Aortic aneurysm

Description:

The "true" aortic aneurysm represents the pathological expansion of its gleam affecting all covers of a vascular wall. The main defect consists in destruction of elastic fibers of an average cover therefore the remained fibrous fabric stretches and leads to increase in diameter of a vessel that in turn causes tension of its wall. In process of progressing of this process and further expansion of a gleam the probability of a gap increases. "False" aneurisms are formed usually owing to an injury and represent such ruptures of an internal or average cover of a wall from which expansion of a segment of an aorta results, and the wall of aneurism consists only of an outside cover and/or a perivascular clot.

Most often the spindle-shaped aneurism which is characterized by diffusion expansion of some segment of an aorta meets. At the same time all circle of an aorta is surprised. Unlike this form sacculate aneurism presents itself expansion only of a part of a circle of an aorta in the form of protrusion.

Aortic aneurysm symptoms:

Aneurisms of a ventral aorta. In 75% of cases of an aortic aneurysm arise in its abdominal part, directly below renal arteries. As the reason of almost all aneurisms of a ventral aorta serves arteriosclerosis. More than 10% of similar patients have multiple aortic aneurysms. There are messages on existence of family predisposition to development of aneurisms of a ventral aorta. Aneurisms develop at men aged more often 60 years are more senior. More than at 50% from them the accompanying arterial hypertension comes to light. Frequency of development of a disease increases at tobacco smoking.

The diagnosis is often made at physical inspection during which it is possible to find the pulsing education in a middle part of an epigastrium. At radiological survey of an abdominal cavity curvilinear calcification of a wall of aneurism is found. The diagnosis at ultrasonography is confirmed. Long ultrasonic V-scanning allows to visualize a ventral aorta both in cross, and in a longitudinal projection, and also to determine the sizes of a ventral aorta, thickness of its walls and to find existence of a clot in a gleam of a vessel (fig. 197-1). Thanks to not invasiveness of this method the sizes of aneurism can be determined repeatedly. Diameter of aneurism of a ventral aorta increases with a speed about 0,5 cm a year. The computer tomography also allows to diagnose quite precisely aneurism of a ventral aorta and to identify patients with high risk of its gap. At the time of detection of aneurism the disease can proceed asymptomatically, pains in a stomach and a waist can be its first signs.

The forecast depends on the sizes of aneurism and that is very important, on existence of the accompanying atherosclerotic defeat of cardiovascular system. Normal diameter of a ventral aorta makes 2,5 cm. If diameter of aneurism exceeds 6 cm, then the probability of a gap it within 10 years reaches 45 - 50%. At the same time it does not exceed 15-20% if diameter of aneurism less than 6 cm.

The ischemic arteriosclerotic heart trouble which more than 50% of patients with aneurisms of a ventral aorta have considerably worsens the forecast of a disease. In one group of patients without clinical signs of a coronary disease of heart by which did not carry out surgical treatment survival in 5 years of observation made 50%. In the presence of coronary heart disease survival for the same span was only 20%. Long observation of the patients who were not exposed to surgical intervention concerning this disease showed that about 30% from them died as a result of a rupture of aneurism, and 30% - from the accompanying cardiovascular pathology.

At the correct selection of patients surgical intervention increases life expectancy, preventing a rupture of aneurism. In the presence of symptoms of aneurism or signs of its progressing, and also at aneurisms with a diameter more than 6 cm the emergency surgical intervention is shown. To choose option of treatment of patients with aneurisms of average diameter, from 4 to 6 cm, without clinical symptoms of a disease it is much more difficult. Operational mortality at the planned interventions which are carried out to a rupture of aneurism makes about 5-10%. It depends on the aneurism sizes, but in much bigger degree from existence of the accompanying cardiovascular pathology. In the absence of the expressed accompanying pathology of cardiovascular system asymptomatically the proceeding aneurisms of the small sizes (4-6 cm) have to be exposed to surgical correction. In the presence of the expressed associated diseases can be reasonable to conduct conservatively the patient under control of repeated ultrasonographies. Operation should be carried out in case of symptoms of a disease or essential increase in the sizes of aneurism.

