Aneurysm of the aorta of the abdominal cavity: causes, signs, diagnosis, stenting

Among the serious pathologies, which under certain conditions can lead to a fatal outcome, one of the first places is occupied by an aneurysm of the aorta of the abdominal cavity. The term "aneurysm" means a pathological widening of the vessel's site: the vessel wall is stretched and weakened, as a result of which the vessel may burst and rupture. In addition, the risk remains high for the formation of thrombi in the affected largest artery.

Since the aorta is one of the main vital vessels, such changes in it can cost the patient not only health, but also life.

[1], [2], [3], [4]

Epidemiology

Aortic aneurysm belongs to a number of the most dangerous pathologies. Due to the rupture of an aneurysm, such famous persons as Albert Einstein, Charles de Gaulle, actor Andrei Mironov and singer Eugene Belousov left the life. And all his life, none of these people did not suspect that he has such a serious illness.

Considering the statistical data, it can be found that the aneurysm of the aorta of the abdominal cavity in the male population after 60 years is diagnosed in 3-5% of cases. In childhood, the disease is very rare and is associated with genetics.

In general, the disease is considered quite common. For example, 7% of people find an aneurysm during autopsy. In this case, not in all cases, death occurred precisely for this reason. Nevertheless, the aortic aneurysm of the abdominal cavity is on the tenth place in the list of the most common causes of death.

Among all localizations of the aneurysm, the dilatation of the abdominal aorta is most common, in 37% of patients. An aneurysm of the ascending department is diagnosed in 23% of patients, aortic arch aneurysm in 19% of patients, and an aneurysm of the descending thoracic aorta in 19.5% of patients.

[5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15]

Causes of the abdominal aortic aneurysm

In most cases, the development of an aneurysm of the abdominal aorta is associated with atherosclerotic transformations in the vessels. The mechanism is simple: the process of formation of atherosclerotic plaques leads to damage to the internal vascular layer, which leads to thinning of the wall and the appearance of protrusion.

Nevertheless, there are a number of other possible causes of the disease:

• inflammatory reactions in the aorta, for example, in patients with tuberculosis, syphilis, rheumatism, microbial endocarditis, mycoplasmosis, aortoarteritis of nonspecific etiology;
• congenital malformations of the vessel, which include Marfan's disease and connective tissue dysplasia;
• damage to the abdominal aorta as a result of injuries to the abdominal cavity, chest or spine;
• postoperative complications after interventions on arteries;
• sepsis and fungal infections affecting the aorta.

[16], [17], [18], [19], [20]

Risk factors

Risk factors include all factors predisposing to the development of the disease. They can be conditionally divided into those that can be eliminated, and those that you can not get rid of anymore.

• Irreducible factors:

1. elderly age;
2. male gender (in men an aneurysm develops more often);
3. adverse heredity (if relatives already had cases of aneurysm of the abdominal aorta).

• Eliminate factors:

1. bad habits (in particular, smoking);
2. high blood pressure;
3. high cholesterol in the blood;
4. high blood sugar limit;
5. significant errors in nutrition;
6. significant excess weight;
7. physical inactivity.

To correctly prevent the development of an abdominal aortic aneurysm, it is necessary to completely eliminate or minimize the effect of removable risk factors. To do this, first of all, you need to adjust your lifestyle and nutrition.

[21], [22], [23], [24], [25], [26], [27]

Pathogenesis

In addition to the defect in the development of the aortic wall, other physical and physiological factors are involved in the appearance of the aneurysm. Expansion of the vessel most often occurs in areas of excessive functional tension, in the zone of increased blood flow, unusual pulse amplitude, etc. Continuous damage to the artery against the background of increased enzyme activity leads to the destruction of the elastic framework and to the development of nonspecific signs of degeneration in the vascular wall.

The already formed aneurysm gradually progresses, as the tension in the wall increases as the vessel is diametrically widened. Inside the aneurysm, the blood circulation slows down, a kind of turbulence is observed. The distal department receives less than half the blood volume that is inside the aneurysm. This is because when you enter the damaged aortic zone, the blood diverges along the walls, while the central flow is held back by the turbulent process and blood clots that are in the cavity. Clumps within the aneurysm serve as a factor in the further development of thromboembolism of the distal aortic branches.

