• pain in the abdominal region
• tension in the anterior abdominal wall

• disturbance of peristalsis
• collapse.

Without emergency treatment leads to death.

Symptoms differ in the direction of the rupture - where will the blood go from the ruptured aneurysm:

• into the retroperitoneum

Such a gap is characterized by constant pain, which can radiate to the groin, perineum, thigh. There may be pain in the heart. In this case, the blood loss is about 200 ml.

• into the intraperitoneal space

There comes a state of shock, pallor, pain all over the abdomen. Death quickly sets in.

• into the inferior vena cava

Appear shortness of breath, swelling of the lower extremities,. An easily detectable pulsating mass in the abdomen is formed. Staying in this state very quickly leads to severe.

• into the duodenum

In this case, the disease is incorrectly defined, since the symptoms exactly repeat the clinic of gastrointestinal bleeding: hematemesis, collapse, melena (bloody stools with a pungent odor).

Conclusion

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

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Updated: 04.05.2017

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Aorta is the largest vessel in the human body. Through the aorta and its branches, oxygenated blood from the left ventricle of the heart enters all organs. This is the main highway in the human blood circulation, conditionally it is divided into several departments: ascending aorta, aortic arch and descending aorta. The last section is divided into chest and abdominal part. The most common disease of this vessel is. In three out of four cases of vascular disease, abdominal aortic aneurysms occur, and only in one localization occurs in.

Aneurysm- pathological expansion of the vessel, in places of weakening of its walls. Under the influence of high blood pressure, the vessel wall expands and, as a result, it protrudes. According to their shape, aneurysms are divided into saccular and fusiform education. In both cases, blood flow is disturbed, which contributes to the occurrence. In some cases, calcium builds up in the aneurysmal sac and calcifies the vessel wall, making it fragile and predisposing to rupture.

An aneurysm of the abdominal aorta is localized mainly below the place of origin of the renal arteries. Therefore, its complications are dangerous for the pelvic organs and lower extremities. What is the most common complication . During its course, the thrombus spreads from the aneurysmal sac along the course of the vessel. There is a fragmentation of the thrombus, and its pieces are distributed by blood flow to the pelvic organs and extremities. Pieces of a blood clot can clog arteries, leading to necrosis of the lower extremities. But the most dangerous for the patient's life is the rupture of the aneurysm, as a result of which hemorrhage occurs in the abdominal cavity.

Although there are no obvious symptoms of an aneurysm of the abdominal aorta, with complications there are some indirect signs, which will be discussed later, but first we will dwell on the causes of the disease.

Causes of an aneurysm of the abdominal aorta

The development of an aneurysm is due to several factors. Most often, the disease occurs due to atherosclerosis, at which the lumen of the vessel narrows, and its walls become fragile. This leads to dissection of the aortic wall, with the more fragile inner walls rupturing and the outer wall protruding, forming dissecting aortic aneurysm. The causes of an aneurysm of the abdominal aorta are also arterial hypertension, inflammatory diseases of the aortic wall, congenital diseases of the connective tissue, infectious diseases, in particular accompanied by damage to the aorta.

A predisposition to the development of an aneurysm is observed in men older than 60 years, most often in smokers or those who have uncontrolled high blood pressure. Women are less predisposed to this disease. The hereditary factor, the presence of the disease in other family members also plays a role. Proved that Marfan syndrome in parents greatly increases the likelihood of developing an aneurysm.

Diagnosis and symptoms of abdominal aortic aneurysm

In some cases, the disease is almost asymptomatic, which is why it is detected in the diagnosis of other diseases, but more often an abdominal aortic aneurysm can be manifested by the presence of a pulsating mass. In the abdominal cavity, a pulsation is felt in the rhythm of heart contractions.

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

Such meager symptoms of an abdominal aortic aneurysm make it difficult to diagnose the disease in the early stages. In 40% of cases, problems are detected during instrumental examination, if other diseases are suspected. X-ray or ultrasound examination of the aorta gives a more accurate result, it is with such studies that it is most often found.

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

The normal diameter of the aorta in the abdomen is about two centimeters in diameter, aneurysmal expansions can significantly exceed the permissible norms, reaching critical sizes. Extensions less than 5 cm are rarely fraught with rupture, so surgery is not necessary. But it should be noted that this disease does not go away on its own, in most cases, surgery is required over time.

