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Aortic aneurysm – what is it, causes, classification

Aortic aneurysm – what is it, causes, classification

| from Booking Health GmbH | Diagnosis & treatment

Aortic aneurysm is a life threatening disease that can lead to the patient’s death in any moment as a result of a aneurysm rupture. This diagnosis is established when a diameter of the certain artery fragment expands and exceeds the normal size by at least twice as much. Let’s find out what is an aortic aneurysm, its symptoms and...

Aortic aneurysm is a life threatening disease that can lead to the patient’s death in any moment as a result of a aneurysm rupture. This diagnosis is established when a diameter of the certain artery fragment expands and exceeds the normal size by at least twice as much.

Let’s find out what is an aortic aneurysm, its symptoms and necessary treatment.

Clinical picture of the disease

The symptoms of aortic aneurysm depend on its location. This will be an abdominal part in 80% of the cases.

Three classic symptoms of aortic aneurysm are peculiar for this kind of pathology:

  • Abdominal pain is observed in 90% of cases
  • Auscultated noise (murmur) above the aorta – 75% of cases
  • Visible or felt by the patient pulsation in the abdomen – in 40% of cases

20% more cases are located in the thoracic part when signs and symptoms of aortic aneurysms are absent in 75% of patients.

Patients may have such complaints as:

  • Heart pain or back pain
  • Dizziness, shortness of breath, weakness
  • Edema of the upper body
  • Decreased heart rate and drooling
  • Difficulty swallowing
  • Hoarseness of voice

Sometimes, symptoms of aortic aneurysm arise from the central nervous system. This is a focal neurological symptom associated with impaired cerebral circulation.

Such a large variety of clinical signs in the lesions of the aorta in the thoracic region is due to the fact that the widened portion of the vessel can compress various structures. These are  subclavian and carotid arteries, the upper hollow vein, the vagus nerve, trachea, larynx, esophagus and other structures of the chest cavity.

 

Aortic aneurysm
(c) depositphotos

 

Diagnostics

Diagnostics of aortic aneurysm is done by means of the following methods:

  • X-ray
  • Ultrasound
  • CT
  • MRI
  • Angiography

Diagnostics of thoracic aortic aneurysm is most often not provided intentionally as 3 patients out of 4 do not have any complaints. Therefore, nobody goes to the doctor.

But, an aneurysm will be determined if the following tests are taken:

  • Echo-CG - ultrasound examination of the heart, which is prescribed for suspected cardiac pathology
  • Radiographic examination of the chest - is prescribed for suspected pneumonia, fracture of the ribs and many other pathologies

But in the case of abdominal localization, there are usually symptoms of aortic aneurysm. Diagnostics is carried out purposefully. It usually starts with ultrasound. This method allows you to detect the expanded part of the vessel and measure its diameter. Unlike thoracic aneurysm, abdominal aortic aneurysm is rarely found on x-ray. Firstly, because an x-ray of the abdominal cavity is much less frequent, and second, because pathology is much harder to detect, and often it remains unnoticed in the picture.

After determining the symptoms of an aortic aneurysm, diagnostics with an X-ray or ultrasound, refining studies are carried out. CT or MRI makes it possible to obtain the most accurate information about the location of the enlarged part of the vessel, the state of the branches of the aorta, its walls, the presence of thrombi, etc. To increase the diagnostic value of the studies, intravenous contrasting can be used. In some cases, angiography can be prescribed. This is an unsafe, but sometimes necessary, X-ray examination with intra-arterial contrast. It is used for suspected lesions of the aorta branches or for better planning of the operation.

Dissection and rupture of aortic aneurysm

Aneurysm doesn’t usually cause severe symptoms by itself and bothers the patient’s life quality. But, it carries the threat of complications for the patient’s life.

Dissecting aortic aneurysm is a condition that precedes the rupture. In total, the artery has three layers. If the inner one bursts, the blood begins to seep into the middle, muscle layer. The dissection continues until the vessel is completely ruptured. Dissection of the aortic aneurysm is fraught with massive internal bleeding. Therefore, if during the diagnostics it is established that the aortic aneurysm is dissecting, this is an indication for an emergency surgical intervention. If there is no treatment, an aortic aneurysm ruptures. The outcome of the disease depends on the location of the bleeding in this case. Lethal outcome makes up 60% in case of abdominal aorta rupture.

