Aortic aneurysm abdominal symptoms:causes, treatment, types of aneurysm, surgery

Update: December 2018

Currently, the accelerated pace of life, lack of time,
permanent employment of young and middle-aged people more and more often
lead to the fact that a person does not pay due attention to his
health, even if something is bothering him. However, it should
remember that many dangerous diseases, causing at the beginning only
slight discomfort, with the development of complications can lead to
sad outcome. This is especially true for abdominal aneurysm
aorta.

The aorta is the largest and most important vessel in the body.
person This artery carries blood from the heart to other organs and
is located along the spine in the thoracic and abdominal cavities.
Its diameter in the abdominal cavity is from 15 to 32 mm, and it is in
this department most often (in 80% of cases) aneurysm develops.
Aneurysm is protrusion, bulging of the vessel wall caused by its
атеросклеротическим, воспалительным or травматическим
damage.

The following types of abdominal aortic aneurysms are distinguished:

  • on the localization of the lesion: suprarenal, infrarenal (above and
    under the place of separation from the aorta of the renal arteries, respectively),
    total (all over).
  • diameter: small (3-5 cm in diameter), medium (5-7 cm),
    large (over 7 cm), gigantic (many times greater than normal
    vessel diameter).
  • by nature: not complicated and complicated (gap,
    delamination, the formation of blood clots on the aortic wall).
  • in a form: sacculate and spindle-shaped. Their differences are that the bulging of the sacculate form
    captures less than half the diameter if you imagine the aorta in
    cross section, and a spindle-shaped aneurysm is bulging
    walls of almost the entire diameter.
  • on the wall structure of the protrusion: true, false and
    stratifying. True aneurysm is formed by all shells.
    vascular wall (inner, middle and outer), and false
    represented by scar tissue replacing the normal aortic wall in
    this site. A dissecting aneurysm is a
    divergence of vessel wall envelopes and blood flow between
    them.

Aneurysm of the abdominal aorta occurs in 5% of men over 60 years of age.
The danger of aneurysm is that it is thinned in the place of protrusion
the wall can not withstand the pressure of blood and burst that
will be fatal. Mortality in this complication is high
and is 75%.

Что может привести к аневризме брюшной aorta?

Causes of aneurysm formation:

  • Atherosclerosis is the most common cause of aneurysm. B 73 –
    90% bulging of the abdominal aorta wall caused by deposition
    atherosclerotic plaques with damage to the inner lining
    vessel.
  • Воспалительные поражения аорты при туберкулезе, сифorсе,
    mycoplasmosis, nonspecific aortoarteritis, bacterial
    endocarditis, rheumatism.
  • Genetic disorders causing vascular weakness
    walls (connective tissue dysplasia, Marfan syndrome).
  • Traumatic damage to the vascular wall may occur
    после закрытых травм живота, груди or позвоночника.
  • Postoperative false aneurysms from anastomoses are extremely rare.
    may form after aortic surgery.
  • Fungal (mycotic) aortic lesions in individuals with
    иммунодефицитом (ВИЧ — инфекция, наркомания) or вследствие
    hits of the fungus – pathogen in the blood (sepsis).

Risk factors for aortic atherosclerosis and formation
aneurysm:

  • male – male suffer more often than women, although women
    aneurysms are also found.
  • age over 50 – 60 years – as the body ages
    the elasticity of blood vessels is disturbed, which causes susceptibility
    walls of the aorta to the action of damaging factors.
  • burdened heredity – the presence of close relatives
    aneurysm, connective tissue dysplasia, having a genetic
    predisposition.
  • smoking adversely affects the cardiovascular system in
    whole, because the substances contained in cigarettes damage
    the inner lining of blood vessels, affect the level of arterial
    pressure, increasing the risk of developing hypertension.
  • alcohol abuse also has a toxic effect
    on the vessels.
  • diabetes mellitus – glucose that cannot be digested
    cells from the blood, damages the inner lining of the vessels and aorta,
    contributing to the deposition
  • overweight
  • hypertension (see drugs to reduce
    pressure).
  • elevated cholesterol

Conditions causing rupture of the aneurysm

  • hypertensive crisis
  • excessive exercise
  • injury, for example, as a result of an accident

 How does an aortic aneurysm manifest in the abdominal cavity?