In order for the disease to progress, and the aneurysmal expansion does not grow in size, the patient must be under the supervision of a doctor precisely to prevent the development of an aneurysm of the abdominal aorta. Every six months is held ultrasound and CT to control the condition and size of the aneurysm. Correction of arterial pressure is necessarily carried out, for this purpose antihypertensive drugs are prescribed. Only the fulfillment of all doctor's prescriptions and timely studies can make it possible to control the patient's condition and carry out surgical intervention in time.

Treatment of an aneurysm of the abdominal aorta with a size of 5 cm is carried out only operatively. Such expansions are often complicated by rupture, which requires immediate surgical intervention, otherwise the rupture ends lethal. But even with immediate intervention, the mortality rate is 50%. Therefore, as soon as the symptoms of an abdominal aortic aneurysm are identified and an appropriate diagnosis is made, it is so important to be under observation, and in case of further expansion of the vessel, perform the operation in a timely manner.

Today, there are two types of surgical treatment, but only a doctor can decide which one is more suitable for the patient, taking into account his condition, lifestyle and other factors. Both types of surgical treatment are based on the implantation of an artificial vessel to restore normal blood circulation in the damaged area of ​​the aorta.

The traditional surgical treatment of abdominal aortic aneurysm involves the implantation of an artificial vessel made of plastic material into the dilated aorta. The aorta, as it were, envelops the implant with its tissues. The entire operation is performed through an incision in the abdomen and lasts about 6 hours. With a radical method of treatment, 90% of operated patients have a favorable prognosis.

The second type of treatment is endovascular insertion of the stent-graph, a special device with which the aneurysmal sac is isolated from the general circulation. In this way, a possible rupture of the thinned wall is prevented and a new path for blood flow is created. With this surgical intervention, the implant is inserted through a puncture in the groin. At the junction of the femoral vessels, a special catheter, through which the device is inserted directly into the aneurysm, where the stent graph opens and forms a channel for normal blood flow. This operation takes from 2 to 5 hours and is a good alternative to the traditional method, especially for patients with a high risk of complications during the operation. But such treatment is contraindicated in patients with pathology of the arteries of the kidneys and other organs.

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

It should not be forgotten that aneurysm rupture, is dangerous with severe bleeding, in which internal organs and tissues are damaged, and even with a successful urgent surgical intervention, kidney failure may develop during and after the operation, which greatly aggravates the patient's condition. Without surgical assistance in case of rupture, the patient does not survive, and such a complication occurs in 90% of patients who refuse surgery in the early stages of the disease.

Abdominal aortic aneurysm is a formidable pathological condition that occurs in about one in twenty people over the age of 65. It is not so much the disease itself that is dangerous, but the consequences to which it can lead. A ruptured aneurysm is often fatal.

Aorta and aortic aneurysm

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

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

The aorta itself consists of three layers:

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

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

Conventionally, four parts are distinguished in the anatomical structure of the aorta:

1. Ascending aorta. Relatively short. The nutrition of the heart comes from the arteries extending from this department.
2. Aortic arch. From here, the blood supply to the head and both hands is carried out.
3. Thoracic descending aorta. Passes at the level of the third or fourth thoracic vertebra up to the diaphragm, along the way nourishing all the organs and formations that are nearby.
4. Abdominal descending aorta. It begins after the passage of the artery of the diaphragm through a special hole. The length is approximately 15 cm. In the region of the lumbar vertebrae, the aorta divides into iliac arteries.

Aortic aneurysm is a saccular bulge of the aorta

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

Abdominal aortic aneurysm - video

Classification

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

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

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

Depending on the shape of the aneurysm are divided into:

• saccular. Protrusion of the vessel wall on one side;
• spindle-shaped. The protrusion occurs on all sides.

Examples of different forms of aneurysms

Depending on sizes:

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

Regarding the course of the disease:

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

Depending on the stage of development of the aneurysm:

• threatening break;
• bundle;
• aneurysm rupture.

