Aneurysm of the ascending aorta.

In general, an aortic aneurysm is a locally dilated section of the aorta two or more times larger than the normal healthy lumen in nearby sections of the vessel. The problem can occur in almost any segment of the main artery of the circulatory system, and one of the variations is an aneurysm of the ascending aorta - we are talking about the area from the supra-aortic crest to the fibrous framework of the aortic valve. The pathology is complex and requires constant monitoring by cardiology specialists, as it has a tendency to constant progression and does not respond well to drug therapy. [1]

Epidemiology

The prevalence of ascending aortic aneurysm depends on many factors. In particular, the disease is more common in people with a history of aggravated heredity, as well as in elderly men who smoke.

According to international statistics, the risks of developing a pathologic bulge with a diameter of more than 30 mm increase significantly in people over 50 years of age, and the marginal risks are typical for people aged 80 years. Aneurysms with a diameter size of 3-4 cm are diagnosed in 1.3% of men from 45 to 54 years old and in 12% of men from 75 to 84 years old. When compared with the incidence of the disease in women, the rates in these age ranges are 0% and 5%.

In regions with a lower incidence of atherosclerosis (e.g., Japan), aneurysms are much less common.

Aneurysms of the ascending aorta in childhood are very rare. Pathology can begin its development in the intrauterine period, or manifest itself after the baby's appearance on the world. Causes of the problem in children:

• Marfan, Turner, Ehlers-Danlos, Loeys-Dietz, Kawasaki syndromes;
• congenital connective tissue abnormalities, arterial tortuosity disease.

The most common causes of aneurysms in adults are atherosclerosis, hypertension, and syphilis. [2]

Causes of the ascending aortic aneurysms

Aneurysm of the ascending aorta is a multifactorial pathology. Its development can be provoked by various diseases, trauma, and even age-related changes. In general, the causes can be divided into two categories: congenital and acquired.

Among the congenital root causes, the leading ones are:

• Marfan's disease is a genetic hereditary connective tissue pathology characterized by symptoms such as deformed chest, elongated fingers, excessive joint mobility, and visual impairment. Cardiovascular system damage is manifested as valve heart failure, aortic aneurysms up to aortic rupture.
• Skin hyperelasticity syndrome (Ehlers-Danlos) is a genetic systemic collagenosis characterized by pale and thinning skin, increased mobility of the fingers, regular bruising, and fragility of the vascular walls, which eventually leads to the development of an aneurysm (and further to its rupture).
• Loeys-Dietz syndrome is an autosomal dominant genetic pathology characterized by specific features such as "wolf's mouth", hypertelorism and aortic aneurysm. Other symptoms may include deformity of the spine and/or feet, malalignment of the spinal structures and the brain, etc. At the same time, aneurysms are characteristic not only of the aorta, but also of other arterial vessels.
• Shereshevsky-Turner syndrome (monosomy X) is characteristic of the female sex. Patients are characterized by stunting, body composition disorders, barrel-shaped curvature of the thorax, absence of the monthly cycle, insufficient development of the sexual system, infertility. Cardiovascular pathology is manifested mainly by the formation of aneurysms and their dissection.
• Arterial kinking is a rare autosomal recessive pathology, which is accompanied by multiple vascular lesions. There is a disorder of connective tissue structures, skeleton.
• Dissecting osteochondritis, Koenig's syndrome - accompanied by abnormal development of the vascular network, lesions of articular cartilage.
• Aortic coarctation is a congenital vascular defect in which there is a narrowing of the internal lumen. In this pathology, aneurysm is its complication, up to dissection.

