Treatment of aortic aneurysm abroad
Aortic aneurysm is a disease, which is distinguished by the expansion or bulging of weak parts of the aorta. A ruptured aneurysm and subsequent bleeding can lead to death. The prevalence of the disease increases which is related to improved diagnostic methods and the increase in patients’ life span.
Aortic aneurysm is one of the most common cardiovascular causes of death among the elderly. Men over the age of 65 and women over the age of 77 are at risk.
Causes of aortic aneurysm
Atherosclerosis is the main cause of aortic aneurysm. All the primary causes combined account for only 5% of all cases of aortic aneurysm.
Other etiological factors include:
- Syphilis, tuberculosis and some other bacterial infections
- Fungal infections
- Congenital defects in the structure of the aorta
- Previous surgery
- Non-specific aortoarteritis
- Allergic inflammation
Risk factors (conditions that increase the risk of aortic aneurysm in the patient):
- High blood pressure
- Dyslipidemia (high cholesterol and triglycerides in the blood)
- Frequent stress
Given that in 95% cases the disease is caused by atherosclerosis, aortic aneurysm share similar risk factors.
Symptoms of aortic aneurysm
The clinical signs of the disease depend on the location of the bulging part of the aorta. Aneurysms can be of the following types:
- Abdominal aortic aneurysm – 37%
- Ascending aortic aneurysm – 23%
- Descending aortic aneurysm – 20%
- Aortic arch aneurysm – 20%
The severity of symptoms also depends on the type of aneurysm, its duration, but most importantly on its size and location.
Symptoms of abdominal aortic aneurysm include:
- Abdominal pain
- Belching, heaviness in the stomach and other dyspeptic symptoms
- Weight loss
- Bowel dysfunction (flatulence, constipations)
- Feeling of pulsation in the abdomen
- Presence of the palpable abdominal mass
Symptoms of ascending aortic aneurysm include:
- Chest pain
- Shortness of breath
- Swelling of the face and upper torso
The symptoms of aortic arch aneurysm are the same. Swallowing disorders in oesophageal compression, cough or hoarseness, when the larynx and trachea are compressed are commonly experienced. If there is a compression of the vagus nerve, it can cause autonomic disorders, such as salivation, bradycardia.
The symptoms of descending aortic aneurysm are manifested by the pain that is felt in the shoulder bone or arm. In rare cases spinal nerve roots can also be compressed and thus movement is hindered resulting in paresis or paralyses. Intercostal neuralgia can be caused by the compression of nerves and blood vessels.
Risk of aortic aneurysm
The disease does not always cause discomfort to the patient. The patient can live all his/her life without knowing that he/she had aortic aneurysm.
However, do not underestimate the danger of the condition. It can be accompanied by lethal complications, especially due to a raptured aneurysm with bleeding.
The following complications are quite rare, but also possible:
- Renal artery thrombosis (causes renal failure)
- Cerebral thrombosis (causes ischemic stroke)
- Congestive pneumonia (if the aneurysm compresses the lung)
Diagnosis of aortic aneurysm
Many patients have aortic aneurysm without any symptoms or they are so slight that they do not warrant a visit to the doctor. Therefore, the detection of disease is complicated. Nevertheless, if the patient is told about his/her complications, the condition is then easier to diagnose.
The diagnosis is based on ultrasound and X-ray readings. Any part of the aorta can be scanned by means of these techniques. The bulge that is twice or even larger in diameter than a normal blood vessel in the corresponding part gives rise to the diagnosis.
The following imaging techniques are necessary to assess risks and to plan a treatment strategy:
- Computed tomography
- Magnetic resonance imaging
The objective of the physician is not only to determine an abnormal expansion of blood vessels, but to find out the following factors:
- Presence of thrombotic masses in the enlarged area of the aorta, if any
- Aortic dissection under blood pressure, if any
- Size, localization, length of aortic aneurysm
- Tear in the inner layer, if any
The doctor assesses the structure of the aorta, condition of the aorta and its adjacent tissues. He will also determine which of them can be compressed (squeezed).
To avoid inaccurate diagnosis, it is better to be diagnosed in a German hospital due to a thorough diagnosis methods. The physicians in Germany will assess the risk of aortic rapture and will advise the best treatment option in each individual situation.
Treatment of aortic aneurysm abroad
Aortic aneurysm usually requires surgical treatment. The risk of rupture can often be fatal, even before the patient has a chance to get to the hospital.
This complication of aortic aneurysm requires emergency surgery, but the efficiency of emergency surgery is lower as compared to an elective one.
The elective surgery is especially necessary for the following patients:
- Patients with the symptoms of aortic aneurysm that are associated with the compression of the adjacent structures
- Patients with the aneurysm of a large diameter or length
- Patients with the aneurysm, which diameter has enlarged by a few millimetres within six months
- Patients with a high risk of complications
The main treatments:
- Prosthetic repair of the aorta (aneurysm is removed and aorta is restored by a prosthesis)
- Endovascular prosthetic repair with stenting
- Aortic valve replacement (can be performed in combination with the prosthetic repair of the aorta, if necessary)
The type of surgery is determined by the clinical situation and technical capabilities of the medical institution. German hospitals usually provide a better quality of treatment and it is sparing for the patient as compared to many other countries. The preference is given to endovascular surgery, which does not involve an open access to the abdominal or thoracic cavity.
Aortic aneurysm - Prognosis
If the disease has a natural course, the prognosis is unfavourable. Depending on the diameter of aortic aneurysm, the risk of its rupture accompanied by hemorrhage is from 20 up to 50%. In case of hemorrhage, the absence of emergency surgery leads to fatality. Only 70-80% of patients, who had time for surgery, can survive (it depends on the location, size of the aneurysm and the quality of medical care).
Those, who had a planned surgery, have a much better prognosis. Intraoperative mortality in different hospitals is substantially different, but rarely exceeds 5%.
To minimize the risks, you should receive treatment in Germany. German hospitals have better equipment. The physicians in Germany have extensive experience in aortic aneurysm surgery. Therefore, medical tourism is well developed here. The leading European hospitals attract patients from all over the world.