Regarding location on the aorta:

• suprarenal. Occur when the upper border of the aneurysm is above the place where the renal (renal) artery originates;
• subrenal. The upper border is located below the place of origin of the renal artery;
• infrarenal. It develops in the lowest part of the aorta near the bifurcation (branching).

Causes and development factors

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

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

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

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

An example of a normal and diseased aorta

Risk factors include:

• smoking;
• Cervopeoid race;
• elevated blood cholesterol levels;
• elderly age;
• male gender;
• heredity;
• increased blood pressure.

Signs and symptoms

In 25% of cases, the disease is completely asymptomatic. At the same time, the risk of death from aneurysm rupture is high, since the person does not suspect about the disease and does not receive any treatment. Often such formations are accidental findings during the examination.

Typical symptoms will be:

• abdominal pain;
• pulsation in the abdomen.

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

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

A ruptured abdominal aortic aneurysm is a life-threatening condition.

The characteristic signs of a rupture will be typical of any internal bleeding:

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

Diagnostics

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

Treatment: drug therapy

Drug therapy for abdominal aortic aneurysm is often only a preparatory step for surgery. It is aimed at reducing the influence of various risk factors. Can be used:

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

Medicines: Coronal, Lovastatin and others - gallery

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

Surgical intervention: resection, endoprosthetics and other methods

Surgery is the main treatment for aortic aneurysm.

Indications for the operation

To date, indications for surgical treatment of aneurysms are:

• aneurysm diameter more than 55 mm;
• bag-shaped aneurysm;
• various kinds of complications;
• gap.

Stages of surgery

The stages of operations are basically the same, regardless of the type of intervention. The only exceptions are intravascular manipulations. With open options:

• the patient is put into a state of anesthesia;
• provide access to the aortic aneurysm, allocate it throughout;
• pinch the vessels and produce a resection of the artery, followed by prosthetics or the establishment of an aorto-iliac bypass;
• after the wound is sutured in layers.

Rehabilitation after surgery

The recovery period after surgery largely depends on the method that was chosen as the treatment. With open methods, rehabilitation takes several weeks, it consists in the prevention of bleeding, thrombosis, and infection. With the endovascular variant, the patient stays in the hospital for only two to three days. Subsequently, he needs to come to his doctor in a month to check the stent-graph.

Feedback from doctors and patients

There is quite detailed information on the topic of stenting an aneurysm of the abdominal aorta. This type of operation is indeed tolerated by patients (especially the elderly) much easier than open prosthetic surgery. At the same time, stenting of an abdominal aortic aneurysm has quite a few limitations (i.e., it can not be performed for every patient); in addition, it is a very, very expensive procedure.

Anna Evgenievna Udovichenko

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

It is not enough to survive the aneurysm, you need to survive the operation to remove it. The risk of surgery for a thoracic aortic aneurysm, which I experienced, is very high. The highest operational lethality, aneurysms of the ascending aorta and the arch of the aorta, and, according to different authors, range from 20 to 75%.

6% live without surgery for 10 years, then they no longer live, and after the operation, a maximum of 40% reaches 5 years. I have, after all, their two aneurysms, one is operated on, and the other is not. Being 2 years ago on examination in Novosibirsk, where I had the first operation, I found out that everyone who had a similar operation at the same time as me, everyone died, except for me and another guy. And that guy is generally well done, he even removed his disability and lives a normal life. But he has one advantage over me, he had one aneurysm, only in the thoracic region.

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

Today I talked with colleagues - leading specialists in Russia in aortic arthroplasty. Their experience in the country is the largest. At the same time, physical activity after the operation was discussed. The verdict is as follows: when limiting physical activity within reasonable limits, this means one thing. Any physical activity associated with an increase in intra-abdominal pressure, blood pressure, and exercises that can directly or indirectly injure the abdominal (or chest) cavity are categorically contraindicated. This means that skiing, snowboarding, rock climbing, skating and rollerblading, parachuting and diving, wrestling and other martial arts, team sports (except chess and checkers 🙂) and so on. (The list can be deepened and supplemented ...) are categorically contraindicated. The world medical literature describes cases of displacement and dislocation of the stent and rupture of aneurysms even when straining in the toilet with chronic constipation. It should not be forgotten that abdominal and/or thoracic aortic aneurysm is a deadly disease with a very high mortality rate. In the event of an aneurysm rupture, no more than 20 percent of patients survive (only one in five!!!). In the long-term postoperative period (after arthroplasty), mortality is from 5 to 10 percent. A patient, even with a successfully prosthetized aortic aneurysm, remains, unfortunately, a sick person who, with the help of modern technologies, was somewhat protected from sudden death from an aneurysm rupture, but he cannot be cured completely. The patient must be reasonable in choosing physical activity in order to LIVE further .