Acquired causes may be due to inflammatory and non-inflammatory intravascular changes:

• Non-specific aortoarteritis is a chronic inflammatory process in arterial vessels with further narrowing of their lumen. The disease is of autoimmune origin, but there are assumptions about hereditary predisposition to pathology.
• Kawasaki disease is an inflammatory pathology that develops under the influence of microbial and viral infection combined with hereditary predisposition. The disease is characterized by fever, enlarged lymph nodes, diarrhea and vomiting, skin rash, cardiac and joint pain, conjunctivitis. Aneurysm develops due to damage to the vascular wall by vasculitis.
• Behçet's syndrome is a type of systemic vasculitis. The patient presents with skin and mucosal ulcerative lesions, diarrhea, nausea, vascular stenosis, thrombophlebitis, and aortic aneurysm.
• Aortitis is an inflammatory process in one or more layers of the aortic wall, which over time causes thinning, stretching and perforation of the vessel. Pathology can affect patients suffering from syphilis, rheumatoid arthritis, tuberculosis, osteomyelitis, bacterial myocarditis.
• Atherosclerosis is the main factor in the development of aneurysm of the ascending aorta. The pathology is characterized by thickening of the vascular wall, narrowing of the internal lumen, deposition of calcium or cholesterol plaque and plaques. Vessels become brittle, fragile, and in the area of the highest load in the ascending section, an aneurysm is formed.
• Elevated blood pressure if it exists for a long time leads to an increase in vascular load. Particularly dangerous in terms of aneurysm development is considered an increase in blood pressure in patients with concomitant atherosclerosis, syphilis or other pathologies accompanied by the appearance of defects in the vascular wall.
• Traumatic injuries to the abdomen and thorax are dangerous because of their long-term consequences - for example, severe bruises and blows can lead to compression, displacement of the ascending aorta, and increased intravascular pressure. As a result, an aneurysm gradually progresses.
• Iatrogenic processes - pathologies of the aorta, resulting from certain medical manipulations - can affect the development of an aneurysm under the influence of other provoking factors.

Risk factors

Risk factors for aneurysm formation include:

• Genetic predisposition. The risk of forming aneurysms of the ascending aorta is significantly increased in close male relatives (approximately three times, if compared with the risk of pathology in other people).
• Cardiovascular problems. It has been observed that aneurysm occurs most often in patients suffering from high blood pressure, heart failure, vascular stenosis, and myocardial infarction.
• Atherosclerosis. Patients with aneurysm have high levels of lipoproteins, which can be considered a marker of progression of atherosclerotic changes.

Risk groups for the occurrence of the disease and the formation of a pathologic bulge in the form of an aneurysm include:

• men (several times more often than women);
• smokers "with a history," and especially those who have smoked for more than two decades;
• Older adults (after 55-60 years of age);
• persons with a family history of aggravation;
• people with prolonged high blood pressure (values exceeding 140/90 mmHg);
• people with sedentary lifestyles;
• patients with any degree of obesity;
• patients with high blood cholesterol levels.

Pathogenesis

The ascending part of the aorta starts from the left cardiac ventricle and runs to the brachial trunk branch, and then continues in the form of the aortic arch. The total length of this segment is about 5-7 cm, with an average diametral dimension in the middle of 15-30 mm. This segment is referred to as the cardiac aorta.

The initial part of the ascending aorta has a slightly dilated lumen (25-30 mm - transverse dimension). This area is called the aortic bulb: it in turn has three sinuses, or bulges, from the border of which form the semilunar flaps that form the aortic valve. This valve opens during systole (cardiac muscle contraction) and closes during diastole.

The aortic vessel is elastic: there are many yellow fibers in its wall, providing adequate stretch and elasticity of the artery. At the moment of systole, blood leaves the ventricles, and the pressure at this time is approximately 120-130 mmHg. Aortic walls are stretched accordingly, after which they return to their previous position without any problems.

Aneurysms of the ascending aorta are most commonly caused by degeneration of its wall, which can be triggered by combined and complex biomechanisms. It is generally believed that the vast majority of aneurysms develop as a result of atherosclerotic changes, but not infrequently the cause is changes in the levels of tissue metalloproteinases, which affects the quality of the arterial wall.