Life expectancy of some patients after a rupture of aneurism is sufficient for performance of the emergency operative measure. They usually arrive in state of shock, with heavy pains in a stomach and a waist. At a palpation it is possible to find the intense pulsing education. Survival when performing an immediate surgery in such conditions makes about 50%.

Aneurisms of the descending aorta. Localization of emergence of an aortic aneurysm, the second for frequency, is its descending department, right after an otkhozhdeniye of the left subclavial artery. These aneurisms have usually spindle-shaped form and are a consequence of arteriosclerosis. Many patients with aneurism of the descending aorta have also an aneurism of a ventral aorta. The first symptoms of a disease find at a thorax X-ray analysis. At the same time, as a rule, clinical symptoms are absent. The diagnosis is confirmed by data of a computer tomography or aortografiya. Technically it is more difficult to carry out a resection of aneurisms of a chest aorta, than a resection of aneurisms of a ventral aorta. The risk of an operative measure in many respects is defined by the accompanying cardiovascular and pulmonary pathology. Operative measure for prevention of a rupture of aneurism is shown when there are clinical symptoms of a disease, with a cross diameter of aneurism more than 10 cm or bystry increase in its sizes and in the absence of the accompanying cardiovascular diseases making intervention impossible.

Traumatic, false, aneurisms of the descending aorta can arise at the patients who transferred a rupture of an aorta. As their most frequent reason serve ruptures of an aorta at road accidents. The gap is usually localized at the level of an arterial sheaf. At the same time pains in a breast and a waist, similar to pains are noted at stratification of an aorta. Arterial pressure on upper extremities is increased while on lower - it is lowered or completely is absent. At a X-ray analysis of a thorax reveal expansion of a mediastinum. The diagnosis is confirmed by data of a computer tomography or angiography. Traumatic aneurisms occur, as a rule, at young people without the accompanying cardiovascular pathology. In these cases surgical treatment is shown.

Less often aneurisms of the descending aorta have the sacculate form, for example at syphilis and other infectious diseases (mycotic aneurisms). Sacculate aneurisms are most inclined to gaps owing to what they have to be exposed to surgical treatment.

Aneurisms of the ascending aorta. Earlier practically all cases of aneurisms of the ascending aorta syphilis was the cause. They were easy to be distinguished at a thorax X-ray analysis on existence of calcification of a wall of the ascending aorta. Syphilitic aneurisms can reach the enormous sizes that is followed by emergence of signs of a prelum of adjacent structures. Now as the most frequent reason of aneurisms of the ascending aorta serves the cystous medial necrosis which can develop as a component of a syndrome of Marfan or to be a consequence of arterial hypertension and/or aging of fabrics of a wall of an aorta. Besides, the reason can be unknown.

Aneurisms of the ascending aorta, especially if they are caused by a cystous medial necrosis, can cause aortal regurgitation and lead to a left ventricular failure. In these circumstances the aneurism resection with substitution of the ascending aorta and valves of an aorta and reimplantation of a coronal artery is shown.

The most common symptom of aneurism of the ascending aorta is pain in a breast which patients often describe as deep unpleasant feeling without clear boundary. Making decision on a resection asymptomatically of the proceeding aneurism for prevention of its gap depends on its sizes, existence and weight of aortal regurgitation and the accompanying cardiovascular pathology. More than 50% of similar patients have additional aortic aneurysms.
Aortic arch aneurisms. These aneurisms meet less often. However they more than others, are inclined to cause various symptoms as, squeezing adjacent structures, lead to a dysphagy, dry cough, voice coarsening, an asthma or pains. Aneurisms of an aortic arch can have the spindle-shaped form at arteriosclerosis or sacculate - at syphilis or other infections. The operational risk at surgical correction of these aneurisms reaches 40-50%.