[28], [29], [30], [31], [32], [33], [34], [35],

Symptoms of the abdominal aortic aneurysm

In the overwhelming majority of cases, the aortic aneurysm of the abdominal cavity does not manifest itself with any symptoms. The patient does not complain about anything, and even the doctor will not be able to suspect that something is wrong. This is the main danger of the disease.

Unfortunately, often the first sign of an aneurysm is its rupture, which entails the death of the patient in almost 90% of cases. The rupture is accompanied by a sudden pallor of the skin, loss of consciousness. If you do not perform an immediate surgery, the patient dies.

Since the symptomatology is absent in most patients, an aneurysm can be detected only during the passage of the diagnosis - during such studies as ultrasound, x-ray, etc. Less often, aneurysms are noticed during abdominal cavity surgery.

In rare cases, when the aneurysm reaches considerable dimensions, the first signs can be observed:

1. pressing pain in the upper part of the abdominal wall - intense, paroxysmal, giving back to the waist or sacrum;
2. a sensation of pulsation in the abdomen - especially during exercise, with increased intra-abdominal pressure.

With large dimensions of the aneurysm, the work of a number of located organs can be disrupted.

[36], [37], [38], [39]

Forms

There are several different classifications of this disease.

• By Location:

1. infrarenal aneurysm, in which the dilatation is lower from the site of divergence of the renal arteries;
2. suprarenal aneurysm, in which the enlargement is higher from the site of divergence of the renal arteries.

• On the etiology:

1. hereditary aneurysm;
2. acquired aneurysm.

• The nature:

1. a true aneurysm with a layered extension of the entire artery and the formation of a "bag";
2. a false aneurysm, which is accompanied by the accumulation of blood between the layers.

• According to the form:

1. spindle-shaped aneurysm with widening along the entire circumference;
2. saccular aneurysm with local protrusion not exceeding ½ the diameter of the vessel.

• By size:

1. small aneurysm - from three to five centimeters;
2. average aneurysm - from five to seven centimeters;
3. a large aneurysm - the size exceeds seven centimeters.

[40], [41], [42]

Complications and consequences

Aneurysm of the aorta of the abdominal cavity is very dangerous - and, first of all, by the fact that for a long time it does not reveal itself by any symptoms. However, contrary to the opinion of many, the absence of symptoms does not at all mean that there is no danger. The most dangerous complication is the rupture of the vessel, it can also occur without preliminary signs of the disease.

The aneurysm is capable of bursting for the following reasons:

• in the absence of adequate treatment (if the doctor insists on the operation, it must be done, otherwise the life of the patient will be endangered);
• during exercise, which is categorically contraindicated to all patients with an aneurysm;
• with high blood pressure;
• when using products that increase gas formation in the intestine;
• with aggravation of atherosclerotic changes in the vessels, with progressive tuberculosis or syphilis.

In addition to the gap, there may be other complications that are much less dangerous:

• frequent dyspeptic disorders;
• disorders of urination, pain in the area of the projection of the kidneys;
• disorders of sensitivity, paresis;
• increased degree of thrombus formation, ischemia.

Rupture of abdominal aortic aneurysm

Aneurysm can be complicated by a rupture, which is accompanied by severe bleeding, a collapoid and shock state, and an acute insufficiency of cardiac activity.

The broken vascular wall - an aneurysm - can break through into the cavity of the pericardium or pleura, into the cavity of the esophagus, into the system of the superior vena cava, into the abdominal cavity. The patient's condition in all cases of rupture is sharply critical: it can be combined with upper vena cava syndrome, hemopericardium and hemothorax, cardiac tamponade, and with any internal bleeding.

If there were thrombi within the aneurysm, then their separation leads to a clinic of acute vascular thrombosis. There is blueing and pain in the fingers of the limbs, haemorrhage in the type of a liveroid, inability to walk. If the thrombus passes into the renal arteries, there arises an increase in arterial pressure according to the rhinovascular type, as well as renal failure.

When a thrombus hits the brain arteries, an acute stroke develops.