An uncomplicated small aneurysm may not
manifest clinically for several years and is revealed
by chance during the examination for other diseases.
The formation of more significant dimensions is manifested by the following
signs of:

  • the most common symptom of aneurysm is dull pain in the abdomen pulling,
    arching character
  • discomfort and feeling of heaviness in the left umbilical region
  • feeling of pulsation in the stomach
  • digestive disorders – nausea, belching, unstable stool,
    lack of appetite
  • pains in lower back, numbness and coldness of the lower limbs

If the patient notices these signs in himself, refer to
doctor for examination, as they may be
симптомами аневризмы брюшной aorta.

Examination for suspected aneurysm

In the absence of symptoms, a diagnosis can be made.
by chance, for example, during an ultrasound scan for diseases
stomach, intestines, kidneys.

In the presence of clinical signs of an aneurysm, the doctor suspected
This disease examines the patient and prescribes
additional research methods. When viewed determined
pulsation of the anterior abdominal wall in the supine position, with
auscultation of the abdominal cavity is heard systolic murmur in
projection of the aneurysm, palpation of the abdomen palpable volumetric
pulsating formation, like a tumor.

From instrumental methods are assigned:

  • Ultrasound and duplex scanning of the abdominal aorta – allows
    visualize the protrusion in the aortic wall, determine the localization
    and the length of the aneurysm, assess the speed and nature of blood flow in
    this site, identify atherosclerotic lesion of the wall and
    presence of wall clots.
  • CT scan or abdominal MRI can be assigned to clarify
    localization of education and evaluation of the spread of aneurysm on
    outgoing arteries.
  • angiography is indicated in case of an unclear diagnosis by
    the results of the previous survey. Is to introduce
    radiopaque substance into the peripheral artery and conducting
    X-ray of the image after the substance enters the aorta.
  • radiography of the abdominal cavity can be informative if
    the walls of the aneurysm deposited calcium salts and occurred them
    monkeying Then on the radiograph you can follow the contours and
    the length of the protrusion, since the abdominal part of the normal aorta in
    norm is not visible.

In addition, mandatory studies are conducted – a general analysis.
blood and biochemical blood tests, level examination
cholesterol, blood test for glucose, rheumatological tests and
others

Treatment of abdominal aortic aneurysm

Drugs that can eliminate aneurysm, not
exists. But the patient must still take medications
prescribed by a doctor to prevent arterial hypertension
pressure that could trigger aneurysm rupture, and for
prevent further damage to the vascular wall.
Such groups of drugs are prescribed:

  • cardiotropic drugs – prestarium, rekardium, verapamil,
    Noliprel, etc.
  • anticoagulants and antiplatelet agents (agents that prevent
    blood clots in the bloodstream) – cardiogram, tromboAss,
    aspicor, warfarin, clopidogrel. Must be assigned with
    caution, because when breaking aneurysm contribute
    further bleeding.
  • липидснижающие средства (аторвастатин, розувастатин и others, см.
    статины — вред or польза) нормализуют уровень холестерина в крови,
    preventing its deposition on the walls of blood vessels (
  • antibiotics and antifungal agents for inflammatory
    processes in the aorta.
  • anti-inflammatory drugs (NSAIDs-diclofenac,
    corticosteroids – prednisolone) for rheumatic heart disease and
    aorta.
  • drugs aimed at correcting glucose levels
    сахарном диабете и others

Effective treatment of the disease is carried out only
surgically. Операция может быть проведена в плановом or
emergency order.

The indication for a planned surgical procedure is
uncomplicated aneurysm larger than 5 cm. Emergency surgery
выполняется при расслаивании or разрыве aorta.

In both cases, the operation is performed under general anesthesia with
connecting the heart-lung machine. Carried out
incision of the anterior abdominal wall with access to the abdominal aorta. After
this, the surgeon applies the clamps above and below the protrusion,
excised the walls of the aneurysm and hemmed artificial prosthesis to
intact areas of the aorta above and below the aneurysm.

The prosthesis is a synthetic tube that is well
takes root in the body and does not require replacement throughout
жизни person Sometimes a prosthesis forked at the end,
for aortic prosthetics below its bifurcation site with a lesion
ileal arteries. The operation takes about 2 to 4 hours.