Maintaining patients with the accompanying arterial hypertension. Arterial hypertension which occurs more than at 50% of patients with aortic aneurysms demands very attentive treatment. Persistent arterial hypertension promotes further expansion of aneurism and serves as the contributing factor to its gap. In addition to standard antihypertensives, recommend to use ß adrenoblockers, allowing not only to lower the arterial pressure, but also to reduce aorta wall tension thanks to oppression of contractility of a myocardium.

Aortic aneurysm reasons:

As the most frequent reason of aneurisms serves arteriosclerosis. Among other reasons it should be noted a cystous necrosis of an average cover, an injury and syphilis or other infections.

Treatment of the Aortic aneurysm:

After the diagnosis of an aortic aneurysm was established to you, your doctor estimates:

    * Whether there is a need for carrying out surgical intervention.
    * Whether you will be able to undergo an extensive operation.
    * May you do without operational treatment, at least, now.

At making decision on the choice of treatment of an aortic aneurysm also such factors as a form, flexibility of an aorta and valves of heart are considered.

When surgical treatment is recommended

Aortic aneurysms which cause symptoms or quickly grow, are considered as those which have risk of a gap. Surgical treatment is usually recommended in the presence of any of these factors.

At men surgical treatment is usually recommended at an aortic aneurysm of belly department of an aorta which has in the diameter of 5,5 cm or more. At women operational treatment is recommended at the smaller sizes of aneurism. Some doctors carry out surgical intervention at the smaller sizes of aneurism though the risk of a gap at the size less than 5,5 cm is considered low.

Operational treatment is also recommended at the small sizes of aneurisms which increase more than by 0,5 cm in 6 months.

Surgical treatment of aneurisms of chest department an aorta is usually recommended at achievement by them in the diameter of 5,5-6,0 cm.

The decision on carrying out operation, its delay or refusal of surgical intervention depends also on other factors. Advanced age or medical problems which can make performing surgery dangerous can be these factors.

Drug treatment of an aortic aneurysm

Aneurisms of the small sizes (less than 5,5 cm in the diameter) which do not represent big risk of a gap, are usually treated by means of medicines which are used for treatment of high arterial pressure, such as beta-blockers. They slow down the speed with which aneurisms grow. In general, the risk of complications at operations on small aneurisms is higher, than possible advantages of such intervention because aneurisms of the small size are broken off seldom.

To you can appoint medicines for treatment of high level of cholesterol and high arterial pressure. Though it is not proved that these indicators slow down growth of aneurism, they can improve quality of your life. They reduce your risk to die of heart attack and a stroke which kill most (66%) of people with aneurisms.

Despite some statements, it was not proved that reception of vitamins C antioxidant properties reduces risk of development of aneurism or its gap.

Changes of a way of life at an aortic aneurysm. Smoking increases aneurism growth rate for 20-25% a year that considerably increases risk of a gap. Your doctor will persistently recommend to you to leave off smoking and, perhaps, will register medicines and therapy that to help you with it. Researches showed that replacement therapy at nicotine addiction using a bupropion of a hydrochloride (Zyban or Wellbutrin) and the subsequent maintenance therapy considerably increase long-term success in smoking cessation. And if you use the substance replacing nicotine, or accept бупропион or нортриптилин, then can double the chances to stop smoking not less, than for 6 months. One more drug which can increase probability that you will leave off smoking it вареницилин (Chantix) which blocks influence of nicotine on a brain. For obtaining more detailed information you watch the subjects Termination of Tobacco Smoking. It is also necessary to avoid passive smoking.

Your doctor will also recommend to you to carry out other changes of a way of life, such as transition to food by the products useful to heart, restriction of alcohol and occupation with physical exercises. Try to be engaged in exercise stresses which increase heart rate. Be engaged not less than 30 minutes and it is desirable daily.