[43], [44], [45], [46],

Diagnostics of the abdominal aortic aneurysm

Many patients are diagnosed with abdominal aortic aneurysm by chance, for example, during ultrasound diagnosis of diseases of the digestive system or kidneys.

If the patient already has any specific complaints, the doctor, suggesting the presence of an aneurysm, recommends an additional diagnosis.

Initially, the doctor performs an examination, determines the pulsation in the abdominal wall with the patient's horizontal position. When listening to the abdomen, a systolic noise is detected in the area of the anomaly. At palpation, it is possible to define a protruding pulsating neoplasm resembling a tumor - this is an aneurysm.

Analyzes are included in the list of mandatory studies, and include:

• general blood analysis;
• biochemistry of blood;
• determination of cholesterol in the blood;
• determination of blood glucose;
• revmoproby.

Analyzes are considered auxiliary types of diagnostics: it is impossible to diagnose an aneurysm solely based on the results of tests.

Instrumental diagnostics includes such research methods:

• Ultrasound examination in combination with duplex scanning - helps to examine the vascular anomaly, to clarify its location and dimensions, to determine the speed and quality of blood circulation in the affected area, to detect signs of atherosclerosis and thrombosis.
• Computer tomography and magnetic resonance imaging - are used for a clearer and more detailed visualization of an aneurysm.
• Angiography with contrasting - is used only to clarify certain vague moments.
• X-ray in an aneurysm is used only when calcium deposits are present on the walls of the affected vessel.

[47], [48], [49], [50], [51]

Differential diagnosis

Differential diagnosis of an aneurysm is often required, as many diseases are characterized by a common clinical picture. For example, pulsation can be accompanied by both tumor processes in the stomach and pancreas, and enlarged lymph nodes.

The tumor has a dense structure, uneven surface. It is difficult to move, and does not reveal systolic noise (only when the tumor is squeezed by the tumor of the celiac and superior mesenteric artery). To clarify the diagnosis used fibrogastroskopiyu, laparoscopy, aortography and ultrasound.

A tumor process in the kidney or an abnormality such as a horseshoe-shaped kidney can also be mistaken for an aneurysm. Often, an aneurysm is confused with a drooping wandering kidney, close to the aorta. Such a kidney can easily be displaced by palpation, it does not differ systolic noise, and the use of isotope scintigraphy allows a true diagnosis.

The aortography helps to finally confirm the aneurysm: this method allows to differentiate the disease from mesenteric lymphosarcoma, from the bending of the aorta against the background of high blood pressure.

Treatment of the abdominal aortic aneurysm

Aneurysm is treated only surgically, regardless of its size and the presence or absence of symptoms. Drug therapy can be prescribed only when there is no possibility of a full intervention.

No drug can reduce the risk of vessel rupture, let alone eliminate an anomaly such as an aortic aneurysm. However, with the help of surgery, the problem is eliminated: the surgeon removes the weakened portion of the vessel and restores its contours and strength.

Aneurysm medications are used primarily to prevent complications, as far as possible. A doctor can prescribe such medicines:

• Cardiotropic:

1. Prestarium is taken once a day from morning until breakfast. The dosage is determined by the doctor. The drug can cause frequent headaches and blurred vision.
2. Verapamil is taken 80-120 mg three times a day. During the reception may occur dyspepsia, increased frequency of urination, attacks of angina.
3. The recurrence is prescribed at 12.5 mg daily, for two weeks. Longer reception may be accompanied by dry mouth, nasal congestion, increased bleeding.
4. Noliprel is taken in the morning, one tablet daily. Treatment can be accompanied by the appearance of paresthesias, headaches, sleep disorders.

• Antithrombotics:

1. The cardiomagnine is taken 75-150 mg daily. The drug can cause an allergic reaction, heartburn and exacerbation of inflammation in the digestive tract.
2. Trombo ACC is taken before meals, 50-100 mg once a day, periodically monitoring the blood coagulability.
3. Clopidogrel is taken 75 mg once a day. Duration of treatment - not less than one month.

• Means for the normalization of cholesterol in the blood:

1. Atorvastatin is prescribed at 10 mg per day, with possible further dosage adjustment. Occasionally during treatment, there is jaundice, muscle pain, insomnia.
2. Rosuvastatin is prescribed for 5-10 mg per day, but in the future, the dose is revised individually. Among the undesirable effects of the drug can be called polyneuropathy, joint pain, jaundice, diarrhea.