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

Diet

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

You can give preference to:

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

It is necessary to refuse:

• fried meat;
• smoked meats;
• foods containing a lot of salt.

Allowed and prohibited products - photo gallery

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

Folk remedies

At the initial stages of the disease, you can use folk remedies that can prevent the further development of pathology and reduce the risk of complications:

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

Treatment prognosis and possible complications

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

Complications are:

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

Prevention

1. Refusal of heavy physical exertion.
2. Diet with the rejection of products that increase gas formation and increase peristalsis.
3. Blood pressure control.
4. Cholesterol control.
5. Visiting a doctor once a year.

Abdominal aortic aneurysm: symptoms and causes - video

Do not underestimate an aortic aneurysm. The absence of symptoms in no way indicates the severity of the condition. It is necessary to undergo preventive monitoring by specialists annually in order not to miss the development of such formidable pathologies.

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 anatomical classification of abdominal aortic aneurysms is of the greatest clinical value, 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, 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 constant 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 palpable, 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, aortic coarctation, 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 mmHg), 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 (neuropathologists, 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:

1. Inflammatory (infectious, infectious-allergic, syphilitic).
2. 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:

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

Causes and risk factors

The results of numerous studies have shown that the main etiological factor of abdominal aortic aneurysm, as well as other localizations of this pathological process (thoracic aorta, aortic arch), is atherosclerosis. In 80-90% of cases, the development of the disease is 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 radiculitis, 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 gastric and duodenal ulcers.

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 anamnesis (indication of family cases of the disease), 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 abdominal aortic aneurysm is an aneurysmectomy (excision of the aneurysmal sac), followed by plastic surgery 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 aggravated history of this vascular pathology are recommended systematic medical supervision with periodic instrumental examination (radiography of the abdominal cavity, ultrasound).

mesenteric thrombosis

The aorta is the largest vessel in the 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, the walls weaken, blood accumulates in various parts of the 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. The remnants of 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, the chest area, which entailed a rupture of the middle layers of the wall of individual sections of the aorta. In this case, weakness of the vascular wall and the formation of an aneurysmal sac are also observed. It is interesting that an aneurysm can develop 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 an injury or a long course of hypertension, an intimal tear occurs in the ascending or descending sections, a special form of pathology develops - a dissecting aortic aneurysm.

A bit of anatomy

The aorta consists of three sections - ascending, descending and arch. From the ascending section, located behind the pulmonary trunk, the coronary arteries of the heart depart. The descending section consists of the thoracic and abdominal sections, separated by the aortic opening of the 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 region of the 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. The situation is aggravated by hereditary predisposition, as well as addiction to tobacco, which has an extremely negative effect on the tone and condition of the vascular walls.

An 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 pronounced symptoms for many years. Only in the later stages of the disease, patients can complain of pressing pain in those places where the aneurysm has formed.

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

How does an abdominal aortic aneurysm manifest 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 ultrasound methods are used, which allow you to accurately determine the location of aneurysms, the thickness of their walls, and the presence of blood clots.

Forecast

An aneurysm of the abdominal aorta is fraught with a high probability of 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 (with pressure from the neoplasm on the nerve endings of the larynx)
• Dyspnea
• Diffuse chest pain
• Swallowing disorders (if an aneurysm has formed near the esophagus)
• Pulsation in the chest

There is also a specific symptomatology that appears when the nerves of the autonomic nervous system are compressed: 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 the thoracic region is detected using radiographic and ultrasound methods of investigation, 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 get medical attention in time and survive after a vessel has 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 are meaningless here: death occurs 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 - more than 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 has not been 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 it is impossible to treat the disease without revising personal habits and taste preferences.