An aneurysm is an abnormal bulge of the arterial walls. If there is a weak zone in the vascular wall, then against the background of pressure, it "bulges": this is how the pathology is formed. If the inner shell of the vessel is further damaged, then its separation occurs with the formation of a false pathway for blood flow. In such a situation, we speak of a dissecting aneurysm. [3]

Symptoms of the ascending aortic aneurysms

Aneurysm of the ascending aorta usually does not cause compression of nearby organs and structures, so it can be asymptomatic for a long time. Then the first signs appear:

• dull pain behind the sternum;
• reflexive shortness of breath, hoarseness;
• sometimes - a decrease in the volume of the chest ("sunken" breasts with a bulging area);
• sometimes upper body swelling.

If the aneurysm ruptures into the superior vena cava, a corresponding syndrome develops, which is characterized by:

• a bluish tint to the skin;
• swelling of the face, neck;
• dilation of visible venous vessels in the upper body region.

Many patients complain of coughing, difficulty swallowing, intrathoracic pain, periodic bleeding from the nose and throat. Symptomatology worsens when a person lies down. This moment forces the patient to adopt a forced sitting or half-sitting posture.

The first signs that an aneurysm dissection is occurring are not always the same, which depends on the size and length of the affected section of the aorta, as well as the characteristics of the lesion.

A dissecting aneurysm of the ascending aorta is a life-threatening condition, as it can lead to disruption of the integrity of the artery and disruption of blood circulation in the body. [4]

Forms

Aneurysms of the ascending segment of the aorta are subdivided according to their location, configuration, origin, and structural vascular changes.

So, by location, such varieties of pathology are distinguished:

• Aortic root and ascending aortic aneurysm - begins at the fibrous ring of the aortic valve and terminates at the sinotubular ridge.
• Aneurysm of the tubular segment of the ascending aorta - located from the sinotubular ridge to the aortic arch.
• An aneurysm of the ascending aortic arch runs between the subclavian artery and the mouth of the brachiocephalic trunk.

Pathology does not always clearly correspond to this division: often combined pathologic bulges involving several segments are detected. If the entire aortic vessel is dilated, the diagnosis of "mega-aorta" is established. [5]

In addition, there is a division based on the form of extended education:

• A spindle-shaped aneurysm of the ascending aorta (aka fusiform) is characterized by uniform dilation around the entire circumference of the artery;
• A sac-shaped (sac-like, sac-like) aneurysm has the appearance of a lateral sac (lateral bulge) with dimensions no larger than ½ of the vessel diameter;
• Dissecting aneurysm - characterized by blood flowing into the cavities formed between the wall layers of the artery.

Fusiform aneurysm of the ascending aorta may be found in the tubular portion or in the aortic arch, but is more often combined.

The dissection of pathologic enlargement, in turn, is subdivided into several variations:

1. The inner layer in the cardio-aortic region is damaged, and the dissection passes without reaching the descending section.
2. The intima is damaged and there is a dissection of the cardiac aortic segment or aortic arch, without spreading to the descending segment.
3. The intima is torn, and the dissection extends to the descending section.

Depending on the course of the pathology are distinguished:

• Acute dissection (develops over 1-48 hours);
• Subacute stratification (develops over a period of 49 hours to 28 days);
• Chronic stratification (occurs over several months).

Complications and consequences

The aorta is the largest and most powerful blood vessel in the human body. Through it, blood flows to all human organs. That is why in case of violation of this artery, damage to other organs and systems is simply inevitable, which is caused, first of all, by the growing oxygen and nutrient deficiency.

Among the most common complications of an aneurysm are the following:

• development of renal, cardiac, pulmonary failure;
• aortic wall dissection, aortic wall rupture;
• clotting.

Fatal outcome is observed in about 40% of patients within three years from the time of diagnostic detection of the pathology, and in almost 60% of patients within five years. In most cases, patients die as a result of aneurysm rupture and cardiac or pulmonary failure.

