Aneurysm of the thoracic aorta. Symptoms, diagnosis and treatment of pathology

What is a vascular aneurysm?

Thoracic aortic aneurysms are classified depending on its location, shape, etiology ( the reasons), clinical course and other factors. When formulating a diagnosis, a classification is used for a more detailed description of the pathology.

Due to the disease of the aortic aneurysm are:

• inflammatory etiology ( the reasons) - with syphilis, nonspecific aortoarteritis ( Takayasu's disease is an autoimmune inflammatory disease of the aorta and its branches.), fungal infection and others;
• non-inflammatory etiology- with atherosclerosis, trauma, arterial hypertension;
• congenital- with Marfan's syndrome ( hereditary connective tissue disease), coarctations ( congenital local narrowing of the lumen) aorta, hypoplasia ( underdevelopment of a tissue or organ) and others.

Depending on the localization, there are:

• aneurysm of the sinuses of the aorta sinuses of Valsalva);
• aneurysm of the sinuses of the aorta sinuses of Valsalva) and the ascending aorta ( cardio aorta);
• aneurysm of the ascending aorta cardio aorta);
• aneurysm of the ascending aorta and its arch;
• aneurysm of the aortic arch;
• aneurysm of the ascending aorta, arch and descending aorta;
• aneurysm of the arch and descending thoracic aorta;
• aneurysm of the descending aorta thoracoabdominal aneurysm).

• True aneurysms ( aneurysma verum). With a true aneurysm, the expansion of the aortic lumen occurs due to the thinning and protrusion of all three layers of the wall with pathological changes in the structure. The aneurysm has a smooth expansion and is 50% or more larger than the aortic diameter.
• Pseudoaneurysms or false aneurysms ( aneurysma spurium). False aneurysms are not an expansion of the lumen of the vessel, but only create its "appearance". Occur when the inner layer of the aortic wall is damaged. As a result, blood flows out of the lumen of the vessel through the defect and accumulates in a capsule of connective tissue called a pulsating hematoma. It looks like a unilateral protrusion of the aortic wall.

• small- 4 - 5 centimeters in diameter;
• medium- 5 - 7 centimeters in diameter;
• large- more than 7 centimeters.

• fusiform ( fusiform) aneurysms- the aortic area is evenly expanded along its entire circumference;
• saccular ( saccular) aneurysms- protrusion of the aortic wall in the form of a sac, not exceeding half of its diameter in size;
• dissecting aneurysms ( aneurysma dissecans) - characterized by blood flow between the internal ( tunica intima) and average ( tunica media) layers of the wall through the damaged inner shell, followed by delamination of the vessel.

According to DeBakey's classification, aortic dissection is distinguished:

• I type– damage to the inner layer ( tunica intima) at the level of the ascending aorta ( cardio aorta) with wall dissection to the level of the thoracic and abdominal aorta of the descending section;
• II type- damage to the intima and stratification of the vessel wall in the ascending section ( cardio aorta) or in the aortic arch, without involvement of the descending aorta in the process;
• III type- intimal tear and wall dissection affect the descending thoracic aorta, sometimes with the spread of the process in the abdominal aorta or retrograde in the arch and ascending aorta.

• type A - proximal ( near) - dissection of the ascending aorta cardio aorta);
• type B - distal ( remote) - dissection of the aortic arch and descending aorta.

• sharp- from several hours to several days ( 12 o'Clock in the noon) from the onset of the disease;
• subacute- several days to several weeks 3 – 4 weeks) from the onset of the disease;
• chronic- a few months from the onset of the disease.

Causes of an aortic aneurysm

Congenital diseases include:

• Marfan syndrome. A genetic hereditary disease of the connective tissue, in which anomalies of the eyes, bones, cardiovascular and skeletal systems occur. Manifested by deformity of the chest "chicken breast", sunken breast), abnormally long fingers ( arachnodactyly, "spider fingers"), hypermobility ( pathological increased mobility and flexibility) joints, long limbs, farsightedness or myopia, and many others. Defeat of cardio-vascular system manifested by an aortic aneurysm more ascendant), rupture of the aorta, insufficiency of the heart valves, which in 90% of cases leads to death.
• Ehlers-Danlos syndrome type IV ( vascular type). A rare genetic systemic connective tissue disease caused by impaired collagen synthesis ( protein - the basis of connective tissue). There are several types of the disease that differ in symptoms and prevalence - vascular type, classical type, hypermobility type and others. The vascular type occurs in 1 person per 100,000 population. The disease manifests itself with bruising, hypermobility of the fingers and toes, pallor and thinning of the skin. As well as the fragility of the walls of blood vessels, which leads to aortic aneurysm and subsequently its rupture.
• Lois-Dietz syndrome. A hereditary genetic disease that often affects the cardiovascular and skeletal systems. Pathology is manifested by a triad - splitting of the sky ( cleft palate) or palatine uvula, widely spaced eyes ( hypertelorism), aortic aneurysms. Other symptoms include scoliosis ( spinal curvature), clubfoot ( deformity of the feet, in which they are turned inward), abnormal connection of the brain and spinal cord and others. Symptoms of damage to the cardiovascular system are similar to those of Marfan's disease. But they are characterized by the development of aneurysms not only of the aorta, but also of small arteries, as well as earlier dissection and rupture of the aorta.
• Shereshevsky-Turner syndrome. Refers to chromosomal pathologies. With this syndrome, one X chromosome of a pair of XX or XY chromosomes is missing. More often, the pathology occurs in the female. It is characterized by short stature, malformation, barrel chest deformity, amenorrhea ( lack of a menstrual cycle), underdevelopment of internal and external genital organs, infertility. About 75% of patients with Turner syndrome have pathologies of the cardiovascular system. Aortic aneurysm and aortic dissection are often diagnosed. Aortic dissection is 100 times more common in women with Turner syndrome than in other women. These are usually people in their 30s and 40s.
• Syndrome of arterial tortuosity. A rare genetic disease that is transmitted in an autosomal recessive manner, that is, when both parents are carriers of the defective gene. Vessels are affected - tortuosity, lengthening, narrowing appears ( stenosis), aneurysm of the arteries, in particular the aorta. The connective tissue of the skin is affected ( excessive stretching of the skin), skeleton ( chest deformity, pathological excessive joint mobility), facial features change ( lengthening of the face, underdevelopment of the upper jaw, narrowing palpebral fissure ). About 40% of patients die before the age of 5 years.
• Syndrome combining aneurysm and osteoarthritis. An inherited disorder that causes joint abnormalities, aneurysms, and aortic dissection. It accounts for 2% of all hereditary diseases of the aorta. The patient has osteoarthritis - damage to the cartilage tissue of the surface of the joints. As well as dissecting osteochondritis or Koenig's disease - separation of part of the cartilage from the bone and displacement into the joint cavity. There is excessive tortuosity of the vessel, aneurysms and dissection of the aorta in all its departments.
• Coarctation of the aorta. It is a congenital defect of the aorta, which is manifested by partial or complete narrowing of its lumen. The main symptoms are shortness of breath, weakness, pain in the region of the heart, a more developed upper half of the body, cold lower extremities, and others. A complication of coarctation is an aneurysm ( protrusion of the walls) and bundle ( exfoliation of the inner shell - intima) aorta.

• Takayasu syndrome ( nonspecific aortoarteritis). it chronic inflammation walls of the aorta and its branches, followed by their narrowing ( stenosis). This syndrome can occur under other names - Takayasu's disease, nonspecific aortoarteritis, Takayasu's arteritis, aortic arch syndrome. The nature of the disease is autoimmune ( immunity attacks the body's own cells), but recently the hypothesis of a genetic predisposition to the disease has become more relevant. In Takayasu's syndrome, the aortic arch is more commonly affected. During inflammation, the inner surface of the vessel is damaged, and the inner and middle layers of the vessel thicken. There is a destruction of the middle membrane and its replacement with connective tissue with the appearance of granulomas ( connective tissue nodules). This leads to damage to the aortic wall in the form of stretching, protrusion and thinning.
• Kawasaki syndrome. A rare inflammatory disease of the arteries of various calibers. The disease often manifests itself in children aged from several months to five years. The disease develops when exposed to bacteria and viruses against the background of a genetic predisposition. Kawasaki syndrome is manifested by fever, swollen lymph nodes, loose stools, vomiting, pain in the heart and joint pain, skin rashes, inflammation of the outer shell of the eyes ( conjunctivitis), reddening of the mouth and throat ( enanthem) and other symptoms. One of the complications of this disease is an aortic aneurysm against the background of damage to the vessel wall by the inflammatory process.
• Adamantiadis-Behçet disease. The disease belongs to the group of systemic vasculitis ( inflammatory process in the walls of blood vessels). The cause of the disease is viral and bacterial infections, toxins and autoimmune reactions. An important role is played by heredity. Patients develop ulcers in the genital area, oral mucosa, inflammation of the joints ( arthritis), inflammation of the mucous membrane and vascular membrane of the eye, nausea, diarrhea and others. Vascular lesions are manifested by stenosis ( narrowing of the lumen), thrombophlebitis ( thrombosis and vascular inflammation) and aortic aneurysm.
• Specific and nonspecific aortitis. Aortitis is an inflammation of a separate layer or the entire thickness of the aortic wall, as a result of which the walls become thinner, stretched and perforated. This leads to a bulge in the aortic wall - an aneurysm. Specific aortitis develops with certain diseases. These include syphilis venereal disease), tuberculosis ( infectious disease of the lungs, bones), rheumatoid arthritis ( inflammation of the joints). Nonspecific aortitis appears after infectious ( osteomyelitis, sepsis, bacterial endocarditis), fungal and allergic diseases.
• Gsell-Erdheim syndrome ( idiopathic cystic median necrosis of the aorta). Rare disease of unknown etiology reasons for the appearance), in which the elastic skeleton of the middle shell is affected ( tunica media) walls of the aorta. In the middle shell occur pathological changes leading to tissue death - necrosis. Such a wall defect leads to dissection of the aorta in a limited area or throughout its length. Often the disease is complicated by aortic rupture with localization above the aortic valves, in the aortic arch, in the area before the aortic bifurcation. The disease is more common in young and middle-aged males ( 40 - 60 years old).

• Atherosclerosis. Atherosclerosis is the main cause of aortic aneurysm. It is a chronic disease manifested by thickening of the walls of the vessel and narrowing of its lumen, which leads to disruption of the blood supply to the organs. On the inner wall of the aorta, calcium, cholesterol and other fats are deposited in the form of plaque and plaques. The walls lose their elasticity and become brittle and brittle. An aneurysm appears in the weakest and most stressed place in the aorta.
• Arterial hypertension. Hypertension is a persistent increase in blood pressure ( above 140/90 millimeters of mercury). With an increase in blood pressure, the load on the walls of the vessel increases. A high risk of aortic aneurysm formation appears with prolonged arterial hypertension against the background of atherosclerosis, syphilis, Marfan's syndrome and other diseases in which there are already defects in the vessel wall.
• Injuries. Chest injuries are dangerous because the consequences can appear much later. Aneurysm thoracic aorta can develop within twenty years of injury. On impact to the chest area usually in a head-on collision in a car accident) various forces act on the relatively immobile parts of the aorta. This leads to displacement, compression of the vessel, an increase in blood pressure. As a result, the integrity of the aortic wall is damaged, which gradually progresses to an aneurysm.
• iatrogeny. Iatrogenicity is the appearance of pathological processes in a patient, unintentionally caused by the manipulations of medical personnel. In the case of the aorta, these may be various diagnostic procedures or surgical interventions. Injury to the aortic wall from these procedures may slowly progress to aneurysm formation. The risk is especially high in people with arterial hypertension, atherosclerosis and other diseases that cause pathological changes in the aortic wall.

• people with a hereditary predisposition;
• men;
• persons over 60;
• hypertension ( patients with high blood pressure);
• obese people;
• patients with diabetes;
• smokers;
• patients with a history of chest trauma medical history).

Symptoms of an aortic aneurysm

Depending on the location of the pathology of the aorta, there are:

• symptoms of an aneurysm of the sinuses of the aorta;
• symptoms of an aneurysm of the ascending aorta;
• symptoms of an aneurysm of the aortic arch;
• symptoms of an aneurysm of the descending aorta;
• symptoms of an aneurysm of the thoracoabdominal aorta.

Symptoms of an aortic sinus aneurysm

A small aneurysm usually does not show up. Symptoms appear only if it breaks into neighboring organs. Often an aneurysm ruptures into the pulmonary trunk, a large blood vessel that runs from the right ventricle of the heart to the lungs. This is manifested by retrosternal pain, rapidly increasing shortness of breath, cyanosis ( cyanosis skin ), liver enlargement, edema, progressive left ventricular and right ventricular failure. A similar clinical picture is observed when an aortic aneurysm ruptures into the right heart. Such complications lead to the rapid death of the patient.

Large aneurysms compress neighboring organs and vessels. With compression of the pulmonary trunk, right atrium and right ventricle, subacute right ventricular failure develops. It is manifested by swelling of the veins of the neck, an increase in the liver and the development of edema. lower extremities. The rapid progression of compression of the pulmonary trunk can lead to the sudden death of the patient. In some cases, the aneurysm compresses the superior vena cava with the appearance of the so-called Stokes' collar - swelling of the neck and head, swelling of the upper limbs and shoulder blades.

Symptoms of an aneurysm of the ascending aorta

When an aneurysm ruptures into the superior vena cava, superior vena cava syndrome occurs. Syndrome of cyanosis ( cyanosis) skin, swelling of the face and neck, expansion of superficial veins on the face, neck, upper limbs. Some patients may experience cough, swallowing disorders, chest pain, esophageal and nosebleeds. Symptoms are aggravated in the supine position, so patients take a forced semi-sitting position.

Symptoms of an aneurysm of the aortic arch

With compression of the bronchi, trachea, lungs, shortness of breath appears ( frequent, labored breathing), which is more pronounced during inspiration. Hemoptysis may also occur, which usually precedes an aneurysm rupture. In severe cases, stridor breathing, noisy wheezing, may occur. When the aneurysm is located in the terminal part of the aortic arch, compression of the left bronchus occurs. The left bronchus is narrower and longer, so when it is compressed, air will not enter the lung. This may lead to a decline atelectasis) lung and the absence of gas exchange in it. This condition is manifested by pain in the region of the collapsed lung, cyanosis of the skin, shortness of breath, increased heart rate and arterial hypotension ( low blood pressure).

With compression of the left lower laryngeal nerve ( most often affected by the right inferior laryngeal nerve) the timbre of the voice changes, coughing and suffocation appear ( more often on inspiration). When a venous aneurysm is compressed, swelling and cyanosis appear ( cyanosis) face, swelling of the veins of the neck.

An aneurysm of the aortic arch may be complicated by a breakthrough into the esophagus or trachea. First there is hemoptysis, scanty vomiting of blood, and then profuse bleeding.

Symptoms of an aneurysm of the descending aorta

With the pressure of the aneurysm on the nerve roots, the patient develops severe and excruciating pain in the corresponding departments, which cannot be treated with painkillers. The bodies of the thoracic vertebrae can deform and collapse under constant pressure from the protrusion of the aorta. In severe cases, this can lead to loss of voluntary movement of the lower extremities.

