Abdominal aortic aneurysm (aneurysm of the abdominal part of aorta) is a condition, characterised by the protrusion of the aorta wall or when the aorta doubles in diameter. This disease is complicated by the aneurysm rupture during the first year after the diagnostics in 40% of cases. There are about 30-40 cases a year for every 100 000 people. Men suffer from the abdominal aortic aneurysm 8-10 times more than females. Another risk factor for the disease is age, as 80% of patients with abdominal aortic aneurysm are over the age of 60 years old.
Abdominal aortic aneurysm can be a result of many causes. It can be congenital, which is very rare, or acquired.
Congenital aneurysm is an effect of the abnormal aortic wall development that can be seen with the following diseases and conditions:
Abdominal aortic aneurysm is more common. Aneurysm develops due to the inflammatory or non-inflammatory processes.
Aneurysm with inflammatory background appears with:
Aneurysms with inflammatory background include:
Atherosclerosis is the most common reason for abdominal aortic aneurysm, this makes 96% of all cases.
Lots of patients do not experience any symptoms of aneurysm. In this case the aneurysm is detected after the bleeding, that often leads to the patient’s death, or by accident while having an examination for another disease. Asymptomatic aneurysms are rarely detected while abdominal surgeries.
If the disease is accompanied by symptoms, the clinical picture depends on:
Uncomplicated aneurysm indicates a classic triad of clinical features:
Pain in the abdomen is experienced by 90% of patients. Pain is constant, dull, aching and of low intensity and located mostly in around belly-button on the right side. It can extend into the groin and the lower back. Pain does not increase during palpation.
Presence of a pulsating sensation in the abdomen area, more often it can be found on the left part, middle or upper abdomen. Presence of this symptom reveals the magnitude of the abdominal aortic aneurysm and increased risk of its rapture.
Systolic noise above the abdominal aorta can be detected among 75% of patients and it is auscultated with a phonendoscope.
Symptoms that appear only with abdominal aortic aneurysm of specific location:
Feeling of pulsation in the abdomen is experienced by 40% of patients and is accompanied by bloating.
Radicular syndrome is caused by compression of the roots of spinal cord. Motor disorders appear in the lower extremities, pain in the legs and lower back.
Abdominal syndrome is manifested by belching, vomiting, constipation, diarrhea, poor appetite and weight loss. Symptoms develop if the duodenum is compressed.
Urologic syndrome occurs when there is blood in urine, urination disorders and is a result of the ureters or kidneys compression.
Chronic ischemia of the legs develops when iliac and femoral arteries are compressed. There is intermittent claudication (a sharp pain in the legs that occurs with exercise, and goes away after a short rest) and trophic disorders (pigmentation of the skin of legs, hair loss).
Diagnostics of the abdominal aortic aneurysm is not a big deal. It can be easily detected with the help of ultrasound.
This method of diagnostics helps to receive information about:
Afterwards more precise methods of examination are prescribed such as CAT or MRI. They help to find the tears of the inner aorta layers, evaluate the aneurysm’s structure, visualize thrombotic masses. Evaluation of the neighbouring anatomical structures is done parallel to other methods.
If the branches of the abdominal aorta getting involved into the pathological process, angiography can be used then (X-ray with contrast), but angiography is not applied for every patient, as it is invasive and has high risks.
In case, abdominal aortic aneurysm has been detected surgery is recommended to take care of massive internal bleeding that can start any time. Surgery is done as soon as possible, if there no contraindications. If there are some, the patient receives the conservative therapy. After compensation of the pathological process the surgery is done.
Aneurysm resection with prosthetic repair is a basic treatment method. Linear or bifurcation prostheses are applied here and the surgery is invasive.
Distant endovascular prosthetic repair is a new kind of surgery implemented actively in the recent years. Access to the destination is performed via the femoral or iliac artery. This kind of surgery allows lowering the hazards for the patient and shortening the post-surgery rehabilitation period.
If not treated, aneurysm ruptures in 60% of cases and is accompanied by intensive internal bleeding. Condition leads to lethal results in 100% of cases without any emergency medical help.
In case of aortic aneurysm rupture:
If the emergency surgery was provided, survival depends on the location of the bleeding and its intensity. Hospital mortality of such patients is quite high and amounts to 30-70% of cases. In case of hemorrhagic shock connected with the loss of large blood amounts, mortality reaches 77%
Simultaneously, in most cases modern diagnostics of aneurysm and planned surgery give a positive prognosis. 5 year survival rate is about 50%. It has to be mentioned that the majority of patients die because of reasons not connected to the abdominal aortic aneurysm. 5 year survival is determined by the accompanying cardio-vascular pathology.
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