Ruptured ascending aortic aneurysm

The complication is manifested by extensive hemorrhage, rupture into the vascular lumen or into nearby tissues. The patient's blood pressure rises sharply and then falls just as sharply. Detected asymmetric pulsing in the arms and legs, severe weakness, skin cyanosis, increased sweating. If the pathological zone is characterized by large size, it is not excluded compression of nerve endings, other vessels and nearby organs.

The main symptoms of rupture:

• impaired blood supply to the heart muscle, burning pain in the heart;
• deterioration of blood supply to brain structures, fainting and coma, paresis and paresthesias of the extremities;
• compression of mediastinal structures, the appearance of hoarseness, difficulty breathing, the clinical picture of superior vena cava syndrome;
• circulatory disorders in the abdominal organs, the development of acute renal failure, digestive disorders.

A ruptured aneurysm is characterized by a sharp deterioration in the patient's condition. There is severe weakness, blurring or loss of consciousness, pulse irregularities, severe chest pain. [6]

Diagnostics of the ascending aortic aneurysms

History taking is an important part of the diagnostic process, which gives the doctor an idea of what kind of pathology we are talking about. In addition to finding out the symptoms and listening to the patient's complaints, family history is also collected. In particular, it is necessary to pay attention to hereditary diseases.

The next stage is to examine the patient, assessing his physical data, skin condition and type of breathing. In addition, blood pressure is measured, a cardiogram, cardiac ultrasound is performed. When probing the area of the ascending artery, a different-sized pulsating formation can be felt, and in the course of auscultatory examination, vessel noises are listened to.

Laboratory tests are another important part of diagnostic measures. The most commonly ordered tests are:

• general blood test;
• blood chemistry;
• lipidogram (helps determine the likelihood of atherosclerosis).

Mandatory indicators that require detailed consideration:

• cholesterol;
• low-density lipoproteins;
• high-density lipoproteins;
• blood glucose levels.

The above tests are not basic for the diagnosis of aneurysm of the ascending aorta, but they help to suspect the problem and assess the risks of pathology.

Instrumental diagnosis is crucial:

• X-ray - allows to investigate the boundaries and dimensions of the required aortic compartments. If a dilated shadow of the vessel and an altered configuration of the mediastinum are detected, the diagnosis of an aneurysm is not in doubt. Another typical sign: compression of nearby organs.
• Intravascular ultrasound is indicated for a layer-by-layer study of the aortic wall, which provides comprehensive information on the structural changes of the artery. Atherosclerotic layering, blood clots, areas of intra-wall damage are visualized during the study.
• Ultrasound echocardiography is used to evaluate the vascular wall structure, detect intravascular defects, and determine aneurysm size and location.
• Ultrasound Doppler ultrasonography indicates the extent of aortic wall damage and the degree of change in the vascular lumen, and helps to determine the type of aortic blood flow.
• CT also provides an opportunity to study the arterial structure, visualizes intra-wall lesions, deposits and thrombi, and determines the diameter of the ascending aorta in case of aneurysm and its localization.
• Aortography with contrast can determine changes in both the structure and functionality of the aorta. Injection of contrast agent allows to see wall bulging or narrowing, dissection.
• Combined CT and angiography (with contrast agent) clearly visualizes the artery, identifies aneurysms and pseudoaneurysms, and delineates the contours of dissections.
• MRI successfully visualizes the delineation of blood flow and the vascular wall, and the additional use of contrast allows to assess the diametric size of the pathological focus, its configuration and the extent of the lesion.

Differential diagnosis

A dissecting aneurysm of the ascending aorta has a number of symptoms that may also occur in other diseases, which requires a careful differential diagnosis:

• with osevere coronary syndrome, acute aortic valve insufficiency, pericarditis;
• with pulmonary embolism;
• with acute cerebral circulatory failure and cerebrovascular complications;
• with a thoracic aortic aneurysm;
• with acute pancreatitis, cholecystitis;
• with cystic masses or mediastinal tumors;
• with pleurisy, atherosclerotic embolism, myofascial pain syndrome.