Collapse of the lung, pulmonary hemorrhage, development of pneumonia ( pneumonia) - all this is the result of compression of the lung by an aortic aneurysm.

When an aneurysm ruptures into the lung tissue, bronchus, pleural cavity ( the space between the lung and its shell) appear hemoptysis, shortness of breath, cyanosis of the skin, accumulation of blood in the pleural cavity.

Symptoms of an aneurysm of the thoracoabdominal aorta

In case of compression of blood vessels ( celiac trunk, superior mesenteric artery) collaterals are formed - lateral bypass vessels that provide normal blood supply to organs. That's why internal organs will not suffer from a lack of oxygen and nutrients, but the patient will experience excruciating pressure pains in the abdomen ( ventral toad). A large aneurysm compresses the renal arteries, which can lead to a persistent increase in blood pressure.

Symptoms of a dissecting aortic aneurysm

Dissecting aneurysm appears suddenly and mimics the symptoms of neurological, cardiovascular and urological diseases. There is a sharp, unbearable, growing pain along the course of aortic dissection, which spreads into various areas (along the spine, behind the sternum, between the shoulder blades, in the lower back and others). The patient's blood pressure first rises, and then drops sharply. There is asymmetry of the pulse on the upper and lower extremities, severe weakness, cyanosis of the skin, excessive sweating. With a large size of a dissecting aneurysm, compression of the nerve roots, blood vessels, and neighboring organs occurs.

This appears:

• ischemia ( decreased blood supply) myocardium- pain, burning sensation in the region of the heart;
• ischemia of the brain or spinal cord- impaired consciousness in the form of fainting or coma, loss of sensation or movement in the lower extremities;
• compression of the mediastinal organs ( with dissecting aneurysm of the ascending aorta) - hoarseness, shortness of breath, superior vena cava syndrome and others;
• ischemia and compression of the abdominal organs ( dissecting aneurysm of the descending aorta) - acute renal failure, hypertension, ischemia of the digestive system and others.

Complications of an aortic aneurysm

Complications of an aneurysm of the thoracic aorta are:

• heart, lung, kidney failure;
• aortic rupture;
• dissection of the aortic wall;
• thrombus formation.

The main complications leading to death are:

• aneurysm rupture - 40% of deaths;
• heart failure - 35% of deaths;
• pulmonary insufficiency - 15 - 25% of deaths.

Diagnosis of an aortic aneurysm

The doctor may prescribe a number of laboratory tests - complete blood count and biochemical blood test. The main attention is paid to the lipid profile ( blood lipid analysis). The level of lipids allows you to assess the risk of developing atherosclerosis. Examine the level of cholesterol - a fat-like structural component of cells. Low density lipids ( LDL - "bad" cholesterol) contribute to the formation of atherosclerotic plaques. High density lipids ( HDL - "good" cholesterol) prevent plaque formation. The level of sugar in the blood indicates the presence of diabetes.

All of the above methods of diagnosing a patient do not allow to accurately diagnose an aortic aneurysm. To confirm or refute the diagnosis, the doctor prescribes instrumental methods visualization of the aorta. This helps to study its structure in detail, detect defects, determine the exact location and size of the aneurysm.

Instrumental methods for examining the aorta

Treatment of an aortic aneurysm

If there are no indications for surgical treatment, then the doctor chooses expectant management and supportive drug treatment. Expectant management consists in constant observation of a patient with a small aortic aneurysm. Once every six months, the patient must undergo diagnostic examinations to monitor changes in the aorta over time.

Supportive drug treatment is aimed at eliminating the causes of the aneurysm and maintaining concomitant diseases in the compensation stage, that is, the minimum negative impact of the pathology on the body. Also, drug treatment is aimed at reducing the impact of the deforming force on the walls of the aorta by lowering blood pressure and contractile function of the heart.

The purpose of the supporting drug therapy is:

• Blood pressure control. The optimal blood pressure values ​​for patients with concomitant diabetes mellitus and chronic kidney disease are 130/80 millimeters of mercury. For the rest, 140/90 millimeters of mercury is allowed. α-receptor blockers are used - prazosin, urapidil, phentolamine, β-receptor blockers - bisoprolol, metoprolol, nebivolol, angiotensin-converting enzyme inhibitors ( ACE) - captopril, enalapril, lisinopril.
• Decreased contractility of the heart. Use drugs from the group of β-receptor blockers ( atenolol, propranolol), which reduce myocardial contractility, its oxygen demand and heart rate.
• Normalization of lipid levels. Dyslipidemia ( lipid metabolism disorder) leads to atherosclerosis - the deposition of cholesterol and lipoproteins ( complexes of proteins and fats) on the vessel wall. To normalize lipid levels, drugs of the statin group are used ( simvastatin, rosuvastatin, atorvastatin).

When is surgery necessary for an aortic aneurysm?

An emergency operation is performed according to vital indications, regardless of concomitant diseases and the patient's condition. Indications are the threat of rupture or dissection of the aorta, as well as an aneurysm that has ruptured. Preparation for the operation is carried out as quickly as possible. These may be the necessary instrumental examinations, blood tests, blood grouping, carried out directly in the operating room.

Before the operation, the patient will undergo the necessary instrumental examinations and laboratory tests. An anesthesiologist, cardiologist, cardiac surgeon, vascular surgeon, as well as other specialists in case of concomitant diseases will be consulted. The anesthesiologist will select the type of anesthesia depending on the type of operation. After surgery, the patient expects a long recovery period and lifestyle changes. He will be registered with a cardiologist and periodically undergo instrumental examinations.

Indications for surgical treatment of aortic aneurysm are:

• expansion of the thoracic aorta more than 5 centimeters ( Normal diameter does not exceed 3 cm), since the risk of dissection or rupture of the aorta increases significantly with its diameter of more than 6 centimeters for the ascending aorta and more than 7 centimeters for the descending aorta;
• expansion of the thoracic aorta up to 5 centimeters in patients with Marfan syndrome ( the risk of aortic rupture with a diameter of up to 6 centimeters in such patients is 4 times higher) and other genetic diseases that provoke the development of an aneurysm;
• dissecting aortic aneurysm ( is the leading cause of death and disability in patients);
• rapid growth rate of the aneurysm ( more than 3 millimeters per year);
• patients with cases of aortic aneurysm rupture in relatives;
• pronounced symptoms of aortic aneurysm;
• high risk of aneurysm rupture.

• myocardial infarction ( less than 3 months);
• severe pulmonary insufficiency;
• renal, liver failure;
• malignant neoplasms last stage;
• acute cerebrovascular accident ( ischemic, hemorrhagic stroke);
• sharp infectious diseases;
• chronic diseases in the acute stage;
• inflammatory processes.

Surgical operations for aortic aneurysm are divided into:

• open– prosthetic aorta;
• endovascular ( intravascular) – installation of a stent graft ( cylindrical metal frame);
• hybrid- combined operations.

Aortic prosthesis

The advantage of this treatment method is:

• good visualization and the ability to correct all disorders caused by the aneurysm;
• treatment of aneurysms of any shape and size;
• higher reliability and long-term effect.

• complex surgical access - the need to open the chest or abdominal wall;
• prolonged anesthesia - from 2 to 6 hours;
• the need for artificial circulation and cooling of the patient;
• high risk of complications during and after surgery;
• the presence of a large number of contraindications;
• long recovery period;
• large postoperative scars.

• Operation Bentalla-De Bono– simultaneous replacement of the aortic valve, aortic root and ascending aorta, which is used in the pathology of the aortic valve and ascending aorta ( with Marfan syndrome);
• operation david- prosthesis of the ascending aorta with preservation of its own aortic valve;
• Borst technique– simultaneous replacement of the ascending aorta, aortic arch and descending aorta ( "elephant's trunk").

Endovascular ( intravascular) operations

Endovascular surgery is minimally invasive ( minor damage to the skin). Under local anesthesia in a vessel ( usually in femoral artery ) introduce a special catheter ( handset). Under X-ray control, a stent is delivered through this catheter to the area of ​​the aorta with an aneurysm. The stent is a cylindrical metal frame that is folded in and opened at the site of the aneurysm. The patient is discharged the next day after the operation. This method has more advantages over aortic replacement.

The advantages of this operation are:

• the use of local anesthesia;
• less traumatic operation;
• no need for artificial circulation;
• minimal blood loss during surgery;
• the possibility of carrying out with severe concomitant diseases;
• minimal risks and complications;
• quick recovery ( up to two weeks);
• slight pain after surgery.

Hybrid operation

Shunting is the creation of a shunt ( artificial branch), providing blood flow around the affected area of ​​the vessel. advantage this method is less traumatic, the ability to avoid large-scale surgical intervention and multiple stenting.

Surgical treatment of thoracic aortic aneurysm

Postoperative period for aortic aneurysm

The patient will stay in the hospital for several days. If the attending physician notes the satisfactory and stable functioning of the cardiovascular and other body systems, the patient is discharged home.

• Moderate physical activity. It is necessary to observe physical activity as much as the patient's well-being after the operation allows. You need to start with a short walk, then move on to light physical exercises that do not lead to the appearance pain. Early physical activity prevents the formation of blood clots in the lower extremities, improves blood circulation of organs and tissues, improves function digestive system.
• Diet. In the first days after the operation, the patient will be prescribed diet No. 0, which is used in the rehabilitation of the patient. It includes rice water, low-fat broths, compotes. Next, the patient must follow diet number 10, prescribed for diseases of the cardiovascular system. It consists in limiting the intake of liquid and salt, excluding alcohol, fatty, fried foods. More fruits, vegetables, light soups, lean fish are recommended in the diet.
• Mode of work and rest. In the first few days after the operation, it is recommended to observe bed rest and rest. After discharge from the hospital for a month or more, do not drive vehicles, do not lift heavy objects ( over 10 kilograms), instead of a bath, take a shower, observe the daily routine.
• Medical treatment. It is necessary to strictly adhere to the medical prescription of the doctor, aimed at maintaining normal level blood pressure, prevention of thrombosis, improvement of blood circulation.
• Healthy lifestyle. The patient should quit smoking, get rid of excess weight, exclude alcohol, avoid stress. Also adhere to all doctor's recommendations on physical activity, daily routine, diet.

After the operation, the doctor will explain the need and frequency of consultations and diagnostic procedures. This is necessary for dynamic observation and exclusion postoperative complications. The frequency will depend on the type of operation performed and the individual characteristics of the patient.

The full recovery period lasts from several weeks to 2-3 months, depending on the type of aneurysm and the extent of the operation. A healthy lifestyle and regular exercise play an important role.

Prognosis for aortic aneurysm

The main causes of death in aortic aneurysms are:

• rupture of the aneurysm 35 - 50% of cases);
• cardiac ischemia ( 35-40% of cases);
• strokes ( 20% of cases).

What is the difference between thoracic and abdominal aortic aneurysms?

The main differences between abdominal and thoracic aortic aneurysms are:

• The frequency of the disease. Thoracic aortic aneurysm occurs in 6-10 cases per 100,000 people per year, the ratio of men and women is 2/1, 4/1. At autopsy, it occurs in 0.7% of cases. Abdominal aortic aneurysms account for 80–95% of all diagnosed aneurysms. About 200,000 cases are registered annually in the world. The ratio of men and women is 5/1, 10/1. Abdominal aortic aneurysm at autopsy occurs in 0.6–1.6% of people ( 5 - 6% of cases in patients older than 65 years).
• Anatomical structure and location. The thoracic aorta includes the ascending aorta, the aortic arch, and the descending aorta. The thoracic part of the aorta closely borders on the organs - the heart, bronchi and lungs, the esophagus. This leads to the appearance of a diverse and rapidly manifesting symptomatology.
• Symptoms. Due to its anatomical features, thoracic aortic aneurysm has a diverse and pronounced symptomatology. There are shortness of breath, cyanosis of the skin, impaired swallowing, pain in the heart, palpitations, swelling of the head and neck, and others. Abdominal aortic aneurysm can be asymptomatic for a long time until it ruptures. The main symptoms are pain and a feeling of pulsation in the abdomen, heartburn, constipation, impaired urination, lower back pain, numbness of the legs, impaired movement and sensitivity in the lower extremities.
• Complications. Due to its proximity to vital organs, thoracic aortic aneurysm can lead to serious organ complications with further death. With abdominal aortic aneurysm, the most formidable complication is aortic rupture.
• Treatment. Aortic aneurysms of the thoracic and abdominal sections with small sizes are treated with medication. Surgical treatment has a number of features. Surgical treatment of thoracic aortic aneurysm is much more difficult. This is due to access to the aorta - thoracotomy, that is, opening the chest wall, accompanied by a violation of the integrity of the ribs. When operating on the thoracic aorta, the surgeon is significantly limited in time, as the blood supply to vital organs suffers. Access to the abdominal aorta is obtained by incision of the abdominal wall - laparotomy.

How common is thoracic aortic rupture?

The probability of rupture of an aneurysm with its diameter:

• less than 5 cm– risk less than 1%;
• more than 5 cm– the risk is more than 10%;
• more than 7 cm– the risk is more than 30%.

The main signs of an aortic rupture are:

• sudden intense pain in the chest or abdomen ( can spread to the area between the shoulder blades, jaw, neck, perineum, legs);
• headache - sharp, throbbing in the back of the head;
• severe weakness;
• nausea and repeated vomiting;
• impaired consciousness ( short-term or long-term, mild or comatose);
• thready pulse;
• low blood pressure;
• rapidly growing hematoma collections of blood);
• hyperthermia ( elevated body temperature).

What can be done to prevent aortic rupture?

Causes of aortic rupture include:

• a significant increase in blood pressure;
• pregnancy and childbirth;
• psycho-emotional overexcitation;
• heavy physical activity.

Patients diagnosed with an aortic aneurysm should undergo a thorough evaluation. The doctor must accurately determine the type of aneurysm, its location and size, and then select the treatment. The risk of aortic rupture depends not only on the size of the aneurysm, but also on comorbidities and lifestyle of the patient. In the presence of an aneurysm, the best prevention of aortic rupture is surgical treatment. Your doctor may suggest more gentle surgeries such as aortic stenting and hybrid surgeries.

To prevent aortic rupture, you should:

• see a cardiologist
• periodically undergo instrumental examinations ( echocardiography, MRI, ultrasound);
• maintain a normal weight;
• maintain blood pressure within normal limits;
• eliminate the factors of atherosclerosis ( elevated level cholesterol, smoking, sedentary lifestyle);
• surgery ( especially patients with genetic diseases of the aorta);
• avoid strenuous exercise weight lifting, air travel, sauna visits, sports).

How to issue a disability group for aortic aneurysm?

During the examination, medical and even surgical treatment, there is no question of determining the disability group. After the diagnosis of an aneurysm for several months, the patient undergoes a full course of drug therapy, if necessary, surgical removal of the aneurysm is performed with a long course rehabilitation activities. And only after that, if the patient has persistent impairments to the functioning of the body, it makes sense to refer the patient to a medical and social examination to determine the disability group.