After ушивания операционной раны пациент переводится в
resuscitation department, where it is under observation until 5 – 7
days. After этого еще две – три недели or дольше, в зависимости
from the course of the postoperative period, is in the core
department, and is discharged home under the supervision of a cardiologist and
cardiac surgeon in the clinic at the place of residence.

Contraindications for elective surgery

  • acute myocardial infarction
  • acute stroke (not earlier than 6 weeks after
    occurrence)
  • chronic heart failure in the late stages
  • severe failure of the liver and kidneys
  • acute infectious diseases
  • decompensation of concomitant diseases (diabetes mellitus,
    bronchial asthma and others)
  • acute surgical pathology (pancreatitis, appendicitis,
    cholecystitis and others).

Due to the fact that in preparation for the planned intervention
the patient and the doctor have time, in contrast to the complicated
aneurysm, the patient can be carefully examined taking into account
possible contraindications and evaluation of compensatory capabilities
organism.

There are no contraindications for emergency surgery, since
operational risk is several times less than mortality from complications
aneurysm, so any patient with suspected aneurysm rupture
should be taken on the operating table.

In the 90s of the last century, an Argentine scientist was tested
a device for prosthetic aorta, called graft – stent. it
aortic prosthesis, representing the trunk and two legs, supplied
catheter controlled by x-ray television through the femoral artery
to aneurysm and self-reinforcing in the walls of the aorta special
hooks.

  • The surgery is endovascular, performed without incision.
    передней брюшной стенки под местным or общим наркозом.
    Duration 1 – 3 hours.
  • Advantages of aortic arthroplasty – low invasiveness, in
    compared with open surgery, and faster recovery
    organism.
  • Disadvantages – due to the fact that the aneurysm itself is not excised, but
    the prosthesis is inserted as if inside the protrusion, the aneurysm continues
    exist. Gradually, the protrusion of the aortic wall spreads
    above the stent attachment site, which leads to the development of new ways
    blood flow, the formation of blood clots, exfoliation of the vessel wall, and how
    consequence, increases the risk of complications. Often these processes
    require a conventional operation, therefore, despite the good
    results in the early period after arthroplasty, it
    performed less frequently than open surgery.

Mass distribution of endoprosthetics is limited to considerable
the cost of the clinic for the purchase of graft – stent (the cost of one
prosthesis abroad is about 500 thousand rubles, the cost
the operation itself 20 – 40 thousand rubles), especially since the stent should
be made individually for a specific patient. In Russia
This operation refers to high-tech assistance, and in
some clinics are conducted according to quotas of the Ministry of Health of the Russian Federation. Open
operations, especially on an emergency basis, are free.

Complications after surgery

  • Mortality after surgery in planned order 0 – 0, 34% per year in
    remote period.
  • Mortality after an operated aneurysm rupture in the first
    two months – 90%.
  • Operational mortality varies greatly:
    • in planned operations it is 7–10%;
    • during operations for rupture of the aneurysm – 40 – 50%;
    • with endoprosthetics – 1%.

The statistics and experience of the surgeons show that the operation
in a planned order is much preferable for the patient, since
delay in the presence of evidence for the operation is fraught with danger for
of life. But with careful patient preparation and evaluation
operational risks, development of complications after
operations. They rarely develop, and make up less than 4%.

Complications in the early postoperative period

  • pulmonary edema
  • swelling of the brain
  • renal failure
  • discrepancy and inflammation of the wound
  • bleeding disorders and bleeding in internal
    organs
  • при эндопротезировании – эндолики, or негерметичность
    fixed prosthesis
  • thromboembolic complications – separation and clotting of blood clots in
    arteries of the intestine, lower limbs, brain, pulmonary
    artery.

Prevention of complications is the careful selection of the prosthesis,
enhanced patient monitoring in the postoperative period, admission
antibiotics, the appointment of heparin for standard surgical
pattern.

In the remote period, there are

  • prosthesis infection (0.3 – 6%)
  • prosthetic – intestinal fistula (less than 1%)
  • prosthesis thrombosis (3% within 10 years after surgery)
  • sexual dysfunction (less than 10% in the first year after
    operations)
  • postoperative hernia.

Prevention of long-term complications – the appointment of antibiotics in
any invasive, dental, gynecological studies
and urological procedures, if accompanied by penetration
in the body tissue; lifelong intake of statins, antiplatelet agents,
beta blockers and ACE inhibitors. Impotence prevention is
accurate selection of the iliac arteries and the aorta at the time of surgery,
so as not to damage the nearby nerves.