Aneurysm dissection is an urgent condition that can lead to the death of the patient at any time. If the dissection affects all layers and the aorta ruptures, the person quickly loses a huge amount of blood. Lethality due to rupture can be up to 80%. It often happens that the diagnosis is made incorrectly, suspecting other diseases. Meanwhile, precious time is already lost. To prevent an unfavorable development of events, it is necessary to conduct a particularly careful differential diagnosis, taking into account all possible manifestations of pathology.

Treatment of the ascending aortic aneurysms

Treatment measures are supervised by doctors of cardiology and surgery. The therapy regimen for ascending aortic aneurysm is prescribed after all necessary diagnostic procedures. At an early stage of pathology and in the absence of a threat of dissection of the ascending aneurysm, conservative methods are practiced, and surgery is offered only in the presence of specific indications.

Surveillance tactics consists in systematic monitoring of the aneurysm condition. Every 6 months, diagnosis is repeated, noting dynamic changes in the aorta. In addition, supportive medical measures are prescribed:

• stabilization of blood pressure indicators (in case of excessive pressure use drugs-blockers of alpha-receptors or beta-receptors, or angiotensin-converting enzyme inhibitors - for example, Phentolamine, Bisoprolol, Captopril, etc.);
• optimization of cardiac activity (beta-receptor blockers - in particular, Propranolol - are used to stop signs of myocardial hypoxia, decrease its contractile activity);
• normalization of lipid parameters (use medications belonging to the category of statins - for example, Simvastatin, Atorvastatin, etc.).

The patient is necessarily pointed out the need for a healthy lifestyle, avoiding bad habits, correction of nutrition. Physiotherapeutic treatment is not indicated.

Medications

Drug therapy is prescribed before and after surgery or as part of conservative treatment. It usually involves the use of the following groups of pharmaceuticals:

• Statins - reduce the risks of myocardial ischemia and heart attack.
• Beta-blockers - prevent the occurrence of cardiovascular complications.
• Antiaggregants - improve blood flow, prevent clotting.
• Hypotensive drugs - normalize blood pressure, reduce the risk of rupture of the pathologically altered artery, reduce the likelihood of complications.

The approximate scheme of therapy looks like this:

• Clopidogrel - in the amount of 75 mg daily orally, for several months (at the discretion of the doctor). Prolonged use is usually well accepted by the body, in rare cases headache, dizziness, paresthesias may occur.
• Ticagrelor - 90 mg twice daily, orally, for several months.
• Acetylsalicylic acid - 100 mg daily orally for at least 12 months. Possible side effects include heartburn, abdominal pain, nausea, bronchospasms.
• Heparin - 5 thousand units 4 times a day subcutaneously or intravenously for 3-5 days. Treatment may be accompanied by transient thrombocytopenia.
• Dexamethasone - in the amount of 4 mg daily intravenously for 3-7 days (under control of blood pressure and blood picture).
• Cefazolin - in the amount of 2 thousand mg once intravenously (before surgical intervention). Before administering the drug, make sure that the patient is not allergic to it.
• Cefuroxime - in the amount of 1500 mg once intravenously (before surgery). It is important to check that the patient is not allergic to the drug.
• Ketoprofen - 100 mg for pain syndrome, intramuscularly.
• Diclofenac - 25 mg for pain syndrome, intramuscularly (preferably not more than 5-7 days in a row).

Herbal treatment

Folk remedies are not the best method of treatment for ascending aortic aneurysm. It is too serious and life-threatening a disease, so it is very risky to rely on medicinal plants and at the same time lose precious time in this situation.