When determining disability, the following are taken into account:

• the patient has heart failure due to impaired blood flow, with aneurysm;
• the presence of comorbidities that prevent surgical treatment and aggravating the patient's condition ( diabetes mellitus, renal and hepatic pathology);
• the age of the patient, his profession and working conditions.

What are the features of thoracic aortic aneurysm during pregnancy?

During pregnancy, the load on the initial sections of the aorta also increases, cardiac output increases, followed by an increase in heart rate and circulating blood volume, especially in the last trimester of pregnancy.
All this, ultimately, can lead to the formation of an aortic aneurysm or expansion with dissection of an existing aneurysm.

The causes of an aortic aneurysm during pregnancy do not differ from the main causes. It can also be congenital and acquired diseases. Of the congenital pathologies accompanied by the formation and dissection of the aorta, the most studied is Marfan's syndrome ( congenital pathology connective tissue), occurring with a frequency of 1/3000 - 1/5000.

The causes of acquired aortic aneurysm are:

• hereditary predisposition;
• injuries, accidents;
• arterial hypertension;
• vascular atherosclerosis;
• syphilis in an advanced stage with a violation of architectonics vascular wall;
• Wrong lifestyle of a woman, obesity, smoking.

With an aneurysm of the thoracic aorta, a pregnant woman may complain of:

• back pain, aggravated by inhalation;
• labored breathing;
• feeling of a coma in the throat with difficulty swallowing;
• snoring in sleep.

• feeling of numbness of the fingers and toes with chilliness due to circulatory disorders;
• pain in the abdomen and lower back;
• sensation of pulsation in the abdomen;
• fainting;
• jumps in blood pressure.

• Ruptured aortic aneurysm. This is an extremely dangerous condition for a woman's life. If the aneurysm is small, then a pregnant woman needs to follow a certain regimen of work and rest, a diet.
• High risk of thrombosis. This is due to a violation of the normal blood circulation in the cavity of the aneurysm. Blood clots can clog arteries and veins, and in some cases wander through the circulatory system and get into the heart valves with its subsequent stop.
• Spontaneous abortion. Termination of pregnancy can be caused by insufficient blood circulation of the fetus due to compression of the vascular aneurysm.
• Detachment of the placenta, followed by severe uterine bleeding. This complication often leads to the death of the fetus and mother.

According to vital indications, they carry out:

• chest x-ray;
• computed tomography with contrast injection of a contrast agent intravenously), which allows to trace the accumulation of contrast in the aneurysm;
• aortography with contrast;
• Ultrasound of the abdominal and thoracic cavity.

The basis for the prevention of aneurysm formation is timely medical control of blood pressure, coagulation and anticoagulation systems of the body, as well as maintaining a healthy lifestyle with proper nutrition and moderate physical activity.

In medical practice, there are rare cases of aortic aneurysm during pregnancy with consequent severe complications.

Do aortic aneurysms occur in children?

Aortic aneurysm in children is caused by:

• Marfan syndrome;
• Ehlers-Danlos syndrome;
• Turner syndrome;
• Lois-Dietz syndrome;
• congenital disorder of connective tissue formation ( gene defect, magnesium deficiency, collagen deficiency);
• coarctation of the aorta;
• arterial tortuosity syndrome;
• Kawasaki syndrome.

The symptoms of an aortic aneurysm in children do not differ from those in adults. This is a cough, hoarseness, difficulty breathing, chest pain with irradiation ( bestowal) in the back. The difficulty in diagnosing an aneurysm in children is that the child cannot always explain what is bothering him. This is especially true for newborns.
Diagnosis of aortic aneurysm in children consists of genetic and instrumental examination ( x-ray, MRI, CT, ultrasound, echocardiography).

Treatment of an aortic aneurysm in children is usually surgical. The enlarged section of the aorta is excised and replaced with a prosthesis. The operation is followed by a long rehabilitation period and regular check-ups with a doctor. Life prognosis for aortic aneurysm ( even after her surgical treatment) is often unfavorable. This is due to severe comorbidities ( valvular insufficiency, heart and aortic defects, collagen deficiency) and complications ( aortic rupture).

Can an aortic aneurysm be treated with traditional methods?

The tactics of treatment are selected by the doctor individually for each patient. Treatment may be surgical or medical alone, depending on the size and location of the aneurysm, as well as the risk of complications. In any case, supportive drug therapy is prescribed, which can be combined with traditional medicine. But you should not self-medicate and before treatment with folk remedies, you must definitely consult with your doctor.

Medicinal herbs are used to strengthen the vascular wall, regulate blood pressure, lower cholesterol levels.

These include:

• infusion of jaundice levokoy- Pour 2 tablespoons of dry grass with a glass of boiling water, leave for 30 minutes and strain, take 4-5 times a day, 1 tablespoon;
• hawthorn infusion- 4 tablespoons of dried and chopped fruit pour 3 cups of boiling water, leave for 30 minutes, strain and drink 200 milliliters three times a day before meals;
• dill infusion - Pour 1 tablespoon of dry grass with 1 cup of boiling water, leave for 15-20 minutes, strain and take 1/3 cup 3 times a day before meals;
• Siberian elderberry infusion - Pour 1 tablespoon with 200 milliliters of boiling water, leave for 30 minutes, strain and take 1 tablespoon 1 time per day;
• a decoction of yarrow, St. John's wort and mountain arnica- leaves of yarrow, St. John's wort and arnica in a ratio of 4/3/1 dry, grind and pour 200 milliliters of cold water for 4 hours, then boil for 5 minutes, cool, strain and take 3 times a day in equal portions.

Can you fly with an aortic aneurysm?

Blood clots can form in an aortic aneurysm. They can be attached to the vessel wall and not disturb the patient. But during a flight under pressure, a blood clot can break off and be carried with the blood stream through the human body. This is extremely dangerous as it can lead to pulmonary embolism ( occlusion of a blood vessel by a thrombus), ischemic stroke ( acute disorder blood circulation of the brain due to blockage of the vessel by a thrombus) and death. A long flight, immobility, sitting position, pressure drops lead to vasoconstriction in the lower extremities, slowing down blood flow and increasing blood viscosity. All this significantly increases the risk of thrombosis.

Also, when climbing to a height, atmospheric pressure drops, which leads to a decrease in the oxygen concentration in the aircraft. For people with a sick heart and blood vessels, this is extremely dangerous, as it can lead to a heart attack. These patients require an additional source of oxygen. But due to the explosive nature of oxygen, not all planes allow you to take oxygen on board.

During air travel, it is impossible for the patient to receive the necessary medical care. Especially in critical conditions requiring immediate surgical intervention ( ruptured aortic aneurysm). This can lead to the death of the patient.

Before flying, a patient with an aortic aneurysm or cardiovascular disease should:

• get advice from a cardiologist;
• undergo instrumental examinations;
• carry out the necessary medical treatment;
• read the rules of the airline ( clarify what medications you can take with you, is it allowed to take oxygen on board the aircraft).

• recent stroke or myocardial infarction less than six months);
• with aortic aneurysm of medium and large sizes;
• with dissecting aneurysm high blood pressure contributes to further separation of the vessel wall);
• with an increased risk of aneurysm, blood clots;
• with the risk of aneurysm rupture;
• with arterial hypertension;
• with heart disease;
• after surgery on the aorta or heart ( the period after the operation is less than a month or six months, depending on the operation).

• try to move more get up every 30 minutes, do leg exercises);
• provide additional inhalations of oxygen;
• take medications to reduce anxiety, blood pressure, to prevent blood clots, and others.

How long do people live with an aortic aneurysm?

Not all patients are diagnosed with an aortic aneurysm on time. In this case, the aneurysm can develop asymptomatically for a long time. The patient, unaware of his disease, continues to smoke, work hard physically, do not monitor blood pressure. This leads to an increase in the protrusion of the aortic wall in size and an increased risk of its rupture and death of the patient. Also, not all patients can undergo surgical treatment.
This is due to the general condition and severe concomitant diseases, in which the patient may not survive anesthesia and surgery.

Aortic rupture and dissection can occur at any time, regardless of the size and location of the aneurysm. Survival in such cases is low - from 20% to 50% of patients.

Once an aortic aneurysm is diagnosed, life expectancy for patients depends on:

• The patient's age. Patients under 50 years of age have fewer comorbidities, but at the same time, they are more susceptible to stress and heavy physical exertion.
• Causes of aortic aneurysm. With genetic diseases of the aorta, life expectancy is short, since often genetic diseases are accompanied by life-incompatible complications and lack of treatment. After a chest injury, it is possible to develop a thoracic aortic aneurysm for decades. In hypertension, atherosclerosis, aneurysm progresses in proportion to the progression of these diseases. Life expectancy in these cases depends on the compensation of diseases.
• The size of the aneurysm and its rate of enlargement. Larger aneurysms increase the risk of rupture. Also, the rapid progression of the aneurysm can lead to life-threatening complications.
• Lifestyle and bad habits. Overweight, strenuous exercise some sports, weight lifting), smoking lead to accelerated development of aortic aneurysm. For example, smoking contributes to an increase in the growth rate of aortic aneurysms up to 35 millimeters per year.
• Associated diseases. Diabetes mellitus, arterial hypertension, atherosclerosis and other diseases that cause pathological changes in the vessel wall significantly accelerate the development of an aortic aneurysm.
• Supportive care and regular medical check-ups. The life expectancy of the patient significantly depends on treatment and monitoring. So the doctor can detect an aortic aneurysm at the earliest stage of its development and delay the time of surgical treatment for many years thanks to the supportive drug treatment and modification of the patient's lifestyle. Also regular medical examinations help prevent such dangerous complications like aortic rupture and aortic dissection.

Chest pain is one of the most common reasons for seeking medical attention. The cause of chest pain may be clear, but is often atypical. Cases where patients complain of chest pain are the most difficult to diagnose.

The differential diagnostic range in such cases is extremely wide and includes, among other things, diseases that pose an immediate threat to life, such as myocardial infarction with and without ST segment elevation, unstable angina, thromboembolism pulmonary artery and dissecting aortic aneurysm.

Dissecting aortic aneurysm (RAA) is a rather difficult problem in terms of primary diagnosis. The reason for this is both the low frequency of this pathology and the high variability of clinical manifestations.

Without the use of cardiac surgical methods in early dates diseases, the prognosis is extremely unfavorable, and the two-week survival rate does not exceed 20%, therefore timely diagnosis RAA is the most important task.

The term "dissecting aortic aneurysm" refers to the sudden formation due to various reasons aortic intima defect with subsequent penetration of blood through this defect into the degeneratively changed median membrane, the formation of a hematoma and longitudinal dissection of the aortic wall.

Dissection (dissection) occurs mainly in the distal, less often in the proximal section. A hematoma can develop along the course of the aorta and block one of its branches, starting from the branches of the aortic arch and ending with the intestinal arteries.

Retrograde dissection may involve the coronary arteries. The right coronary artery is most commonly involved. Retrograde dissection can lead to weakening of one or more leaflets of the aortic valve and its insufficiency.

The false channel is located in the outer half of the middle shell of the aorta. Its outer wall is only a quarter of the original thickness of the aortic wall. This is the reason for frequent aortic ruptures in patients with dissecting aneurysms.

Rupture of an aneurysm of the aortic arch occurs most often in the mediastinal cavity, rupture of the descending aorta - in the left pleural cavity, abdominal aorta - in the retroperitoneal tissue. Since the parietal pericardium attaches to the ascending aorta just proximal to the origin of the brachiocephalic trunk, rupture of any part of the ascending aorta can lead to pericardial tamponade.

Classifications of dissecting aortic aneurysms

Classifications of dissecting aortic aneurysms are usually based on the location of the proximal rupture of the aortic intima and the extent of the dissection of the aortic wall. Since the rupture of the inner lining of the aorta can theoretically occur in any segment and be multiple, the variants of aortic dissection are very diverse.

However, in practice, the rupture of the inner membrane most often occurs in the anterior wall of the ascending aorta at the border of the proximal and middle thirds, as well as in the initial segment of the descending aorta distal to the bed of the left subclavian artery.

It is on this principle that the simple and widespread Stanford classification, according to which there are several types of bundle:

• type A- intimal rupture is in the ascending aorta with or without damage to the arch or descending aorta;
• type B- the tear is located in the descending aorta, while the dissection extends proximally and distally.

To determine the prognosis of the disease and develop conservative and operative tactics in the clinic, a modification is used. M. DeBakey classification:

• type I- the rupture of the inner membrane is localized in the ascending part of the aorta, and the dissection of its walls extends to the abdominal part of the aorta;
• type II- rupture of the inner membrane is localized in the ascending part of the aorta, the dissection ends with a blind sac proximal to the brachiocephalic trunk;
• type III- rupture of the inner lining of the aorta is localized in the initial section of the descending part of the thoracic aorta distal to the mouth of the left subclavian artery.

According to another classification, there are five classes of aortic dissection.

• The 1st class includes the classic aortic dissection with the formation of false and true moves without the formation of a message between them,
• to the 2nd - intramural hematoma or hemorrhage,
• to the 3rd - a penetrating manifestation of an atherosclerotic plaque in the aortic wall due to tearing of its capsule,
• to the 4th - small limited or partial dissections of the aorta with the formation of a protrusion of its wall
• to the 5th - iatrogenic or post-traumatic aortic dissections (for example, aortic dissection with a catheter inserted into it for cardiac catheterization).

Intimal rupture, which is the beginning of a dissecting aneurysm, is found in the ascending aorta in approximately 70% of cases. In 10% of cases, it is found in the arch, in 20% - in the descending part of the thoracic aorta. In rare cases, there is a tear in the intima of the abdominal aorta.

Dissection (dissection) of the aorta can be acute (up to 2 weeks) and chronic (more than 2 weeks).

Prevalence RAA is estimated on average as 1 in 10,000 hospitalized (however, a significant proportion of patients die on prehospital stage). This pathology is the cause of 1.1% of sudden deaths and 3-4% of all sudden deaths from cardiovascular disease; detected in 1 case per 400 autopsies.

To predisposing factors Aortic dissections include diseases and conditions accompanied by cystic degeneration of the media:

• long-term arterial hypertension,
• congenital connective tissue defects (Marfan, Ehlers-Danlos, Turner syndromes),
• polycystic kidney disease,
• elderly age(60-70 years);
• congenital heart defects (coarctation of the aorta, bicuspid or unicuspid valve);
• atherosclerosis of the aorta;
• pregnancy;
• chest trauma,
• severe physical and emotional stress;
• systemic vasculitis (especially often granulomatous, giant cell arteritis);
• chemical and toxic effects (drugs, such as cocaine);
• iatrogenic causes.

Clinical picture

Most frequent symptoms with RAA, there are a sudden onset of pain with a lightning-fast achievement of maximum intensity, localization of pain in the chest, and back pain. The pain is described by patients as very intense or unbearable, the worst pain they have ever experienced, the pain is sharp or tearing.

A significant proportion of patients may experience one or another change in the ST segment or T wave.