What is the danger of abdominal aortic aneurysm without surgery?

This disease is fraught with the development of life-threatening complications,
таких, как расслоение, разрыв or тромбоз aorta.

Dissecting abdominal aortic aneurysm

Due to the gradual thinning of the walls of the aorta and
penetration of blood into the wall of the vessel, exfoliating its shell.
This hematoma spreads further until the wall breaks.
under the influence of blood pressure and will not break
aorta.

  • симптомы: резкие pains in животе or спине, резкая слабость,
    pallor, lowering blood pressure, cold profuse sweat,
    loss of consciousness, collapse, shock and death. Sometimes the patient may even
    do not have time to get to the hospital.
  • diagnosis: emergency abdominal ultrasound, according to indications – CT
    or МРТ.
  • treatment: emergency surgery.

Aortic rupture

There is a breakthrough of blood from the aorta into the abdominal cavity. or
retroperitoneal space. Symptoms, diagnosis and treatment
similar to those with dissecting aortic aneurysm. Shock
condition and death are due to massive blood loss and
impaired heart function.

Aneurysm Thrombosis

Rarely complete obstruction of the thrombotic masses of the whole
lumen, mainly occurs the formation of wall clots,
which can be transported through the bloodstream into smaller arteries and
cause overlap of their lumen (renal, iliac arteries,
arteries of the lower extremities).

  • signs: in case of renal artery thrombosis – sudden strong
    low back pain, no urination, general poor
    health, nausea, vomiting; with ileal and femoral thrombosis
    артерий – внезапное похолодание нижних конечностей (одной or
    both), intense pain, fast blue skin of the legs, violation
    motor function.
  • diagnostics: ultrasound and duplex scanning
  • treatment: anticoagulant therapy, surgical extraction
    thrombus

What kind of lifestyle to lead a patient with abdominal aneurysm
aorta?

Before the operation. If the aneurysm is small (up to 5 cm), and not
planned surgery planned, doctors take a wait-and-see tactic
and watch the patient. The patient must visit every six months
doctor for examination if the growth of the aneurysm is fast (more than
0.5 cm in half a year), he will be assigned to surgery.

After surgery, the patient visits the doctor every month in the first year,
then every six months in the second year and then once a year.

Both before and after surgery, the patient should take the prescribed
doctor medication. It is recommended to observe the following simple
healthy lifestyle activities for prevention
aneurysm growth and complications:

  • Proper nutrition and weight loss. Excluded
    fatty, fried, spicy, salty food. Animals are limited
    fats, confectionery. Fresh vegetables and fruits are recommended,
    cereals, dairy products, low-fat varieties of poultry, meat and fish,
    juices, compotes, fruit drinks. Meal 4 – 6 times a day, small
    in portions. It is better to cook products in steam, boiled, shabby
    the form.
  • Reducing cholesterol – taking statins as directed
    physician restricting cholesterol intake from food.
  • Blood pressure monitoring is an exception
    psycho-emotional stress, heavy physical labor, regular
    medication, normalizing pressure, limiting table salt
    in food.
  • Complete refusal of smoking and alcohol. It is proven that smoking
    triggers aneurysm growth, and alcohol increases pressure, which can
    provoke a vascular catastrophe.
  • The exclusion of significant physical exertion (in early
    postoperative full bed rest with a gradual
    recovery of motor activity). Sports activities
    contraindicated. Walking is allowed on minor
    distances.
  • Correction of associated diseases – diabetes,
    diseases of the heart, liver, kidneys, etc.

Prognosis of the disease

Prognosis without treatment is unfavorable, since natural
the course of the disease leads to complications and death.

  • Mortality with small aneurysm sizes (up to 4–5 cm) less than 5%
    per year, and with sizes of 5–9 cm and more – 75% per year.
  • Mortality after detection of medium to large aneurysms
    size in the first two years is high and is 50 – 60%.
  • The prognosis after the rupture of the aorta is extremely unfavorable, since
    100% of patients without treatment die immediately, and 90% – in the first two
    months after surgery.
  • The prognosis after the planned treatment is favorable, 5-year
    survival rate after surgery is high 65-70%.

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