Aortic aneurysm is an abnormal expansion of aorta, main artery of the body, due to weakening of its walls. Depending on location of aorta aneurysm, disease can be manifested as chest or abdominal pain. There can also be dysphonia, dysphagia, edema and cyanosis. Aortic aneurysm develops if there was irreversible expansion of blood stem lumen.
According to the segmental classification there are such types of aorta aneurysm:
There is also true and false aorta aneurysm. True aneurysm is mainly characterized by thinning and extreme bulging of all layers of aorta. False aneurysm has the same symptoms as true aneurysm with a difference that it was formed by connective tissue. False aneurysm usually develops because of pulsating hematoma, which could be a result of trauma or postoperative complications.
Among other specific complications of aortic aneurysms doctors differentiate gaps of aneurysmal sac, which are in most cases accompanied by internal bleeding and extreme bruising. A person can also develop aneurysm thrombosis and thromboembolism of the arteries.
Etiologically aortic aneurysms are divided into congenital and acquired ones. Congenital aneurysms are always caused by such hereditary diseases of aorta wall as Marfan syndrome, dysplasia and hereditary elastin deficiency.
Acquired aortic aneurysm can be a result of such inflammatory diseases as syphilis and postoperative infections. If acquired aorta aneurysm was not caused by inflammation, it can develop because of atherosclerosis. Also if a person underwent heart or abdominal surgery, he could develop mechanical damage of aorta, which leads to development of traumatic aneurysms.
Risk factors of aortic aneurysm are:
Aortic aneurism caused by any factor listed above, can increase in size. Also blood flow in aneurysmal sac slows down to a great extent and becomes turbulent. Only about 50% of blood flow gets to its final destination in blood circulation. Big number of blood clots in cavity of aneurysm is a risk factor for venous thromboembolism mostly of distant branches of aorta.
Aortic aneurysms can be completely asymptomatic or accompanied by painful symptoms. Aortic aneurysm symptoms are:
Symptoms may be accompanied by compression of stomach and duodenum. Often patients complain of increased pulsation in abdomen. Patients with aortic insufficiency can also have shortness of breath, tachycardia, and dizziness. If aneurysm is large, there can also be swelling of face and upper body. In some cases aneurysm of aorta leads to compression of esophagus, and then a person has such manifestations of disease as hoarseness (dysphonia), dry cough, bradycardia, and excessive salivation.
Diagnostic methods for detection of the aortic aneurysm mainly include X-ray, general examination, ultrasound, and tomography. Auscultatory sign of aneurysm is the presence of systolic murmur in the place of aorta expansion. Such murmur can be heard through stethoscope. Abdominal aortic aneurysm can, in most cases, be detected by palpation of abdomen.
X-ray exam of patients with aneurysm includes fluoroscopy and radiography of the chest, abdominal plain radiography and X-ray of esophagus and stomach. Ascending aorta aneurysms can be diagnosed by echocardiography or, in other cases, by a Doppler ultrasound.
Computed tomography (CT) of chest / abdominal aorta can accurately visualize the aneurysmal expansion and reveal presence of bundles and thrombotic masses. Final stage of diagnosis includes aortography, which can show specified location, size and length of aortic aneurysm. It can also indicate if patient need to undergo surgery. Aneurysm of the thoracic aorta should be differentiated from lung tumor, as it has almost the same symptoms and it is more difficult to diagnose than other types of aneurysm.
In case of asymptomatic non-progressive aortic aneurysm only limited dynamic observation and constant X-ray control are required. To reduce the risk of complications, a patient can also be advised to undergo hypotensive and anticoagulant therapy to eliminate the risk of clot forming and to lower cholesterol.
Surgical intervention is necessary in abdominal aortic aneurysms with a diameter greater than 3.5 cm. Also aneurysms of thoracic aorta need to be surgically repaired. Surgical treatment of aneurysms includes aneurysmal excision of the modified portion of the vessel. Some patients need replacement of vascular prosthesis. Usually surgery is done under local or general anesthesia.
Although this disease can be asymptomatic, in general, aneurysms have unfavorable prognosis due to high risk of death from aortic rupture or thromboembolic dysfunctions. Probability of rupture of an aortic aneurysm with a diameter of 5 cm is 50%, with a smaller diameter is 25% per year. Early detection and surgical treatment of the aortic aneurysms can lower significantly mortality rate and bring good long-term results.
Preventive recommendations include:
Persons at risk for development of aortic aneurysm should undergo ultrasound screening. Generally, people with aortic aneurysm should avoid excessive physical activities and weight lifting. If they have high or low blood pressure, they need to take drugs that can control blood pressure. Alcohol and fatty food need to be eliminated from everyday consumption. People also need to eat less salt, which can form salt deposits in body and thus increase the size of aneurysm. Nevertheless, the most important preventive step for patients with aneurysm is monitoring of aneurysm monthly to detect any change in its development.
If not treated on time, aortic aneurysms can be complicated by rupture with the development of massive bleeding, collapse and acute heart failure. Rupture of aneurysms can occur in pericardial and pleural cavity, esophagus and abdomen. At the same time a person can develop severe, sometimes fatal condition of hemopericardium.Hide
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