With the proximal type of dissection, an aortic regurgitation murmur may be heard.

Both with the proximal and distal types of dissection, the asymmetry of the pulse (decrease in its filling or absence) and blood pressure in the upper or lower extremities can be determined.

In some patients, certain neurological disorders may be detected.

Relatively rare is a secondary (most often posterior-lower) myocardial infarction associated with the spread of dissection at the mouth of the coronary artery.

Diseases that have a clinical picture similar to RAA include:

• acute coronary syndrome;
• aortic insufficiency without dissection (dissection);
• aortic aneurysm without dissection (dissection);
• musculoskeletal;
• pericarditis;
• mediastinal tumor;
• pleurisy;
• pulmonary embolism;
• cholecystitis.

The presence of RAA can be suspected if the patient has pain; pain associated with fainting (syncope); pain in combination with symptoms of heart failure; pain in combination with symptoms of CNS damage (stroke); heart failure without pain; symptoms of CNS damage (stroke) without pain; changes on a chest x-ray without pain; no pulse without pain.

According to the recommendations of the working group of the European Society of Cardiology, to confirm the diagnosis, clarify the type of dissection (localization, extent), diagnose and clarify the severity of aortic insufficiency and the diagnosis of extravasation (periaortic or mediastinal hematoma, pleural or pericardial effusion), preference should be given to transthoracic echocardiography followed by transesophageal echocardiography and intravascular ultrasound, multispiral computed tomography or magnetic resonance imaging.

Angiography may be performed to determine the anatomical substrate for planned percutaneous intervention in hemodynamically stable and unstable patients, but not routinely. Chest X-ray does not provide additional information.

Therapeutic measures

Below are the initial diagnostic and treatment measures that should be carried out if AAA is suspected, in accordance with the recommendations of the European Society of Cardiology Expert Group.

1. Collection of a detailed anamnesis and a complete examination (if possible).

1. Provision of venous access, blood tests (KLA, CPK, troponin I (T), D-dimer, hematocrit, lipids).

1. ECG in 12 leads.

1. Monitoring of blood pressure and ECG.

1. Pain relief (morphine).

1. Decrease in systolic blood pressure, preferably β-blockers (propranolol, metoprolol, esmolol), with contraindications - calcium antagonists.

1. Transportation to the ICU.

1. In severe arterial hypertension additional vasodilators.

1. Transthoracic (transesophageal) echocardiography.

All patients with dissecting aortic aneurysms are treated surgically.

Clinical example

We present a clinical example of in vivo diagnosis of AAA based on the characteristics of the course of the disease and the clinical picture.

Patient A., 59 years old. No complaints at the time of admission. Previously, she did not suffer from cardiovascular diseases.

For the first time 3 days before going to the hospital, there was a stabbing, piercing pain of moderate intensity in the region of the heart and between the shoulder blades without connection with physical activity and movement, aggravated by palpation, persisted for several hours after self-administration of analgesics. A repeated similar attack developed on the eve of admission to the hospital.

Consulted by a neurologist, vertebrogenic thoracalgia was suggested. An ECG was performed, changes were detected (negative T waves in leads III and aVF), for which the patient was referred to the hospital with a diagnosis of IHD. Posterior diaphragmatic myocardial infarction.

During an objective examination, a moderately intense diastolic murmur was heard over the aorta and along the right edge of the sternum.

Taking into account the acute nature and duration of chest pain in combination with the identified signs of aortic insufficiency, presumably acute (there was no information about a pre-existing heart disease, the heart borders were within the normal range, there were no signs of chronic heart failure), it was suggested that there was RAA ascending section of the aorta.

The patient was admitted to the ICU, where it was planned to start an esmolol infusion, conduct transthoracic and, if necessary, transesophageal echocardiography.

10 minutes after admission, the patient suddenly lost consciousness, cessation of blood circulation (electromechanical dissociation) was diagnosed. Resuscitation measures are unsuccessful.

Diagnosis: Dissecting aneurysm of the ascending aorta. Hemopericardium. Cardiac tamponade.

Pathological anatomical examination revealed a non-extended dissection of the ascending aorta with a supravalvular rupture and hemorrhage into the pericardial cavity.

P. V. Dolotovskaya, I. V. Graifer, S. V. Efremov, N. V. Furman

An aneurysm is the resulting protrusion of the wall of a blood vessel, provoked by its stretching or thinning due to any acquired or hereditary pathologies. The danger of such a problem largely depends on the location of the vascular defect and the caliber of the artery or vein.

Aortic aneurysm is rightfully included in the list of the most dangerous conditions that can lead to almost instant death. The insidiousness of this disease lies in the fact that the patient may not even be aware of its presence for a long time, and the aorta is the largest vessel human body, and when a large aneurysm that has formed on it ruptures, the patient may die or have a serious condition caused by massive bleeding in a matter of minutes.

Brief information about the aorta

The aorta is the largest and longest artery of the human body, which is the main vessel of the systemic circulation. It is divided into three parts: ascending, aortic arch and descending. The descending aorta, in turn, is divided into the thoracic and abdominal sections. The length of this large vessel occupies the distance from the sternum to the lumbar spine. Such dimensions of the artery indicate that when pumping blood, the highest pressure is created in it, and that is why areas of protrusion (aneurysm) can often form on it.

Mechanisms and causes of aneurysm development

Also, due to its anatomical features, the aorta is most susceptible to infections, atherosclerotic changes, trauma, and death of the medial membrane of the vessel. All of these predisposing factors contribute to the development of aneurysms, dissection, atherosclerosis, or inflammation of the aorta (aortitis). Stretching or thinning of the walls of this largest artery is caused either age-related changes, or various injuries or diseases (syphilis, atherosclerosis, diabetes mellitus, etc.).

According to statistics, it is atherosclerotic plaques that in most cases are the root cause of this disease. Also, not so long ago, scientists suggested that the herpes virus can contribute to the development of an aortic aneurysm. At the moment, these data have not yet been conclusively confirmed, and scientific research is under development.

In the initial stages of the disease, aortic aneurysms do not manifest themselves in any way and can be detected absolutely by chance during the examination of the patient for other diseases (for example, when performing ultrasound of the vessels, abdominal organs or heart). In the future, atrophy of elastic fibers occurs in the middle wall of this artery. They are replaced by fibrous tissue, and this leads to an increase in the diameter of the aorta and an increase in stress in its wall. With persistent progression of such pathological processes, the risk of rupture increases significantly.

Types of aneurysms

Aortic aneurysms can vary in structure and shape.

According to its pathological features, aneurysm is:

• true - is a protrusion of the vessel wall, which is formed from all the vascular layers of the aorta;
• false (or pseudoaneurysm) - is a protrusion of the vessel wall, which is formed from pulsating hematomas, the walls of the vessel consist of para-aortic connective tissue and sublayer deposits of blood clots.

In its form, an aortic aneurysm can be:

• saccular - the cavity of the pathological protrusion of the aorta communicates with its lumen through the cervical canal;
• spindle-shaped - occurs most often, its cavity is similar to the shape of a spindle and communicates with the aortic lumen through a wide opening;
• stratified - the cavity is formed due to dissection of the walls of the aorta and is filled with blood, such an aneurysm communicates with the aortic lumen through the stratified wall.

By clinical manifestations cardiologists distinguish the following types of aneurysms:

Symptoms

The severity and nature of the signs of aortic aneurysm is predetermined by the place of its localization and the stage of development. They are nonspecific, varied, and, especially if they are insufficiently pronounced or rapidly progressing, they are attributed to patients with other diseases. The sequence of their appearance is always determined by such pathological processes:

• during an aortic intima tear, the patient develops pain and blood pressure drops sharply;
• in the process of dissection of the aortic wall, the patient has sharp pain migrating nature, repeated episodes of lowering blood pressure and organ symptoms (they are determined by the location of the aneurysm, intimal tear and hemorrhage);
• during a complete rupture of the aortic wall, the patient develops signs of internal bleeding (sharp pallor, cold sweat, lowering blood pressure, etc.) and hemorrhagic shock develops.

Depending on the combination of all of the above factors, the patient may experience:

• pain of a burning, pressing or tearing nature, localized or radiating to the arm, chest, shoulder blades, neck, lower back or legs;
• cyanosis of the upper part of the body with the development of hemopericardium;
• syncope that develops when the vessels that flow to the brain are damaged and irritated or when the patient is suddenly anemized due to massive bleeding;
• severe bradycardia at the beginning of intimal tear, followed by tachycardia.

In most patients, aortic aneurysm, especially in the early stages of its development, is asymptomatic. This course of the disease is especially relevant when the pathological protrusion of the vessel wall is located in the thoracic aorta. In such cases, signs of pathology are either detected by chance during instrumental examination for other diseases, or they make themselves felt more clearly if the aneurysm is localized in the area of ​​the aortic bend into the arch. In some cases, with vascular irritation, aortic dissection in the coronary vessels and compression of the coronary arteries, the clinical picture of an aortic aneurysm is combined with symptoms of myocardial infarction or angina pectoris. With the location of the pathological protrusion in the abdominal aorta, the symptoms of the disease are clearly expressed.

An ECG examination of a patient with an aortic aneurysm may show a variable picture. In 1/3 of cases, no abnormalities are found on it, while in others, signs of focal myocardial lesions and coronary insufficiency are observed. In aortic dissection, these signs are persistent and are found on several repeated ECGs.

AT general analysis blood in a patient revealed leukocytosis and signs of anemia. With dissection of an aortic aneurysm, a decrease in the level of hemoglobin and erythrocytes is constantly progressing and is combined with leukocytosis.

Also, in patients with this disease, some neurological symptoms may appear:

• convulsions;
• disorders in urination and defecation;
• hemiplegia;
• fainting states;
• paraplegia.

When the femoral and iliac arteries are involved in the pathological process, signs of impaired blood supply to the lower extremities are observed. The patient may experience: pain in the legs, swelling, blanching or cyanosis of the skin, etc.

In the case of dissection of an aneurysm of the abdominal aorta, a pulsating and growing tumor is formed in the abdomen, and when blood flows into the pleural cavity, pericardium or mediastinum, when the borders of the heart are tapped, their displacement, expansion and disturbances are observed. heart rate up to cardiac arrest.

Symptoms of a ruptured aortic aneurysm

In most cases, a ruptured aortic aneurysm is not accompanied by any specific symptoms. Initially, the patient may experience discomfort and mild pain, and at the onset of bleeding to clinical picture signs of hemorrhagic shock join.

In the case of a massive and rapid hemorrhage, fainting and intense pain can occur in different parts of the body (if the dissection or rupture of the aorta occurs in close contact with the nerve bundle). The further prognosis of such significant blood loss depends on the total volume of blood lost.

Treatment

For the treatment of an aortic aneurysm, the patient must contact a vascular surgeon or a cardiac surgeon. The definition of its tactics depends on the growth rate, localization and size of the aneurysm, which are determined during dynamic observation and constant radiological control. If necessary, to reduce the risk of developing possible complications or preparing the patient for surgical treatment, anticoagulant, antiplatelet, hypotensive and anticholesterolemic drug therapy is carried out.

The decision to perform planned surgical treatment is made in such clinical cases:

• aneurysm of the abdominal aorta with a diameter of more than 4 cm;
• thoracic aortic aneurysm with a diameter of more than 5.5-6 cm;
• a constant increase in the size of a small aneurysm by 0.5 cm or more within six months.

An emergency surgical operation is carried out as soon as possible, because with massive or prolonged bleeding, the patient dies in a short time. Indications for it may be such terminal situations:

• embolization of peripheral arteries;
• dissection or rupture of the aorta.

To eliminate the aneurysm, operations are performed, the purpose of which is to excise and suture or replace the damaged part of the aorta with a prosthesis. In the presence of aortic insufficiency, aortic valve replacement is performed during resection of the thoracic vessel.

One of the minimally invasive options for surgical treatment may be endovascular prosthesis followed by the installation of a stent or vascular prosthesis. If it is impossible to perform such operations, traditional interventions are performed with open access to the site of localization by resection:

• abdominal aneurysms;
• thoracic aneurysms with left ventricular bypass;
• thoracic aneurysms with cardiopulmonary bypass;
• aneurysms of the aortic arch with cardiopulmonary bypass;
• abdominal aortic aneurysms;
• abdominal aortic aneurysms with cardiopulmonary bypass;
• aneurysms of the subrenal aorta.

After completion of surgical treatment, the patient is transferred to the cardio intensive care unit, and when all vital functions are restored, to vascular department or a heart center. AT postoperative period the patient is prescribed analgesic therapy and symptomatic treatment.

The prognosis for aortic aneurysm will be determined by its size, rate of progression, and concomitant pathologies of the cardiovascular and other body systems. In the absence of treatment, the outcome of the disease is extremely unfavorable, because due to the rupture of the aneurysm or the development of thromboembolism, the patient is fatal. According to statistics, about 95% of patients die within the first three years. This is due to the frequent latent course of the disease and the high risk of aneurysm rupture, the diameter of which reaches 6 cm. According to statistics, about 50% of patients die with such aortic pathologies per year.

With early detection and planned surgical treatment of aortic aneurysms, the postoperative prognosis becomes more favorable, and the lethal outcome is no more than 5%. That is why, for the prevention and timely detection of this disease, it is recommended to constantly monitor the level of blood pressure, lead a healthy lifestyle, undergo regular scheduled preventive examinations and all doctor's prescriptions for drug therapy of concomitant diseases.

Medical animation on the topic "Aortic Aneurysm":

Thoracic aortic aneurysm

The aorta is the leading arterial blood vessel, it connects all parts of the body and internal organs to our heart. An aneurysm of the thoracic aorta is an indicator of exhaustion, the production of vessel tissues, which in many cases leads to a sudden rupture of the wall and, as a rule, ends in death.

Causes

The natural causes of the disease are many factors, it is the complex component that plays a decisive role. A person who does not think about his health is always at risk. The main causes predisposing to the appearance of thoracic aortic aneurysm:

• obesity by a third of normal weight;
• smoking;
• genetic predisposition to aneurysm;
• infections;
• congenital connective tissue disorders, Marfan's syndrome;
• over sixty years of age;
• inflammatory processes of the walls of blood vessels, previously transferred aortic dissection;
• atherosclerosis;
• chest injury;
• pathology of the heart valve;
• high blood pressure.

It is noticed that representatives of the white race suffer from the disease of thoracic aortic aneurysm more often than representatives of others. Also, the predisposition of men is higher than that of women.

Symptoms of the disease

Usually, an aneurysm of the thoracic aorta grows slowly and does not manifest itself at first. This is the difficulty in diagnosing the disease on early stages. Slowly growing aneurysms do not always lead to rupture of vessel tissues, adding up to 1 cm in diameter per year, they do not pose a danger. Only aggressive growths of the affected areas are life-threatening, the risk of rupture in this case is fatally high. The rapid growth of the aneurysm contributes to the appearance of sudden pain in the abdomen and chest, radiating to the back. The thoracic and abdominal aorta is more often affected by aneurysms, less often it occurs between the sternum and the abdominal region.

