Scientific editor: OA Strokina practicing therapist, doctor of functional diagnostics. Work experience since 2015.
September 2018.
Aortic aneurysm - limited sacciform aortic wall bulging or expansion of the entire aorta more than half as compared with the norm. This pathology is the second occurrence frequency among the diseases after aortic atherosclerosis.
Kinds
The main classification is the division of pathology at the place of occurrence:
- aneurysm of the thoracic aorta;
- aneurysm of the abdominal portion.
Each of these is further divided into sub-sections, which correspond to the anatomical characteristics of most of the aorta and the branches extending from it. It is because of this classification, in many respects and is based tactics of the patient.
Also aneurysms vary due to the occurrence:
- Atherosclerotic aortic aneurysm develops as a result of the collapse of atherosclerotic plaques, and sclerosis of the aortic wall; usually located in the abdominal aorta.
- Posttraumatic aortic aneurysm - false aneurysm of the aorta, which develops as a result of the healing of bruises walls formed at wound aortic wall. A typical location - the isthmus of the aorta.
- Congenital arise due to the presence of the patient and another connective tissue disease (Marfan syndrome, fibromuscular dysplasia, etc.)
- Inflammatory aneurysm form a separate cohort of atherosclerotic and formed as a result of excessive immune system response in atherosclerotic process going in the aortic wall.
- Syphilitic aortic aneurysm develops in the Tertiary period syphilis; It is generally located in the ascending part of the aortic arch or.
There is also a clinical classification:
- uncomplicated, flowing almost imperceptibly with minimal symptoms;
- complicated (break) - the most formidable embodiment of the disease with rupture of the aortic wall and the flow of blood into the abdominal or thoracic cavity. This type of aneurysm is rarely positive outcome;
- dissecting aortic aneurysm develops due to the defect and the inner shell wall of the bundle of blood flowing under pressure through a defect; formed bruise and intravascular channel. This channel can communicate with the aortic true lumen at several points. wall of aortic dissection is possible in any of its department, but usually within 5 cm from the aortic valve and immediately after the point of origin of the left subclavian artery.
Symptoms of aortic aneurysm
Clinic disease depends on the location of the aneurysm and the degree of expansion of the aortic wall. When expanding in the ascending portion of the aorta - aortic insufficiency - primary manifestation of the disease.
Its symptoms can be:
- weakening of the pulse on the affected side;
- hoarseness (paralysis of the left vocal cord) due to compression of the left recurrent laryngeal nerve;
- larynx displacement due to transmission of the aneurysm ripple on the bronchi, trachea and larynx;
- shortness of breath due to compression of the trachea and bronchi aneurysm;
- patients take a forced position - lying on his side with his head held high and shoulders;
- possible compression of lung development pneumonia.
When the location of the aneurysm in the descending part of the thoracic aorta may include the following symptoms:
- chest pain caused by stretching of the nerve plexus of the aorta; Unlike anginaThey are less intense, longer and not tested nitroglycerin;
- swallowing disorder occurs when an aneurysm compression of the lower esophagus.
If the expansion of the aorta occurred in the abdominal part, the detection often becomes a random find, since there are no symptoms, she did not give. Sometimes you can still suspected pathology of such practices:
- constant nagging dull pain often in the lower abdomen, lower back, not associated with the movements of the body;
- patients feeling ripple or pulsating formation in the stomach;
- with increasing aneurysm pain increases sharply and begin to bear burning, unbearable character.
aneurysm rupture accompanied by a sharp intense pain with the development of shock from loss of blood.
Diagnosis and treatment
Special laboratory diagnosis of aneurysms do not require. However, according to standard assays (shared, biochemical blood tests) may cause suspect of the pathology (inflammatory processes will be increased erythrocyte sedimentation rate, leukocytes, C-reactive protein; in atherosclerotic - relevant changes of lipid profile and increase total cholesterol).
Diagnostics aortic aneurysm is conducted by means of:
- X-ray of the chest;
- echocardiography (Ultrasound of the heart);
- Abdominal ultrasound;
- Computed Tomography;
- Magnetic resonance imaging;
- Contrast angiography (aortography);
- Intravascular ultrasound (rarely used because of the low availability of equipment).
Specific treatment - only surgical - prosthetic aorta.
To date, the Russian medical community considers it necessary to consider surgical treatment in the presence of an aneurysm diameters from 45-50 mm and aneurysm growth rate of more than 6 mm.
Drug therapy is used to reduce the risk of aneurysm complications, that is, their gaps and to improve the prognosis after surgery. Treatment in this case is directed to the accompanying diseases: hypertension, coronary heart disease, lung disease and kidney.
complications
The most severe complication is a sudden rupture with bleeding, usually in the pleural cavity or in the retroperitoneal space (rarely - in the duodenum), able to determine the lethal Exodus.
sources:
- Russian Society of Angiology and Vascular Surgery. National guidelines for management of patients with abdominal aortic aneurysms. - year 2013.
- ESC recommendations (European community cardiologists) for diagnosis and treatment of diseases of the aorta. - year 2014.
- abdominal aortic aneurysm. - Clinical recommendations of the Russian Federation, 2016.