• Medications that normalize blood glucose in patients with diabetes mellitus.

Vitamins

To further strengthen the vascular wall in case of aneurysm of the aorta, vitamin preparations should be included in the regimen. Which of them are the most effective and popular?

• Ascorutin is a combination of rutin and ascorbic acid. The drug reduces the fragility of blood vessels, accelerates tissue repair and normalizes carbohydrate metabolism.
• Aspartame is a preparation of potassium and magnesium. Asparta improves cardiac activity, normalizes the balance of electrolytes, has antiarrhythmic properties.
• Vitrum cardio is a multivitamin-mineral complex preparation, which is recommended as a preventive agent for preventing the development of myocardial ischemia, atherosclerosis, and complication after a stroke.
• Doppelgerz Cardiovital is a drug whose action is based on the cardiotonic and sedative properties of hawthorn.

A lot of multivitamins are known to strengthen the blood vessels. However, the best drug will help to choose a doctor, taking into account all indications and contraindications to the use of this or that remedy.

Physiotherapeutic treatment

Physiotherapy in most cases is contraindicated in the aortic aneurysm of the abdominal cavity, since it can provoke an increase in blood circulation in the affected area of the artery and aggravation of the patient's condition.

Alternative treatment

Alternative recipes can be an excellent addition to traditional aortic aneurysm therapy. However, the use of such recipes does not at all mean the possibility of abandoning the operation, since this is the only way to completely eliminate the problem.

• To improve the prognosis for an aneurysm, take a medicine based on dry elderberry. One tablespoon of elderberry is infused in a glass of boiling water for half an hour. Infusion take 1 tbsp. L. Three times a day.
• Brew in 200 ml of boiling water 2-3 tbsp. L. Icteric. Take 1 tbsp. L. Infusion 4 times a day, with honey.
• Well strengthens the vessels infusion of ordinary dill. To prepare a medicine 1 tbsp. L. Dill insist in one liter of boiling water, drink during the day.
• Grind dry fruit of hawthorn in a coffee grinder. Brewed 2 tbsp. L. Powder in 0.5 liters of boiling water, insist until cooling and take three times a day between meals.

Herbal Treatment

The mistletoe white plant lowers arterial pressure, improves the condition of blood vessels in atherosclerosis. Infusion of plants in the amount of 200 ml is drunk in small sips throughout the day. The duration of such treatment is one month.

Infusion based on the color of hawthorn drink 100 ml in the morning and in the evening. Tincture of hawthorn can be consumed 30 drops 3 times daily before meals.

Preventive hypotensive effect in aortic aneurysm is demonstrated by motherwort preparations. Infusion of motherwort is recommended to take a tablespoon up to 4 times a day. Tincture is taken on 40 drops with water up to 4 times a day.

The initial duration of treatment with such drugs is one month. In the future, if necessary, you can take drugs for 10 days during each month.

In addition, it is recommended to drink tea with the addition of berries chokeberry, horsetail and yarrow, leaves of mother-and-stepmother and birch.

Homeopathy

Most often, homeopathic doctors recommend treating an aneurysm with a homeopathic remedy like Fluoric Calcium in breeding 3, 6, 12. Other drugs can also be used, depending on the symptomatology present.

• Platinum - breeding 3, 6, 12, 30;
• Aconite - breeding 3x, 3, 6, 12, 30;
• Bryonia - breeding 3x, 3, 6;
• Belladonna - breeding 3x, 3, 6;
• Gelziumium - breeding 3x, 3, 6;
• Drosera Rotundifolia - breeding 3x, 3, 6, 12.

When choosing a preparation, homeopathy is determined taking into account the constitutional type of the patient. The doctor selects a remedy suitable only for this particular case.

You can take such drugs in a complex - then the effect of an aneurysm will be better and more lasting.

Surgery

Surgical intervention can be carried out both planned and urgent. A direct indication for surgery is an aneurysm without complications, the dimensions of which exceed 50 mm. Urgent operation is carried out with the separation or rupture of the vessel.