The main signs of the disease:

• the appearance of shortness of breath;
• hoarse voice;
• cough to hoarseness;
• Horner's syndrome;
• dysphagia, difficulty swallowing;
• constant unpleasant, painful sensations in the chest.

The manifestation of many of these symptoms is facilitated by squeezing the swollen artery of the surrounding tissues and organs. The thinned walls of the arterial vessel "stretch" under blood pressure, the vessel increases, pressing down on the trachea, causing coughing. If the aorta presses on the esophagus, swallowing becomes difficult, pressing the nerves of the larynx contributes to hoarseness.

Horner's syndrome is considered another serious manifestation of the disease. It combines the signs arising from the squeezing of the nerve endings of the autonomic nervous system, which are located inside the sternum.

Characteristic signs of the syndrome:

1. Narrow pupil.
2. Half-drooped eyelids.
3. Increased sweating.
4. Sensation of internal pulsation in the chest area.

If an aneurysm of the thoracic aorta ruptures, then more often a fatal outcome is a foregone conclusion, even with rapid surgical care. However, if death does not occur, the following symptoms of a ruptured thoracic aortic aneurysm appear - a sharp chest pain that spreads to all parts of the body, arterial hypotension, internal bleeding, bouts of vomiting with blood, similar symptoms are observed with myocardial infarction.

Treatment

The presence of the above symptoms, hereditary predisposition is a mandatory reason to come to the doctor for an appointment. The usual procedure in this case will be an ultrasound examination to identify the aneurysm.

Methods for diagnosing aortic aneurysm:

1. X-ray, it shows the presence or absence of an aneurysm.
2. Ultrasound or echocardiography, simple and safe way detect deviations in the structure of the aorta and heart.
3. Computed tomography, provides a layered structure of the body, harmful ionizing radiation, but unmistakable.
4. MRI, magnetic resonance angiography, allows you to get an accurate layered structure of organs and tissues, including blood vessels, using electromagnetic radiation.

Patients at risk for an aneurysm in a leading arterial vessel should have regular ultrasound scans. This is the fastest and cheapest method for diagnosing pathologies of blood vessels and other organs.

Basic treatment for an aneurysm

Naturally, the main task of the doctor and patient in this disease is the prevention of aortic rupture at the site of aneurysm formation. Treatment is divided into two stages:

1. observation;
2. surgical intervention.

Conservative methods, as it were, “delay” the development of a lesion in the aortic area; it is impossible to completely recover from an aneurysm. In the aggressive course of the disease, surgery is indicated.

How is an aneurysm monitored?

Hypertensive patients and patients suffering from atherosclerosis, cardiologists prescribe blood pressure-reducing beta-blockers, angiotensin II inhibitors, and cholesterol-lowering drugs. Patients are advised to stop smoking.

Thus, a visit to the doctor is necessary once every six months to determine the dynamics of the disease, examination and adjustment of the course of preventive treatment to prevent aortic aneurysm rupture.

Operation on the aorta

A rupture of the thoracic aorta at the site of an aneurysm is a catastrophic situation, without the help of a surgeon, a fatal outcome, with surgery, the survival rate reaches 65%. Therefore, it is desirable to carry out the operation as planned, if there are serious indications for this. The main ones are foci of blood accumulation, the process of aortic dissection that has begun.

The severe stage of the disease is characterized by the presence of "burning" pains, like heart attacks, and the collapse of all systems develops. A sign of it is the inability of patients to move their upper limbs (hands).

There is a long history of observing the symptoms of an aneurysm, but the diagnosis is sometimes clear only after a catastrophic rupture. Severe bleeding opens, the pleural cavity is filled with blood, as well as the trachea and esophagus. The patient has signs of hemorrhagic shock - a sharp drop in blood pressure, pale skin, tachycardia, loss of consciousness, lack of correct perception of the surrounding reality. Lack of medical care leads to death. Complications of the disease are also heart failure, clogging of blood vessels with blood clots.

Surgery in this case goes in two ways:

1. endovascular method of treatment;
2. open operation.

The endovascular method is performed using a puncture in the femoral part of the artery, through which a compressed graft, stent, is passed to the site of the expanded part of the artery. It is implanted into the wall of the vessel, representing a synthetic internal frame, while the pressure of the blood flow on the wall of the artery stops, which gives it the opportunity to recover, prevents its rupture. This technique is minimally invasive, i.e., there is little damage to the body. The patient is ready for discharge a few days after the operation. However, the method does not give a 100% guarantee and has not yet been sufficiently studied.

Target surgical operation open type - prosthesis of the damaged aorta. The surgeon cuts the chest and implants a prosthetic blood vessel. Part of the artery is removed and replaced with an artificial implant. Usually, a one-time adjustment of the heart valve is performed, as well as surgical revascularization for those suffering from ischemia. Recovery period after surgery to remove an aortic aneurysm lasts up to one month and depends on general condition organism.

The indication for surgery is the large size of the aneurysm, 5–6 cm in diameter, and its rapid growth.

Aneurysms also need to be operated on:

• after chest trauma;
• with pronounced manifestations;
• after syphilis.

Without treatment, patients with large aortic lesions are prone to thrombus formation. The disease in five years "eats" three out of four people who have not decided on an operation.

Measures to prevent aortic aneurysm

The very first step is to quit smoking. A person with an aneurysm needs to constantly monitor their blood pressure, heart rate. It is especially necessary to be attentive to hypertensive patients with experience, men after 60 years.

If any pathological conditions, abnormalities in the work of the heart, persistent high blood pressure values ​​are noticed, it is necessary to urgently consult a specialist doctor, a cardiologist. Prescribed drugs should be taken regularly, without deviating from the scheme. The seriousness of a disease, such as a thoracic aortic aneurysm, should not be frightening, modern methods of treatment give encouraging results, the main thing is to monitor your health.

Diet to improve the condition of blood vessels

Some products need to be removed from the daily diet forever. These include:

• hydrogenated fats such as margarine and products based on it - cookies, muffins, cakes, semi-finished products in the form of puff pastry, pies:
• egg whites, souffle, marshmallows;
• fatty fried meat.

An excellent replacement for the above products is ocean fish, vegetable oils, vegetables and herbs. Cheeses, cottage cheese, and sour cream should be chosen with a reduced percentage of fat content. Useful energy - whole grain cereals, black bread. Within reasonable limits, garlic, onion, ginger and other spices should be consumed regularly, they contain trace elements useful for blood vessels and the heart.

Increasing physical activity

It is necessary to increase the amount of physical activity on the body smoothly, step by step, under the supervision of a doctor. It is required to achieve a light training effect of the whole organism, and in particular the work of the heart and circulatory system. It is desirable to maintain a normal rhythm of life with a slight deviation towards activity. For example, daily evening walks to the store can be increased by 15-30 minutes, walk a little further. The most important thing is that any action should become regular.

Issues of self-control during additional physical activity:

• pulse 120-140 beats per minute;
• immediately reduce the intensity with the appearance of weakness, pain, shortness of breath, increased sweating.

Gradually, you need to accustom yourself to walking 3-4 km, at a speed of 120 steps per minute, 3-5 times a week. Good luck and health to you!

Thoracic aortic aneurysm

The aorta is one of the large arteries in the human body, which connects the organs and parts of the body with the main organ on which our life depends - the heart. But every second person is diagnosed with various vascular diseases, which poses a serious threat to human health and life.

One of the common pathologies of the aorta is an aneurysm. Thoracic aortic aneurysm is an anomaly of the main artery of the human body, which is characterized by a pathological expansion of the lumen of the aorta in the chest. Such an abnormal expansion provokes a violation of the normal functioning of the valve, which is located between the heart and the aorta. And this is accompanied by a phenomenon in which the blood flow returns back to the heart, but the valve is closed. Thoracic aortic aneurysm causes an increased chance of accidental rupture and bleeding, leading to death.

General information about the disease

The aorta is the largest vessel that begins in the left ventricle, rises slightly upwards and descends in the form of an arc. The part of this vessel that passes through the chest area is called the thoracic aorta, and when it passes into the abdominal cavity, it becomes known as the abdominal aorta. An aneurysm occurs in the ascending aorta. Also, an aneurysm of the thoracic aorta is combined with an aneurysm of the abdominal artery.

The normal diameter of the aortic lumen is 2 cm, and if an aneurysm develops, the diameter can increase to an incredible size, life threatening person. This leads to the development of complications such as stratification of the vascular walls and their rupture. The anomaly occurs in a weakened section of the aortic wall, and the resulting high pressure contributes to its further expansion.
If the aneurysm is not identified and treated in time, then it may rupture, which will open fatal bleeding. The mortality rate is almost 70%, so it is important to notice the signs of the disease early and consult a doctor.

Causes of thoracic aortic aneurysm

There are many reasons that cause the development of the disease, but pathology occurs as a result of exposure to factors:

• being overweight and obese by a third of normal weight;
• bad habits: smoking, alcohol;
• age factor: people over 60;
• Marfan syndrome;
• deposition of cholesterol and atherosclerosis;
• sedentary lifestyle;
• chest injury;
• infectious diseases accompanied by vascular lesions: tuberculosis, syphilis;
• inflammation of the walls of the vessel;
• iatrogenic;
• pathology of the heart valve;
• hypertension.

Thoracic aortic aneurysm occurs in men over the age of 60, especially in whites. And if the pathology was found in a young man, then the cause of its occurrence is congenital or hereditary.

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Symptoms of a thoracic aortic aneurysm

The clinical picture of the pathology is diverse and arises from the influence of certain factors. Symptoms depend on the location and size of the anomaly, the degree of separation of the walls and the effect of the damaged artery on the body.

An aneurysm of the thoracic aorta grows slowly, but at a slow growth rate, aneurysms provoke rupture of aortic tissues and do not pose a serious threat, because they increase in diameter by no more than 1 cm per year. Aortic aneurysm becomes a threat to life if there is an aggressive growth of deformed areas, since the probability of tissue rupture is very high. If the pathology grows very quickly, then there are sudden pains in the abdomen and chest, which can radiate to the back.

Thoracic aortic aneurysm develops without symptoms, and if signs of the disease appear, then their specificity is poorly expressed, which makes it difficult to assume the development of the disease as an aneurysm. Pathology is manifested by the following symptoms:

• pain different intensity in the chest area, which give to the lower back. Pain may occur in the neck or lower jaw;
• frequent shortness of breath;
• hoarseness or hoarseness of voice;
• difficult breathing;
• bouts of dry cough with wheezing in the throat;
• headaches, dizziness;
• low blood pressure;
• cardiopalmus;
• difficulty breathing, dysphagia.

The onset of symptoms is facilitated by squeezing by the dilated artery of organs and tissues that are nearby. The walls of the vessel become thinner, which is why they quickly stretch and blood pressure leads to an increase in the vessel, which eventually begins to put pressure on the trachea, causing coughing. And if the aorta begins to put pressure on the esophagus, then there is difficulty in swallowing, and with pressure on the larynx, hoarseness or hoarseness of the voice.

Another serious symptom of a thoracic aortic aneurysm is Horner's syndrome. This syndrome consists of symptoms resulting from compression of the nerve endings of the autonomic nervous system located in the chest. Horner's syndrome is manifested by the clinical picture:

• constricted pupil;
• increased sweating;
• the eyelids are in a half-closed state;
• feeling of throbbing in the chest.

Symptoms of a ruptured aneurysm

• sharp prolonged pain in the chest or abdomen;
• sharp, throbbing headache in the back of the head;
• severe weakness;
• frequent bouts of nausea and vomiting with blood;
• shock state;
• low pressure;
• increase in body temperature;
• disturbed consciousness;
• internal bleeding.

Similar symptoms can also mean a myocardial infarction or pathological condition blood supply to the heart muscle. Therefore, you need to consult a doctor as soon as there is even the slightest suspicion of serious illness so that the specialist can diagnose the pathology as early as possible and begin immediate treatment, thereby reducing the risk of fatal complications.

Aortic aneurysm complications and prognosis

Thoracic aortic aneurysm can cause the following dangerous complications:

• aortic rupture. This phenomenon poses a threat to the life of the patient. And the larger the aneurysm, the more likely it is to rupture;
• thrombus formation;
• stratification of the vessel wall;
• heart and lung failure.

Given the statistics, complications of aortic aneurysm lead to death in 40% of cases after 3 years of diagnosis, and 60% of cases - 5 years after the discovery of the disease. The prognosis for thoracic aortic aneurysm mainly depends on the size of the anomaly, the rate of progression, and the presence of comorbidities.

Surgical medicine does not stand still, so patients with a similar diagnosis manage to save their lives. main reason death in aortic aneurysm is its rupture, and coronary heart disease and strokes can also lead to a fatal outcome. The likelihood of aneurysm rupture depends on the size of the pathology. An increase in the diameter of the vessel by more than 5 cm poses a threat to the patient's life. Dissection of the aortic wall has a poor prognosis if surgical treatment was not started in the early days.

Diagnosis of thoracic aortic aneurysm

• delivery of general clinical tests;
• radiography. It allows you to detect the presence of an aneurysm;
• Ultrasound of the heart;
• CT scan;
• aortography;
• angiography.

Patients who are at risk for thoracic aortic aneurysm should have regular ultrasound scans, as it is an affordable and inexpensive way to diagnose vascular pathologies. After all the examinations have been completed, you need to contact your doctor again with the results of the studies, each of which is able to provide important information that will allow you to choose the best treatment.

If there is a suspicion of aortic rupture, then it is necessary to undergo an ultrasound echocardiological examination through the esophagus, as well as tomography. In some cases, the doctor may refer you for testing for the presence of syphilis, as it is common cause aortic aneurysms. It is also possible to check for bacterial and fungal blood cultures.

Any operation for an aneurysm of the thoracic aorta is to replace the damaged part of the aorta with a special prosthesis that prevents the risk of rupture and dangerous bleeding. After any operation on the thoracic aorta, constant monitoring by a doctor for a long time is necessary.

The basis for the diagnosis of aortic aneurysm is radiological (radiography of the chest and abdominal cavity, aortography) and ultrasound methods (USDG, ultrasound of the thoracic/abdominal aorta). Surgical treatment of an aneurysm involves its resection with aortic replacement or closed endoluminal aneurysm replacement with a special endoprosthesis.

aortic aneurysm

An aortic aneurysm is characterized by an irreversible expansion of the lumen of the arterial trunk in a limited area. The ratio of aortic aneurysms of different localization is approximately the following: abdominal aortic aneurysms account for 37% of cases, ascending aorta - 23%, aortic arch - 19%, descending thoracic aorta - 19.5%. Thus, the share of thoracic aortic aneurysms in cardiology accounts for almost 2/3 of all pathology. Thoracic aortic aneurysms are often combined with other aortic malformations - aortic insufficiency and aortic coarctation.

Classification of aortic aneurysms

In vascular surgery, several classifications of aortic aneurysms have been proposed, taking into account their localization by segments, shape, wall structure, and etiology. In accordance with the segmental classification, there are: aneurysm of the sinus of Valsalva, aneurysm of the ascending aorta, aneurysm of the aortic arch, aneurysm of the descending aorta, aneurysm of the abdominal aorta, aneurysm of combined localization - the thoracoabdominal part of the aorta.