Bleeding can open into:

  • Into the retroperitoneal space - in 70% of cases
  • Into the duodenum - in 20% of cases
  • Into the abdominal cavity - in 10% of patients

Complications are always accompanied by severe pain. With massive blood loss, paleness of the skin, shortness of breath, loss of consciousness is possible to observe. Without medical assistance, lethality reaches 100%. About 50% of patients die within the first day after the bleeding, another 35% - within 1 week.

Even more dangerous pathology is a thoracic aortic aneurysm. The lethality reaches 95%. Bleeding opens into the pericardium (pericardial sac) or the mediastinal fiber. Less often there is a bleeding into the esophagus or structures of the tracheobronchial tree. If the aortic aneurysm ruptures, the prognosis is unfavorable. The patient dies shortly from increasing heart failure.

Treatment

Regardless of its location, aortic aneurysm treatment is only surgical. The choice of the intervention depends on the aneurysm location.

Ascending aortic aneurysm treatment is performed surgically. This pathology is handled by cardiovascular surgeons. The operation is quite complicated. The aneurysm is removed. The defect is replaced not with a synthetic prosthesis, but with its own vessel taken from another part of the body, or a formed pericardium. Aneurysm of the aortic arch treatment is similar.

Ascending aortic aneurysm indications for planned surgery are as follows:

  • Clinically significant regurgitation (reverse blood flow)
  • The presence of aortic heart aneurysm symptoms
  • Reaching the size of the extended section of 6 and more cm
  • With an aneurysm of 5 centimeters, if there are cases of sudden death of relatives in an anamnesis
  • With aortic aneurysm treatment is required if it increases in diameter by more than 1 cm per year
  • In case of a combination with aortic valve disease, if the diameter of the enlarged ascending aorta exceeds 4 centimeters

Emergency intervention is required in case of detecting an abnormality or dissecting aortic aneurysm.

In case of location of the pathology in the descending aortic part or in the abdominal cavity, the essence of the surgery is to replace the artery fragment with an artificial prosthesis. They can be linear and bifurcation. Bifurcation prostheses are used in cases when the infrarenal aortic lesion (below the renal artery) is spreading to the iliac arteries.

Where is it better to undergo a surgery?

As long as aortic aneurysm treatment is very complicated, a patient has to make the right choice of hospital. Many patients prefer to undergo quality medical assistance. One of the popular destinations is Germany.

Cost of surgery for aortic aneurysm in German hospitals is higher than in the majority of the developing countries.

Nonetheless, people often prefer to undergo surgery in Germany and there are many reasons for this:

  • Highly qualified doctors work in Germany - many operations with an aortic aneurysm are very complicated, and the outcome directly depends on the skills of the cardio surgeons team
  • All large clinics are well-equipped
  • Quality prostheses are used
  • Low risk of complications and intra-operative mortality

In Germany, endovascular aortic aneurysm surgeries are widely used that do not require opening of the abdominal cavity. Access is through the femoral or iliac artery. This provides a better postoperative tolerance, a lower risk of complications and a better aesthetic effect. After such surgical interventions, patients recover faster. In this case, the cost of surgery for aortic aneurysm, which was conducted using endovascular operating access, is comparable to the price of a conventional open surgery.

Arrangement of treatment

Many patients want to have surgery in Germany, but they are held back  because of a number of difficulties. We are ready to take on all the difficulties associated with the arrangement of treatment. Booking Health has been a leader in the medical tourism industry for many years.

Advantages of contacting us are:

  • We will choose the best clinic for you
  • You will be operated on by an authoritative doctor, not a young inexperienced specialist
  • The waiting time for the operation will be reduced. This is important, because an aneurysm rupture can occur at any time
  • You will save up to 70% of the funds
  • You will be insured against complications. In case of additional costs, they will be covered by an insurance company
  • You will receive a doctor's consultation within 3 months after the end of the program
  • You will not need to take care of organizational issues, hence this will allow you to focus on treatment and recovery after surgery

Our specialists will translate medical documentation for you; help you to issue a visa, book tickets. In Germany we will provide you with an interpreter, provide a transfer from the airport to the clinic and back.

 

Choose treatment abroad and you will for sure get the best results!

 


Author: Dr. Nadezhda Ivanisova

 

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