Treatment should be prescribed only by a doctor, and it can be both conservative and surgical. If the medical specialist allows you to combine traditional therapy with folk methods, then in this case it is allowed to use herbs - for example, such as those that help strengthen the walls of the arteries, stabilize blood pressure, normalize the cholesterol level in the blood. Among such plants can be distinguished particularly effective:

• Jaundice lacfiole: a couple of tablespoons of crushed dry plant poured boiling water, insist for half an hour and filtered, take up to five times a day for 1-2 tbsp. Liters.
• Hawthorn: crushed berries in the amount of five tablespoons pour 600 ml of boiling water, insist under a lid for half an hour, filter and drink one glass three times a day half an hour before the main meals.
• Dill: dried plant in the amount of 1 tbsp. Pour 200 ml of boiling water, kept under a lid for 20 minutes, filtered and drink 100 ml three times a day before meals.
• Black elderberry: pour 2 tbsp. Of the plant 0.5 liters of boiling water, insist for half an hour, filter and drink one sip on an empty stomach daily.
• Plants St. John's wort and yarrow: drink tea on the basis of plants three times a day one cup.

In the process of folk treatment, it is necessary to regularly visit the doctor, monitor blood pressure and blood picture. Self-treatment and ignoring the prescriptions of doctors is not allowed.

Surgical treatment

Surgery may be performed routinely or as an emergency.

Indications for surgery are usually as follows:

• if the ascending segment of the aorta is dilated to five centimeters or more (the norm is up to 3 cm, and the risk of complications increases significantly with dilatation of more than 6 cm in diameter);
• if the ascending aorta dilates up to 5 centimeters in people with Marfan's disease or other hereditary pathologies that are considered risk factors for aneurysm development;
• if there's a dissection of the ascending aorta;
• if the expansion of the pathologic segment exceeds 3 mm per year;
• if there has been a family history of aneurysm rupture (there is an unfavorable hereditary factor);
• if the clinical picture is particularly intense and the patient's condition worsens;
• if there's an increased risk of compromising the integrity of the ascending aorta.

In addition to indications, there are contraindications to surgery:

• "fresh" myocardial infarction;
• a severe course of pulmonary deficit;
• severe renal and/or hepatic impairment;
• stage 3-4 cancer;
• acute infections or exacerbations of chronic pathologies, acute inflammatory diseases (temporary contraindications);
• acute phase of ischemic, hemorrhagic stroke.

Before the operation, the patient is prepared for the upcoming intervention: strengthen the immune system, treat chronic pathologies, which is necessary to prevent the development of postoperative complications. [7]

Surgery for aneurysm of the ascending aorta

Your doctor may recommend these types of surgeries for ascending aortic aneurysm:

• Open intervention according to the classical technique. Based on the localization of the problem area of the artery, an incision is made under general anesthesia, the pathologically altered segment is removed, replacing it with a prosthesis.
• Endovascular surgery. Using local anesthesia, a catheter is inserted into the artery, advancing it to the pathologically dilated area. Then a special endoprosthesis (metal frame, stent-graft) is inserted to strengthen the vascular wall and prevent its rupture.

At the preoperative stage, the patient is examined, consulted with an anesthesiologist. Obligatorily adjust the current treatment, temporarily withdraw from the drug regimen drugs that affect the processes of blood coagulation. Also prescribe a preventive course of antibiotics. It is also important to completely give up smoking and drinking alcoholic beverages. As described by statistics, the refusal of bad habits for 2 months halves the likelihood of complications. [8]

If the patient is noted to have a low hematocrit, a preoperative blood transfusion is indicated.