Evaluation of the morphological structure of aortic aneurysms allows us to subdivide them into true and false (pseudoaneurysms). A true aneurysm is characterized by thinning and outward protrusion of all layers of the aorta. By etiology, true aortic aneurysms are usually atherosclerotic or syphilitic. The wall of the false aneurysm is represented by a connective tissue formed as a result of the organization of a pulsating hematoma; own walls of the aorta are not involved in the formation of a false aneurysm. Pseudoaneurysms by origin are more often traumatic and postoperative.

Saccular and fusiform aortic aneurysms are found in shape: the former are characterized by local protrusion of the wall, the latter by diffuse expansion of the entire diameter of the aorta. Normally, in adults, the diameter of the ascending aorta is about 3 cm, the descending thoracic aorta is 2.5 cm, and the abdominal aorta is 2 cm. An aortic aneurysm is said to occur when the diameter of the vessel in a limited area increases by 2 or more times.

Taking into account the clinical course, uncomplicated, complicated, exfoliating aortic aneurysms are distinguished. Specific complications of aortic aneurysms include rupture of the aneurysmal sac, accompanied by massive internal bleeding and hematoma formation; thrombosis of aneurysm and thromboembolism of arteries; phlegmon of surrounding tissues due to infection of the aneurysm. A special type is a dissecting aortic aneurysm, when, through a rupture of the inner membrane, blood penetrates between the layers of the artery wall and spreads under pressure along the course of the vessel, gradually exfoliating it.

The etiological classification of aortic aneurysms is detailed when considering the causes of the disease.

Causes of an aortic aneurysm

According to etiology, all aortic aneurysms can be divided into congenital and acquired. The formation of congenital aneurysms is associated with hereditary diseases of the aortic wall - Marfan's syndrome, fibrous dysplasia, Ehlers-Danlos syndrome, Erdheim's syndrome, hereditary elastin deficiency, etc.

Acquired aortic aneurysms of inflammatory etiology occur as a result of specific and nonspecific aortitis with fungal lesions of the aorta, syphilis, and postoperative infections. Non-inflammatory or degenerative aortic aneurysms include cases of disease caused by atherosclerosis, defects in suture material and prostheses. Mechanical damage to the aorta leads to the formation of hemodynamic-poststenotic and traumatic aneurysms. Idiopathic aneurysms develop with median necrosis of the aorta.

Risk factors for the formation of aortic aneurysms are older age, male sex, arterial hypertension, smoking and alcohol abuse, hereditary burden.

The pathogenesis of aortic aneurysms

In addition to the defectiveness of the aortic wall, mechanical and hemodynamic factors are involved in the formation of an aneurysm. Aortic aneurysms often occur in functionally stressed areas experiencing increased stress due to high blood flow velocity, steepness of the pulse wave and its shape. Chronic traumatization of the aorta, as well as increased activity of proteolytic enzymes, cause destruction of the elastic framework and nonspecific degenerative changes in the vessel wall.

The formed aortic aneurysm progressively increases in size, since the stress on its walls increases in proportion to the expansion of the diameter. The blood flow in the aneurysmal sac slows down and becomes turbulent. Only about 45% of the blood from the volume in the aneurysm enters the distal arterial bed. This is due to the fact that, getting into the aneurysmal cavity, the blood rushes along the walls, and the central flow is restrained by the turbulence mechanism and the presence of thrombotic masses in the aneurysm. The presence of thrombi in the aneurysm cavity is a risk factor for thromboembolism of distal aortic branches.

Symptoms of an aortic aneurysm

Clinical manifestations of aortic aneurysms are variable and are determined by the location, size of the aneurysmal sac, its length, and the etiology of the disease. Aortic aneurysms can be asymptomatic or be accompanied by scanty symptoms and be detected at routine examinations. The leading manifestation of an aortic aneurysm is pain caused by damage to the aortic wall, its stretching or compression syndrome.

The clinic of abdominal aortic aneurysm is manifested by transient or persistent diffuse pains, discomfort in the abdomen, belching, heaviness in the epigastrium, a feeling of fullness in the stomach, nausea, vomiting, intestinal dysfunction, and weight loss. Symptoms may be associated with compression of the cardia of the stomach, duodenum, involvement of visceral arteries. Often patients independently determine the presence of increased pulsation in the abdomen. On palpation, a tense, dense, painful pulsating formation is determined.

For an aneurysm of the ascending aorta, pain in the region of the heart or behind the sternum is typical, due to compression or stenosis of the coronary arteries. Patients with aortic insufficiency are concerned about shortness of breath, tachycardia, dizziness. Large aneurysms cause the development of the syndrome of the superior vena cava with headaches, swelling of the face and upper half of the body.

Aortic arch aneurysm leads to compression of the esophagus with dysphagia; in case of compression of the recurrent nerve, hoarseness of voice (dysphonia), dry cough occurs; the interest of the vagus nerve is accompanied by bradycardia and salivation. With compression of the trachea and bronchi, shortness of breath and stridor breathing develop; with compression of the root of the lung - congestion and frequent pneumonia.

When the aneurysm of the descending aorta stimulates the periaortic sympathetic plexus, pain occurs in the left arm and shoulder blade. If the intercostal arteries are involved, spinal cord ischemia, paraparesis and paraplegia may develop. The compression of the vertebrae is accompanied by their usuration, degeneration and displacement with the formation of kyphosis; compression of blood vessels and nerves is clinically manifested by radicular and intercostal neuralgia.

Complications of an aortic aneurysm

Aortic aneurysms can be complicated by rupture with the development of massive bleeding, collapse, shock, and acute heart failure. Aneurysm rupture can occur in the system of the superior vena cava, the pericardial and pleural cavities, the esophagus, and the abdominal cavity. At the same time, severe, sometimes fatal conditions develop - superior vena cava syndrome, hemopericardium, cardiac tamponade, hemothorax, pulmonary, gastrointestinal or intra-abdominal bleeding.

With the separation of thrombotic masses from the aneurysmal cavity, a picture of acute occlusion of the vessels of the extremities develops: cyanosis and soreness of the toes, livedo on the skin of the extremities, intermittent claudication. With thrombosis of the renal arteries, renovascular arterial hypertension and renal failure occur; with damage to the cerebral arteries - a stroke.

Diagnosis of an aortic aneurysm

Diagnostic search for aortic aneurysm includes an assessment of subjective and objective data, X-ray, ultrasound and tomography studies. Auscultatory sign of an aneurysm is the presence of systolic murmur in the projection of aortic expansion. Abdominal aortic aneurysms are detected by palpation of the abdomen in the form of a tumor-like pulsating mass.

The radiographic examination plan for patients with thoracic or abdominal aortic aneurysm includes fluoroscopy and chest radiography, plain abdominal radiography, and radiography of the esophagus and stomach. When recognizing aneurysms of the ascending aorta, echocardiography is used; in other cases, ultrasound (USDS) of the thoracic/abdominal aorta is performed.

Computed tomography (MSCT) of the thoracic/abdominal aorta makes it possible to accurately and visually present the aneurysmal expansion, identify the presence of dissection and thrombotic masses, para-aortic hematoma, and foci of calcification. At the final stage of the examination, aortography is performed, according to which the localization, size, length of the aortic aneurysm and its relationship to neighboring anatomical structures are specified. Based on the results of a comprehensive instrumental examination, a decision is made on the indications for surgical treatment of aortic aneurysm.

Thoracic aortic aneurysm should be differentiated from lung and mediastinal tumors; aneurysm of the abdominal aorta - from volumetric formations of the abdominal cavity, lesions of the lymph nodes of the mesentery, retroperitoneal tumors.

Treatment of an aortic aneurysm

With asymptomatic non-progressive course of aortic aneurysm, they are limited to dynamic observation by a vascular surgeon and radiological control. To reduce the risk of possible complications, antihypertensive and anticoagulant therapy, lowering cholesterol levels are carried out.

Surgical intervention is indicated for aneurysms of the abdominal aorta with a diameter of more than 4 cm; thoracic aortic aneurysms with a diameter of 5.5-6.0 cm or with an increase in smaller aneurysms by more than 0.5 cm in six months. When an aortic aneurysm ruptures, the indications for emergency surgical intervention are absolute.

Surgical treatment of aortic aneurysm consists in excision of the aneurysmically altered portion of the vessel, suturing the defect or replacing it with a vascular prosthesis. Taking into account the anatomical localization, resection of the aneurysm of the abdominal aorta, thoracic aorta, aortic arch, thoracoabdominal part of the aorta, subrenal aorta is performed.

In hemodynamically significant aortic insufficiency, resection of the ascending thoracic aorta is combined with aortic valve replacement. An alternative to open vascular intervention is endovascular aortic aneurysm repair with stent placement.

Prediction and prevention of aortic aneurysm

The prognosis of an aortic aneurysm is mainly determined by its size and concomitant atherosclerotic lesions of the cardiovascular system. In general, the natural course of an aneurysm is unfavorable and is associated with a high risk of death from aortic rupture or thromboembolic complications. The probability of rupture of an aortic aneurysm with a diameter of 6 cm or more is 50% per year, with a smaller diameter - 20% per year. Early detection and planned surgical treatment of aortic aneurysms is justified by low intraoperative (5%) mortality and good long-term results.

Preventive recommendations include blood pressure control, the organization of a proper lifestyle, regular monitoring by a cardiologist and an angiosurgeon, drug therapy for comorbidities. Individuals at risk for developing an aortic aneurysm should undergo a screening ultrasound examination.

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Aortic aneurysm. Complications, diagnosis and treatment

Complications of an aortic aneurysm

• Thrombus formation. In the cavity of an aneurysm, whether it is fusiform or saccular, normal blood flow is disturbed. Swirls form in it, which can lead to the formation of blood clots. The thrombus in this case will be sticky platelets. Being in the cavity of the aneurysm, the thrombus does not particularly interfere with the blood flow. However, after leaving the aneurysm, the thrombus can get stuck in vessels of smaller diameter. Predicting exactly where thrombosis will occur is almost impossible. The cerebral artery (with a picture of ischemic stroke), the arteries of the kidney, liver, and extremities may be blocked. Thrombosis stops the flow of arterial blood to the corresponding organ, which leads to rapid tissue death. Often, thrombosis ends in the death of the patient. The problem is that an aneurysm may not manifest itself in any way, and the patient does not suspect that he has a disease. At the same time, blood flow disorders already exist, and a stroke, for example, will be the first (and often the last) manifestation of the disease.
• Pneumonia. Pneumonia may be the result of an aneurysm of the thoracic aorta, if the latter compresses the bronchi or presses on the trachea. Normally, the epithelium of the airways secretes a certain amount of mucus, which clears the bronchi and humidifies the air. Compression also leads to the fact that mucus accumulates in a certain section of the lung. Here are created favorable conditions for the development of infection. If it gets in, then pneumonia develops.
• Clamping of the bile ducts. Aneurysms in the upper part of the abdominal aorta coexist with many different organs. A large aneurysm can, for example, occlude the bile ducts that run from the gallbladder to the duodenum. In this case, firstly, the outflow of bile from the gallbladder is disturbed, and, secondly, the digestion process worsens. The risk of cholecystitis, pancreatitis increases, and the patient may suffer from diarrhea, constipation, flatulence.
• Risk of heart disease. An aneurysm of the thoracic aorta of considerable size can compress the nerve plexuses that regulate the work of the heart. Because of this, patients sometimes experience persistent bradycardia or tachycardia. In addition, pressure often increases in the thoracic aorta itself, which creates an additional load on the left ventricle. As a result, irreversible changes can occur in the aortic valve of the heart or in the heart muscle. Even after removal of the aneurysm and normalization of pressure, disturbances in the work of the heart may remain.
• Ischemia of the lower extremities. Ischemia is called oxygen starvation fabrics. In the lower limbs arterial blood may be ingested in smaller amounts due to an infrarenal aortic aneurysm (located below the origin of the renal arteries). Lack of oxygen leads to poor cell renewal. Increased risk of frostbite trophic ulcers(due to lack of nutrition) and other soft tissue injuries. Aneurysm in this case will play the role of a provoking factor.

Ruptured aortic aneurysm

Dissecting aortic aneurysms rupture most often and quickly, since their wall is less durable. However, even such formations rarely rupture at rest.

• sudden weakness;
• loss of consciousness;
• noise in ears;
• sudden pain;
• rapid blanching of the skin;
• the appearance of a dark spot on the skin of the abdomen (with the accumulation of a large amount of blood in the abdominal or retroperitoneal cavity).

A patient with a ruptured aortic aneurysm needs urgent surgery to control bleeding and resuscitation to maintain vital processes.

Diagnosis of an aortic aneurysm

Physical examination for aortic aneurysm

• visual inspection. Visually, with aortic aneurysms, very little information can be obtained. Any changes in the shape of the chest are extremely rare and only in cases where the patient has lived with a large aneurysm of the thoracic aorta for at least a few years. With an aneurysm of the abdominal aorta of large size, one can sometimes observe a pulsation that is transmitted to the anterior abdominal wall. In addition, when an aneurysm ruptures, purple spots can sometimes be observed on the abdominal wall - a sign of massive internal bleeding. However, this symptom almost never appears on the anterior abdominal wall (usually on the side), since the aorta is located retroperitoneally (separated from the intestines, stomach and other organs by the posterior peritoneum), and hemorrhage occurs primarily in the retroperitoneal space.
• Percussion. Percussion is the percussion of body cavities to determine the boundaries of different organs by ear. With an aneurysm of the abdominal aorta, the approximate size and location of the formation can be determined in this way. Often the area of ​​percussion sound dullness coincides with the "vascular bundle" zone. Then, according to percussion, this zone will be expanded. In addition, with a large aneurysm of the thoracic aorta, the borders of the heart or mediastinum may be slightly shifted. With an aneurysm of the abdominal aorta, percussion is less informative, since the vessel passes along the posterior wall of the abdominal cavity. Palpation in this case will be more informative.
• Palpation. Palpation of the chest cavity is almost impossible due to the rib cage, so palpation is almost never used in the diagnosis of thoracic aortic aneurysm. With an aneurysm of the abdominal cavity, it is often possible to detect a formation pulsating in time with the heart. This eloquently speaks precisely of the presence of an aneurysm, since such formations do not occur in other diseases. In addition, the detection of a pulse can be attributed to palpation. If the heart rate or heart rate varies by different hands or at carotid arteries, this may indicate the presence of an aneurysm of the aortic arch. Weakened or absent pulsation on the femoral arteries (or different frequency on different legs) may indicate an infrarenal aneurysm.
• Auscultation. Listening with a stethophonendoscope (listener) is a very common and valuable diagnostic method. With an aneurysm of the abdominal aorta, by applying a stethoscope to the projection site of the aneurysm, you can hear an increased noise of blood flow. With an aneurysm of the thoracic aorta, pathological changes can be different - a metallic accent of the second tone over the aorta, systolic murmur at the Botkin point, etc.
• Pressure measurement. Most often, patients with an aneurysm are found to have hypertension (increased pressure). With aneurysms of the aortic arch of large sizes, the pressure on different arms may be different (the difference is more than 10 mm Hg).

