Aneurysms of the aortic branches

Aneurysms can develop in any major branch of the aorta. Such aneurysms are much less common than an aneurysm of the abdominal or thoracic aorta. Risk factors include atherosclerosis, hypertension, smoking and older age. Localized infection can cause mycotic aneurysms.

Aneurysms of the subclavian artery are sometimes associated with the presence of the cervical ribs or the syndrome of the upper aperture of the thorax.

Aneurysms of the arteries of the organs are rare. Approximately 60% develop in the splenic artery, 20% in the hepatic arteries, 5.5% in the ascending mesenteric artery. Splenic artery aneurysms develop mainly in women (4: 1).

[1], [2], [3]

Causes of aneurysms of the aortic branches

The causes include fibromuscular dysplasia of the media, portal hypertension, multiple pregnancies, penetrating or blunt abdominal trauma, pancreatitis and infection. Aneurysms of the hepatic artery develop mainly in men (2: 1). They can be the result of previous abdominal trauma, intravenous drug use, media degeneration or periarterial inflammation. Aneurysms of the renal arteries can be delaminated or torn, causing acute occlusion.

[4], [5]

Symptoms of aneurysm of the aorta

Symptoms vary. Aneurysms of the subclavian artery can cause local pain, throbbing sensations, venous thrombosis or swelling (due to compression of adjacent veins), signs of distal ischemia, symptoms of transient ischemic attacks, stroke, hoarseness or impaired motor and sensory function (due to compression of recurrent laryngeal nerve or brachial plexus). Aneurysms of the superior mesenteric artery can cause abdominal pain and ischemic colitis.

Irrespective of localization, mycotic or inflammatory aneurysms can cause local pain and complications of systemic infection (eg, fever, general weakness, weight loss).

Diagnosis of aneurysms of the aorta

Most aortic aneurysms are not diagnosed prior to rupture, although calcified asymptomatic aneurysms can be seen on radiographs or other imaging studies performed for other reasons. Ultrasound or CT scan is usually used to detect or confirm aneurysms of the aortic branches. Angiography helps when it is necessary to determine the connection of symptoms from the peripheral vessels or tissues as a result of the presence of an aneurysm or embolic complications.

[6], [7], [8], [9]

Treatment of aneurysm of the aorta branches

Treatment includes surgical removal of aneurysm and prosthetics. With asymptomatic aneurysms, the decision to take prosthesis is made taking into account the risk of rupture, size, aneurysm localization and perioperative risk.

Surgical treatment of aneurysm of the aortic branches of subclavian aneurysms may include removal of the cervical ribs (if any) before prosthetics.

For aneurysms of organ arteries, the risk of rupture and death is about 10% and is particularly high in women of childbearing age and in patients with hepatic artery aneurysms (> 35%). Absolute indications for surgical treatment of aneurysms of organ arteries are determined for women of childbearing age, patients of other age groups having aneurysms with clinical symptoms and an aneurysm of the hepatic artery. With aneurysm of the splenic artery, the operation can consist of ligation without arterial reconstruction or excision of the aneurysm. Depending on the location of the aneurysm, splenectomy may be necessary.

With mycotic aneurysms, intensive antibiotic treatment is indicated, directed at a specific pathogenic microorganism. In general, an aneurysm of this type requires surgical treatment.