Surgical treatment of aneurysms is carried out using general anesthesia and an IC apparatus. The surgeon makes a cut in the anterior abdominal wall, freeing access to the abdominal aorta. Then the doctor clamps the vessel from above and below, cuts off the enlarged area and installs an artificial implant to the undisturbed parts of the vessel.

An implant, or prosthesis, is a tubular element that is well received by the body and does not require replacement during the entire period of operation. In some cases, a prosthesis is installed with a bifurcation on a finite length. Intervention with an aneurysm lasts from 2 to 4 hours.

After the operation, the patient is placed in the intensive care unit, where he can stay for up to one week. After resuscitation the patient can be placed in the department of cardiology, vascular surgery or cardiosurgery.

When an endovascular procedure is performed, the Stent-Graft implant is introduced into the damaged area of the vessel, with the help of which the structure and blood circulation in the artery are restored. Such an operation is performed using epidural anesthesia. The doctor makes a puncture in the inguinal zone, through it introduces a special catheter and brings an implant to the aneurysm through it. After installation and opening of the device, a duct is formed, which ensures normal blood flow in the vessel. Endovascular surgery is better tolerated by patients, but the effect from it can be short-lived - doctors do not guarantee the absence of the need for a second operation.

Diet and nutrition with abdominal aortic aneurysm

Correction of nutrition for aneurysm of the aorta should be aimed at optimizing the diet. It is necessary to reduce the amount of animal fat used, cholesterol, fast-digestible carbohydrates, and also reduce daily caloric content, which is especially important in the presence of excess weight.

To achieve the set goals, you need to comply with such rules:

1. Practically eliminate the use of animal fat in any form: it can be fat, fatty meat, butter, cream.
2. Except for subject and fried foods.
3. Sharply limit the use of common salt to 5 grams per day, and at elevated pressure - up to 2-3 grams per day.
4. Limit the use of sweets.
5. Increase the proportion of fresh vegetables and fruits in the daily menu.
6. If possible, replace the meat with sea fish.

With aortic aneurysm, it is very important to keep track of your weight, as excess pounds also help increase intra-abdominal pressure. Recommended metrics body mass index - from 18,5 to 24.9 kg per m ², and abdominal circumference figures - less than 90 cm in women and less than 100 cm in men.

When expressed obesity should refer to specialized specialists, such as a dietician and endocrinologist.

[52], [53], [54], [55], [56], [57]

Prevention

Preventive measures consist of correction of a way of life.

• Full refusal from smoking, and even from passive inhalation of cigarette smoke.
• Systematic physical activity: half an hour daily walking, breathing exercises, work on the backyard, bicycling, etc.

Periodically - at least twice a year, you need to check blood pressure, cholesterol and blood glucose.

In addition, it is necessary to make changes in the power supply system, which we mentioned above.

If aneurysm of the aorta of the abdominal cavity is already present, then preventive measures are taken to prevent rupture of the vessel.

• The patient needs to exclude heavy physical overloads, as carrying heavy objects, jumping, intense movements lead to an increase in intra-abdominal pressure, which increases the risk of rupture.
• The patient should strictly follow the dietary principles of nutrition, completely refusing gas-forming food: beer, soda, peas and beans, cabbage, etc. It is also necessary to monitor the normal function of the intestine.
• The patient needs to frequently check blood pressure, especially with a tendency to hypertension. Increased pressure increases the risk of rupture of the artery.

[58], [59], [60], [61], [62], [63], [64], [65]

Forecast

Aneurysm of the aorta of the abdominal cavity often has no pronounced clinical manifestations. Therefore, many patients believe: if it does not bother, then there is nothing serious. But this is not so: an aneurysm - the disease is really serious, which is often complicated by rupture of the artery. A break in 85-90% of cases leads to the death of the patient.

Moreover, it is impossible to predict in advance how the aneurysm of the aorta of the abdominal cavity will behave. Sometimes, it would seem, minor damage quickly increases and leads to rupture of the vessel. There were also descriptions of cases in which people lived long with large aneurysms without even knowing they existed. Therefore, an unambiguous prognosis for the disease can not be provided. The best solution is, if possible, to remove the aneurysm surgically.

[66], [67]