Upon detection characteristic symptoms During the physical examination, the doctor prescribes other diagnostic measures to confirm the diagnosis.

X-ray for aortic aneurysm

Ultrasound for aortic aneurysm

• relatively low cost;
• painless and safe for the patient examination;
• immediate results;
• the duration of the study is only 10 - 15 minutes;
• the ability to determine the shape and size of the aneurysm;
• the possibility of detecting some complications of an aneurysm;
• the possibility of assessing blood flow in the aorta and its branches;
• the possibility of detecting emerging thrombi.

In general, ultrasonography is more common in diagnosing abdominal aortic aneurysms. abdominal wall thinner, and the picture that the doctor receives is more accurate. When examining an aneurysm of the thoracic aorta, a number of pathologies of the heart and lungs can also be detected, which is also important for treatment. The method of examining the organs of the chest cavity using ultrasound waves is called echocardiography (EchoCG).

MRI and CT for aortic aneurysm

• ear implants and built-in hearing aids;
• the presence of metal pins or plates after surgery;
• the presence of a pacemaker;
• some types of prosthetic heart valves.

An important advantage of MRI is that this procedure also allows you to evaluate the blood flow in individual vessels, and not just get an image of the aneurysm itself. Doctors are able to evaluate circulatory disorders and suspect a number of associated disorders.

ECG for aortic aneurysm

Laboratory tests

• Change in the level of leukocytes. It can be observed with some infections, which, in turn, are the cause of the development of an aneurysm. The level of leukocytes usually increases in acute infectious processes and decreases in chronic ones. In chronic cases, the proportion of non-segmented neutrophils in the leukocyte formula also increases.
• Changes in blood clotting. The study of the level of platelets, clotting factors and a number of other indicators often changes if blood clots form in the cavity of the aneurysm.
• Elevated cholesterol. Hypercholesterolemia is an increase in the level of cholesterol in the blood up to 5 mmol / l or more. Most often, this indicates an atherosclerotic lesion of the aorta. Indirectly, this is also indicated by an increased level of triglycerides or low-density lipoproteins (even if total cholesterol is normal).
• In the analysis of urine, in rare cases, blood impurities (microhematuria) can be detected, which are detected in a specific analysis.

However, all these changes are optional, not found at all stages of the disease and not in all patients.

Treatment of an aortic aneurysm

• smoking cessation is perhaps the most important measure for both preventing the development of an aneurysm and delaying the increase in the diameter of an already existing thoracic aortic aneurysm;
• normalization of blood pressure (including with the help of medications);
• normalization of body weight, if necessary with the help of a nutritionist;
• following a diet low in cholesterol to prevent atherosclerosis;
• refusal of serious physical exertion;
• prevention of psycho-emotional stress (up to taking sedatives).

Given that the causes of aortic aneurysm may vary, other preventive measures may be required. They are determined and explained to the patient by the attending physician after the examination.

Medications for aortic aneurysm

• With a small diameter of the pathological area in the aorta (up to 5 cm) during the period of dynamic observation of a patient with a thoracic aortic aneurysm.
• In severe concomitant diseases, when the risk of surgery exceeds the risk of rupture of the aneurysm itself. These conditions include acute disorders of the coronary circulation, acute disorders of the cerebral circulation, heart failure II-III degree.
• In preparation for surgery.

For each patient, the attending physician selects his own treatment regimen, depending on the type and size of the formation, as well as depending on the symptoms and complaints of the patient. However, there are several groups of drugs that are prescribed most often.

• drugs that reduce heart rate (heart rate);
• drugs to lower blood pressure;
• cholesterol-lowering drugs.

To reduce heart rate, beta-blockers are most often used, which affect the innervation of the heart. With contraindications to the use of beta-blockers, verapamil from the group of calcium channel blockers may be prescribed. It is necessary to slow down the heart rate to beats per minute. This significantly reduces the load on the walls of the aorta and reduces the likelihood of complications.

Composition and form of release

Dosage and regimen

Tablets 10 mg, 40 mg

Initial dose 20 mg, average dose per day.

Tablets 25 mg, 50 mg, 100 mg

50 or 100 mg per day.

Tablets 2.5 mg, 5 mg, 10 mg

The daily dose is from 2.5 to 10 mg at a time.

Tablets 2.5 mg, 5 mg, 10 mg

2.5 mg, 5 mg or 10 mg 1 time per day.

Tablets 40 mg, 80 mg

mg 3 times a day.

Blood pressure must also be reduced to reduce stress in the aortic wall. For this purpose, calcium channel blockers, ACE inhibitors (angiotensin-converting enzyme inhibitors) are used. For each patient, the attending physician selects the drugs of the group that best suits him. In some cases, a combination of drugs is possible. The appointment depends on the causes that cause hypertension.

Composition and form of release

Dosage and regimen

Tablets 5 mg and 10 mg

The daily dose is 5 mg or 10 mg once.

Tablets 5 mg, 10 mg, 20 mg

5 mg, 10 mg, 20 mg 2 times a day.

Tablets 5 mg, 10 mg, 20 mg

5 mg, 10 mg, 20 mg once.

Tablets 2.5 mg, 5 mg, 10 mg

2.5 mg, 5 mg, 10 mg 1 time per day.

Tablets 2 mg, 4 mg, 8 mg, 10 mg

Pomg 1 time per day.

Atherosclerosis is a risk factor rapid growth aneurysms, contributing to the weakening of the vessel wall. Timely treatment can delay the progression of the process for a long time. Used drugs from the group of statins, fibrates, sequestrants bile acids. The drug for the treatment of a particular patient is chosen by the doctor, guided by the results of the tests.

Composition and form of release

Dosage and regimen

Tablets 10 mg, 20 mg, 40 mg

Pomg for 1 time, take once in the evening.

Tablets 10 mg, 20 mg, 40 mg

Pomg for 1 time in the evening.

Tablets 10 mg, 20 mg, 40 mg

Pomg 1 time in the evening.

Tablets 145 mg, 160 mg, 200 mg, 250 mg

mg 1 time per day.

g per day of intake.

For various complications of an aortic aneurysm or related disorders, the patient may need other drugs. For example, if an aortic aneurysm occurs as a result of a systemic infection, a course of treatment with antibiotics that are effective against the causative microbe is necessary. Various vitamin complexes, drugs to strengthen the vascular wall, drugs against the formation of blood clots can also be prescribed. However, there are no uniform treatment standards. The specialist is guided by the situation, based on the violations found in the patient. Self-medication with the above drugs without consulting a doctor is very dangerous. Incorrect dose selection can accelerate the rupture of the aneurysm or give an excessive load on other internal organs.

Surgical treatment of aortic aneurysm

• acute circulatory disorders in the vessels of the heart;
• circulatory failure II or III degree;
• serious problems with blood circulation in the vessels of the brain (in the presence of relevant neurological problems);
• the impossibility of adequate revascularization of at least the deep arteries of the thigh (after the operation there will be insufficient blood circulation).

Past myocardial infarction with a stable electrocardiogram for three months or a stroke six weeks ago (in the absence of neurological disorders) are not contraindicated. Such patients may undergo surgical removal of the aneurysm.

• detailed examination of the condition respiratory system(spirography);
• assessment of the state of the kidneys, in order to exclude latent renal failure;
• it is mandatory to assess the condition of the blood vessels of the lower extremities, as well as coronary arteries and arteries of the pulmonary circulation;
• determination of sensitivity to antibiotics prescribed for staphylococci and coli(these microorganisms most often cause postoperative complications).

Regardless of the type of aneurysm, antibiotic therapy is prescribed in advance (usually 24 hours before surgery) as a prevention of postoperative complications. During the day, a sufficient concentration of the antibiotic appears in the blood to prevent the reproduction of pathogenic (pathogenic) bacteria.

• Classic surgery. Classical intervention is understood as a large-scale abdominal operation with general anesthesia and wide tissue dissection. The goal is to remove the section of the aorta with an aneurysm and replace it (usually with a prosthesis). As a result, blood flow through the aorta is restored completely. The big disadvantage of this operation is its trauma. There is a high risk of complications during and after surgery. Even in the absence of complications, the patient, as a rule, recovers for a long time and loses his ability to work for a long time.
• Endovascular surgery. Endovascular surgery is understood as a set of methods in which there is no large-scale tissue dissection. All necessary instruments are brought to the aneurysm through other vessels (often through the femoral artery). Depending on the type and size of the aneurysm, there are several options for intervention. Sometimes a special reinforcing mesh is installed in the lumen of the vessel, which prevents the growth or delamination of the formation. With saccular aneurysms of small sizes, sometimes they resort to "filling" the mouth. Currently, there is a fairly wide range of manipulations through endovascular access. However, they are all performed, as a rule, for small saccular aneurysms, when there is no serious threat of rupture.

If it is a dissection of the aneurysm, rupture or other complications, or the risk of rupture, according to doctors, is very high, only conventional surgery is performed. It gives more extensive access to the aorta, allows you to more reliably fix the problem and better examine other weak areas of the vessel, if any. Also classical surgery is the only treatment option for large and giant fusiform aneurysms.

Alternative treatment of aortic aneurysm

• Infusion of dill greens. Infuse one tablespoon of finely chopped dill in 400 ml of boiling water. Divide this portion into 3 parts and drink during the day.
• Infusion of hawthorn. The fruits of the red hawthorn are well dried and chopped. To prepare the infusion, you need two tablespoons of the resulting powder. Pour the powder into 300 ml of boiling water and infuse for half an hour. Divide into three parts and consume 30 minutes before meals.
• Infusion of levkoy jaundice. This infusion is prepared from two tablespoons of jaundice. 150 ml of boiled water is poured. Drink 15 ml 5 times a day. You can add sugar to the prepared infusion to improve the taste.
• Elderberry decoction. To prepare this decoction, you need Siberian elderberry root. Boil 200 ml of water, add the crushed elderberry root, let it simmer over low heat for 15 minutes. Remove from heat and leave for another 30 minutes. Strain the resulting broth, pour into a glass dish. Drink one tablespoon 3 times a day.

It must be understood that none of the remedies recommended above will have the most important effect - slowing down the growth of the aneurysm. When using traditional medicine, only temporary relief of the symptoms of the disease, such as shortness of breath or swelling, is possible. Therefore, relying on phytorecepts is completely unacceptable. A complete cure can only be guaranteed by timely access to doctors and surgical treatment.

Prognosis for aortic aneurysm

• shape of the aneurysm. As a rule, dissecting aneurysms are the most dangerous. The best prognosis is most often for fusiform true aneurysms, the walls of which are more durable.
• Reason for education. Aneurysms that appeared on the background of atherosclerosis grow more slowly. With syphilis, the prognosis is worse, since the disease that has reached the aortic wall is already at a late stage, and other organs may be affected. In congenital connective tissue diseases, the prognosis is generally poor, as there is no effective treatment.
• size of the aneurysm. Larger aneurysms are more likely to cause more symptoms and have a tendency to rupture. Their prognosis will be worse.
• Patient's age. Atherosclerotic aneurysms usually form in people over 40 years of age. At the same time, they may have various concomitant diseases - coronary heart disease, kidney or liver problems, etc. All this can become a relative or even absolute contraindication to surgical treatment. The prognosis, of course, worsens.
• Disease stage. Fresh aneurysms that have formed in recent weeks have a worse prognosis because it is harder for doctors to assess the risk of rupture. Subacute aneurysms have a better prognosis.
• location of the aneurysm. It is difficult to say which aneurysms are more dangerous - the thoracic or abdominal aorta. In both cases, the rupture most often leads to the death of the patient. An important factor is which branches of the aorta are affected by the aneurysm. This largely determines the volume and complexity of surgical intervention (especially when it comes to prosthetics). The worst prognosis is for multiple aortic aneurysms located in both the thoracic and abdominal cavities.

In general, aortic aneurysm without surgical treatment is considered a disease with a poor prognosis. The very presence of an aneurysm indicates the possibility of its rupture with lethal internal bleeding. The possibilities of preventive methods and drug therapy are not unlimited. If the patient was successfully treated surgically, then the prognosis is favorable. Re-formation of an aneurysm or other complications after surgery is possible, but they no longer pose such a serious danger. In this case, the prognosis will depend more on the patient himself (whether he will conscientiously follow the prescriptions of doctors).

Do aortic aneurysms give disability?

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Complications of an aortic aneurysm

In the absence of timely treatment in patients with aortic aneurysm, the following complications may occur:

• Thrombus formation. In the cavity of an aneurysm, whether it is fusiform or saccular, normal blood flow is disturbed. Swirls form in it, which can lead to the formation of blood clots. The thrombus in this case will be sticky platelets. Being in the cavity of the aneurysm, the thrombus does not particularly interfere with the blood flow. However, after leaving the aneurysm, the thrombus can get stuck in vessels of smaller diameter. Predicting exactly where thrombosis will occur is almost impossible. The cerebral artery (with a picture of ischemic stroke), the arteries of the kidney, liver, and limbs may be blocked. Thrombosis stops the flow of arterial blood to the corresponding organ, which leads to rapid tissue death. Often, thrombosis ends in the death of the patient. The problem is that an aneurysm may not manifest itself in any way, and the patient does not suspect that he has a disease. At the same time, blood flow disorders already exist, and a stroke, for example, will be the first (and often the last) manifestation of the disease.
• Pneumonia. Pneumonia may be the result of an aneurysm of the thoracic aorta, if the latter compresses the bronchi or presses on the trachea. Normally, the epithelium of the airways secretes a certain amount of mucus, which clears the bronchi and humidifies the air. Compression also leads to the fact that mucus accumulates in a certain section of the lung. It creates favorable conditions for the development of infection. If it gets in, then pneumonia develops.
• Clamping of the bile ducts. Aneurysms in the upper part of the abdominal aorta coexist with many different organs. A large aneurysm can, for example, occlude the bile ducts that run from the gallbladder to the duodenum. In this case, firstly, the outflow of bile from the gallbladder is disturbed, and, secondly, the digestion process worsens. The risk of cholecystitis, pancreatitis increases, and the patient may suffer from diarrhea, constipation, flatulence.
• Risk of heart disease. An aneurysm of the thoracic aorta of considerable size can compress the nerve plexuses that regulate the work of the heart. Because of this, patients sometimes experience persistent bradycardia or tachycardia. In addition, pressure often increases in the thoracic aorta itself, which creates an additional load on the left ventricle. As a result, irreversible changes can occur in the aortic valve of the heart or in the heart muscle. Even after removal of the aneurysm and normalization of pressure, disturbances in the work of the heart may remain.
• Ischemia of the lower extremities. Ischemia is called oxygen starvation of tissues. Less arterial blood can reach the lower extremities due to an infrarenal aortic aneurysm (located below the origin of the renal arteries). Lack of oxygen leads to poor cell renewal. The risk of frostbite, trophic ulcers (due to lack of nutrition) and other soft tissue injuries increases. Aneurysm in this case will play the role of a provoking factor.

