Treatment of Abdominal Aortic Aneurysm

About the disease

Aortic aneurysm is an abnormal expansion of aorta, main artery of the body, due to weakening of its walls. Abdominal aortic aneurysm is manifested by abdominal pain. Aortic aneurysm develops if there was irreversible expansion of blood stem lumen.

Doctors differentiate 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 is formed by connective tissue. False aneurysm usually develops because of pulsating hematoma, which could be a result of trauma or postoperative complications.

Other specific complications of aortic aneurysms are 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.

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.

Symptoms

Aortic aneurysms can be completely asymptomatic or accompanied by painful symptoms. Aortic aneurysm symptoms are:

• Transient or permanent heart pain
• Stomach discomfort
• Nausea
• Belching
• Heaviness in epigastrium
• Feeling of fullness
• Dysfunction of bowel
• Considerable weight loss

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.

Diagnosis

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.

Treatment

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. Most common types of surgery are: Replacement of prosthetic abdominal aorta is a sutureless resection of aorta and its replacement with plastic tube.

• Endovascular prosthesis bifurcation of the abdominal aorta is an endovascular repair of aorta with graft insertion.
• Abdominal aorta open prosthetics is type of open repair. According to Oxford Journal.com, this type of treatment can also be used as diagnostic measure. Overall, prosthetic grafts are one of the best available treatment options for both aorta aneurysms and vascular diseases.
• Abdominal aorta endovascular prosthesis is also a type of stent graft treatment, when aneurysm is repaired.

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.

Authors: Dr. Vadim Zhiliuk, Dr. Sergey Pashchenko