Ruptured aortic aneurysm

Rupture of an existing aortic aneurysm can be triggered by the following factors:

When an aortic aneurysm ruptures, the patient may experience the following symptoms:

• sudden weakness;
• sudden pain;
• rapid blanching of the skin;
• the appearance of a dark spot on the skin of the abdomen (with the accumulation of a large amount of blood in the abdominal or retroperitoneal cavity).

Diagnosis of an aortic aneurysm

If you suspect an aortic aneurysm, you should contact your family physician or cardiologist. It is they who can competently conduct an initial examination and prescribe further tests and examinations. A targeted search for an aneurysm of the thoracic or abdominal aorta is successful in most cases. Doctors manage to detect the formation itself, as well as collect all the necessary data (shape, type, size, etc.).

When diagnosing an aortic aneurysm, the following research methods can be prescribed:

• physical examination;
• x-ray examination;
• magnetic resonance imaging (MRI) and computed tomography (CT);
• laboratory tests.

Physical examination for aortic aneurysm

During physical examination, the following research methods are used:

• visual inspection. Visually, with aortic aneurysms, very little information can be obtained. Any changes in the shape of the chest are extremely rare and only in cases where the patient has lived with a large aneurysm of the thoracic aorta for at least a few years. With an aneurysm of the abdominal aorta of large size, one can sometimes observe a pulsation that is transmitted to the anterior abdominal wall. In addition, when an aneurysm ruptures, purple spots can sometimes be observed on the abdominal wall - a sign of massive internal bleeding. However, this symptom almost never appears on the anterior abdominal wall (usually on the side), since the aorta is located retroperitoneally (separated from the intestines, stomach and other organs by the posterior peritoneum), and hemorrhage occurs primarily in the retroperitoneal space.
• Percussion. Percussion is the percussion of body cavities to determine the boundaries of different organs by ear. With an aneurysm of the abdominal aorta, the approximate size and location of the formation can be determined in this way. Often the area of ​​percussion sound dullness coincides with the "vascular bundle" zone. Then, according to percussion, this zone will be expanded. In addition, with a large aneurysm of the thoracic aorta, the borders of the heart or mediastinum may be slightly shifted. With an aneurysm of the abdominal aorta, percussion is less informative, since the vessel passes along the posterior wall of the abdominal cavity. Palpation in this case will be more informative.
• Palpation. Palpation of the chest cavity is almost impossible due to the rib cage, so palpation is almost never used in the diagnosis of thoracic aortic aneurysm. With an aneurysm of the abdominal cavity, it is often possible to detect a formation pulsating in time with the heart. This eloquently speaks precisely of the presence of an aneurysm, since such formations do not occur in other diseases. In addition, the detection of a pulse can be attributed to palpation. If the frequency or filling of the pulse is different in different arms or on the carotid arteries, this may indicate the presence of an aneurysm of the aortic arch. Weakened or absent pulsation in the femoral arteries (or different frequency in different legs) may indicate an infrarenal aneurysm.
• Auscultation. Listening with a stethophonendoscope (listener) is a very common and valuable diagnostic method. With an aneurysm of the abdominal aorta, by applying a stethoscope to the projection site of the aneurysm, you can hear an increased noise of blood flow. With an aneurysm of the thoracic aorta, pathological changes can be different - a metallic accent of the second tone over the aorta, systolic murmur at the Botkin point, etc.
• Pressure measurement. Most often, patients with an aneurysm are found to have hypertension (increased pressure). With aneurysms of the aortic arch of large sizes, the pressure on different arms may be different (the difference is more than 10 mm Hg).

X-ray for aortic aneurysm

Also, with the help of x-rays, a study with contrast (aortography) is possible. In this case, a special substance is injected into the aorta, which intensively stains the vessel in the picture. Thus, the doctor receives clear boundaries of the vessel and its main branches. The shape and size of the aneurysm and its location are well defined. In practice, however, contrast studies are rarely used. Firstly, this is an invasive (traumatic) procedure, since it is necessary to insert a special catheter into the aorta through the femoral artery. Because of this, there is a risk of bleeding, infection, etc. Secondly, in the presence of an aneurysm (especially a dissecting one), there is a high risk of provoking a rupture during the study. Therefore, this procedure is carried out only for special indications.

Ultrasound for aortic aneurysm

Ultrasound for patients with aortic aneurysm has the following advantages:

• relatively low cost;
• painless and safe for the patient examination;
• immediate results;
• the duration of the study is only 10 - 15 minutes;
• the ability to determine the shape and size of the aneurysm;
• the possibility of detecting some complications of an aneurysm;
• the possibility of assessing blood flow in the aorta and its branches;
• the possibility of detecting emerging thrombi.

MRI and CT for aortic aneurysm

MRI uses a special property of nuclear magnetic resonance. The image is obtained by placing the patient in a powerful electromagnetic field, in which the computer detects the movement of hydrogen nuclei. A high-precision image is formed, which shows not only the volumetric shape of the aneurysm, but even the thickness of its walls. All this is very important when making a prognosis for the patient and for the decision on surgical treatment. The study lasts approximately 15-20 minutes, during which the patient cannot move.

MRI has the following contraindications:

• ear implants and built-in hearing aids;
• the presence of metal pins or plates after surgery;
• the presence of a pacemaker;
• some types of prosthetic heart valves.

With computed tomography, the method of obtaining an image is somewhat different. As in the case of radiography, we are talking about the difference in the absorption of x-rays in different tissues of the body. In modern tomographs, the radiation source rotates around the patient, taking a series of images. The computer then simulates the result. The result is a series of high-precision snapshots-sections. An experienced doctor, based on the results of computed tomography, can not only detect changes in the structure of the aorta, but also determine their size, position and other features. Even more informative CT makes the possibility of using contrast. The introduction of a contrast agent into the vessel allows you to get computer model patient's vessels in 3D format. The intensity of X-ray radiation during the procedure remains small, despite the series of images taken. An absolute contraindication for this procedure is pregnancy (there is a risk to the fetus).

ECG for aortic aneurysm

The main advantages of ECG are the speed of the study (the standard procedure lasts about 10 minutes), safety for the patient (the procedure has no absolute contraindications) and immediate results. The resulting record should be carefully studied by a cardiologist, who can use it to obtain a variety of information about the work of the heart.

Laboratory tests

In patients with an aortic aneurysm, the following changes in laboratory tests may be detected:

• Change in the level of leukocytes. It can be observed with some infections, which, in turn, are the cause of the development of an aneurysm. The level of leukocytes usually increases in acute infectious processes and decreases in chronic ones. In chronic cases, the proportion of non-segmented neutrophils in the leukocyte formula also increases.
• Changes in blood clotting. The study of the level of platelets, clotting factors and a number of other indicators often changes if blood clots form in the cavity of the aneurysm.
• Elevated cholesterol. Hypercholesterolemia is an increase in the level of cholesterol in the blood up to 5 mmol / l or more. Most often, this indicates an atherosclerotic lesion of the aorta. Indirectly, this is also indicated by an increased level of triglycerides or low-density lipoproteins (even if total cholesterol is normal).
• In the analysis of urine in rare cases, blood impurities (microhematuria) may be detected. found in specific analysis.

Treatment of an aortic aneurysm

An important part of treatment is the prevention of aneurysm rupture. It includes a change in lifestyle, nutrition, some of the patient's habits. Compliance with preventive measures will allow the patient to better prepare for surgical treatment (it will not be urgent due to delamination or rupture, but planned).

Prevention of aneurysm formation and rupture includes the following recommendations:

• smoking cessation is perhaps the most important measure for both preventing the development of an aneurysm and delaying the increase in the diameter of an already existing thoracic aortic aneurysm;
• normalization of blood pressure (including with the help of medications);
• normalization of body weight, if necessary with the help of a nutritionist;
• following a diet low in cholesterol to prevent atherosclerosis;
• refusal of serious physical exertion;
• prevention of psycho-emotional stress (up to taking sedatives).

Medications for aortic aneurysm

But in the following cases, it is necessary to resort to medications in order to delay the growth of the aneurysm as long as possible and alleviate the symptoms of the disease:

• With a small diameter of the pathological area in the aorta (up to 5 cm) during the period of dynamic observation of a patient with a thoracic aortic aneurysm.
• In severe concomitant diseases, when the risk of surgery exceeds the risk of rupture of the aneurysm itself. These conditions include acute disorders of the coronary circulation, acute disorders of the cerebral circulation, heart failure II-III degree.
• In preparation for surgery.

For aneurysms of the thoracic or abdominal aorta, drugs can be prescribed with the following effect:

• drugs that reduce heart rate (heart rate);
• drugs to lower blood pressure;
• cholesterol-lowering drugs.

Drugs to reduce heart rate in patients with aortic aneurysm

Drugs to lower blood pressure in patients with aortic aneurysm

Cholesterol-lowering drugs in patients with aortic aneurysm

Surgical treatment of aortic aneurysm

Currently, the following contraindications for surgical treatment of aortic aneurysm are distinguished:

• acute circulatory disorders in the vessels of the heart;
• circulatory failure II or III degree;
• serious problems with blood circulation in the vessels of the brain (in the presence of relevant neurological problems);
• the impossibility of adequate revascularization of at least the deep arteries of the thigh (after the operation there will be insufficient blood circulation).

In general, in each individual case, the possibility of surgical treatment and its plan are considered separately. The duration of the operation and its complexity are affected by the type of aneurysm, its location, and the presence of complications.

To detect contraindications and a full preoperative examination of the patient, the following procedures are prescribed:

• detailed examination of the state of the respiratory system (spirography);
• assessment of the state of the kidneys, in order to exclude latent renal failure;
• it is mandatory to assess the condition of the blood vessels of the lower extremities, as well as the coronary arteries and arteries of the pulmonary circulation;
• determination of sensitivity to antibiotics prescribed for staphylococci and Escherichia coli (these microorganisms most often cause postoperative complications).

Currently, there are several options for surgical treatment of aortic aneurysm:

• Classic surgery. The classical intervention is understood as a large-scale abdominal operation with general anesthesia and a wide tissue incision. The goal is to remove the section of the aorta with an aneurysm and replace it (usually with a prosthesis). As a result, blood flow through the aorta is restored completely. The big disadvantage of this operation is its trauma. There is a high risk of complications during and after surgery. Even in the absence of complications, the patient, as a rule, recovers for a long time and loses his ability to work for a long time.
• Endovascular surgery. Endovascular surgery is understood as a set of methods in which there is no large-scale tissue dissection. All necessary instruments are brought to the aneurysm through other vessels (often through the femoral artery). Depending on the type and size of the aneurysm, there are several options for intervention. Sometimes a special reinforcing mesh is installed in the lumen of the vessel, which prevents the growth or delamination of the formation. With saccular aneurysms of small sizes, sometimes they resort to "filling" the mouth. Currently, there is a fairly wide range of manipulations through endovascular access. However, they are all performed, as a rule, for small saccular aneurysms, when there is no serious threat of rupture.

Alternative treatment of aortic aneurysm

As an alternative to drug treatment, the following folk remedies are sometimes used:

• Infusion of dill greens. Infuse one tablespoon of finely chopped dill in 400 ml of boiling water. Divide this portion into 3 parts and drink during the day.
• Infusion of hawthorn. The fruits of the red hawthorn are well dried and chopped. To prepare the infusion, you need two tablespoons of the resulting powder. Pour the powder into 300 ml of boiling water and infuse for half an hour. Divide into three parts and consume 30 minutes before meals.
• Infusion of levkoy jaundice. This infusion is prepared from two tablespoons of jaundice. 150 ml of boiled water is poured. Drink 15 ml 5 times a day. You can add sugar to the prepared infusion to improve the taste.
• Elderberry decoction. To prepare this decoction, Siberian elderberry root is needed. Boil 200 ml of water, add the crushed elderberry root, let it simmer over low heat for 15 minutes. Remove from heat and leave for another 30 minutes. Strain the resulting broth, pour into a glass dish. Drink one tablespoon 3 times a day.

Prognosis for aortic aneurysm

The following factors and indicators influence the prognosis for aortic aneurysm:

• shape of the aneurysm. As a rule, dissecting aneurysms are the most dangerous. The best prognosis is most often for fusiform true aneurysms, the walls of which are more durable.
• Reason for education. Aneurysms that appeared on the background of atherosclerosis grow more slowly. With syphilis, the prognosis is worse, since the disease that has reached the aortic wall is already at a late stage, and other organs may be affected. In congenital connective tissue diseases, the prognosis is generally poor, as there is no effective treatment.
• size of the aneurysm. Larger aneurysms are more likely to cause more symptoms and have a tendency to rupture. Their prognosis will be worse.
• Patient's age. Atherosclerotic aneurysms usually form in people over 40 years of age. At the same time, they may have various concomitant diseases - coronary heart disease, kidney or liver problems, etc. All this can become a relative or even absolute contraindication to surgical treatment. The prognosis, of course, worsens.
• Disease stage. Fresh aneurysms that have formed in recent weeks have a worse prognosis because it is harder for doctors to assess the risk of rupture. Subacute aneurysms have a better prognosis.
• location of the aneurysm. It is difficult to say which aneurysms are more dangerous - the thoracic or abdominal aorta. In both cases, the rupture most often leads to the death of the patient. An important factor is which branches of the aorta are affected by the aneurysm. This largely determines the volume and complexity of surgical intervention (especially when it comes to prosthetics). The worst prognosis is for multiple aortic aneurysms located in both the thoracic and abdominal cavities.

Do aortic aneurysms give disability?

With an aneurysm of the thoracic or abdominal aorta, at first we are not talking about disability. First, you need to undergo a full course of treatment, which includes surgical correction of this pathology. In other words, as long as doctors have treatment options, the patient is not sent for a medical and social examination.

After surgical treatment, a certain time must pass - usually from six months to 1 - 2 years. During this period, the patient visits rehabilitation centers who are doing their best to restore health. In the absence of complications or serious consequences of the disease (or operation), the patient is considered healthy. Of course, the question of obtaining a disability group does not arise again.

If the patient, after a course of rehabilitation, does not get rid of the serious consequences of an operation or illness, he is sent for a medical and social examination. With an aneurysm of the abdominal or thoracic aorta, such consequences can be, for example, disruption of the heart, deterioration of the blood supply to individual organs. Sometimes diseases that led to the formation of an aneurysm (Marfan's syndrome and a number of others congenital diseases), progress, and the patient receives a group not so much because of the aneurysm, but because of the underlying pathology. With Marfan's syndrome, for example, there is weakness of the joints, a serious deterioration in vision, heart defects. Medical and social expertise will consider these manifestations together.

An unoperated aortic aneurysm can also be a reason for obtaining a disability group. For example, if a patient has an aneurysm, but there are serious contraindications for surgery (disturbances in the functioning of the heart, lungs, kidneys, liver, and other concomitant pathologies). All this confuses doctors, since it becomes impossible to solve the problem surgically. The risk from the operation becomes too high. Since the patient has to constantly reckon with the risk of aneurysm rupture and other complications, he is forced to visit doctors frequently and take various medications regularly. This may be the reason for his referral for a medical and social examination.