Open surgeries are divided into two categories: radical and palliative interventions. Radical surgery is performed to completely remove the pathologically altered section of the artery, while palliative surgery only reduces the risk of rupture and eliminates some symptoms of the disease. Radical techniques are used much more often and consist in excision of the damaged segment and installation of an alloprosthesis in its place. In the course of intervention, artificial circulatory equipment is used, shunts are formed to ensure blood supply to other organs and systems. In case of aneurysm of the ascending aorta, the thorax is opened by the technique of sternal dissection (longitudinal sternotomy), the artery is dissected by transverse incision. The pathologically altered part of the aorta is cut off, and the prosthesis is sutured to the distal segment of the artery and then to the proximal segment. If necessary, the aortic valves are prosthetized or repaired at the same time. If it is a saccular aneurysm, the use of an artificial circulation device is not required: the vessel is clamped, the lateral "sac" is cut off, and the lesion is sutured. [9]

In the practice of endovascular interventions, the pathological segment is not excised, but isolated from the circulatory system using a metal frame: blood passes through it without affecting the vascular wall. The cavity between the metal frame and the aneurysm wall is then filled with blood clots, followed by connective tissue replacement. In this case, the framework is something between a stent and an endoprosthesis, it is made on the basis of polytetrafluoroethylene. The stent-graft is inserted into the aortic vessel by catheterization under the control of X-ray equipment. In the aneurysm area, the stent is spread and connected to normal vessel segments above and below the problem area. [10]

Diet for ascending aortic aneurysm

Nutrition in ascending aortic aneurysm is an important factor in preventing the development of complications and preventing the progression of pathology. The diet should be balanced, without overeating. It is optimal to take food 5 times a day in small portions - for example, every 2.5 hours. The following products should be permanently "forgotten":

• coffee, chocolate, cocoa;
• pungent seasonings and spices;
• finished products containing preserving and optimizing additives;
• cheap low-grade products containing a lot of all sorts of "substitutes";
• deep-fried and smoked foods;
• fatty meat, lard, lard, sausages, margarine, any food with trans fats, mayonnaise.

Benefits will come from products such as:

• Vegetables and fruits: avocados, citrus fruits, apples, pomegranates, beets, carrots, pumpkin;
• cereal, beans;
• garlic, leeks, onions;
• berries: currants, raspberries, strawberries;
• greens;
• seafood, fish;
• nuts.

Mushrooms are also useful for aneurysms: it is believed that porcini and champignons contain ergothianin, which neutralizes free radicals and prevents the development of cardiovascular diseases. In addition, mushrooms are rich in protein and fiber, as well as iron, zinc, magnesium, selenium, phosphorus.

Prevention

There is no specific prevention of ascending aortic aneurysm. It is desirable to eliminate the negative impact of such factors as improper diet with a predominance of fatty and spicy foods, smoking, alcohol abuse, sedentary lifestyle, etc.

With regard to preventing rupture of an existing aneurysm, the recommendations are as follows:

• See a cardiologist systematically for follow-up;
• have regular diagnostic examinations;
• prevent the development of obesity;
• monitor blood pressure readings;
• avoid excessive physical activity, do not visit baths and saunas, do not travel by airplane;
• exclude all possible factors that influence the development of atherosclerosis.

It is imperative to keep under control the psychological state of the patient, since often the rupture of an aneurysm is provoked even by relatively small stressful situations.

Forecast

All patients with a diagnosed aneurysm should be hospitalized in a specialized cardiac surgical unit, where they are prescribed and administered medical treatment and the need for emergency surgical intervention is determined.

About 20% of patients with dissecting aneurysms die before they receive medical care. In the absence of therapeutic manipulation, the mortality rate is:

• about 2% per hour for the first 24 hours;
• about 30% for a week;
• up to 80% for two weeks;
• up to 90% for a year.

Lethality at the hospital level with therapeutic measures is estimated at approximately 30% for proximal dissection and 10% for distal dissection.

Survival rates for treated patients who survive the acute period of the disease are 40% at a decade and 60% at five years.

In general, the prognosis for life for patients with an ascending aneurysm depends on factors such as these:

• age of the patient (after 50 years of age the risk of death due to pathology increases);
• the root cause of aneurysm formation (patients die more often in genetically determined pathology);
• the size of the bulge and the dynamics of its development (the larger the aneurysm and the faster it grows, the greater the risk of rupture);
• presence of bad habits, other features (worsen the prognosis of the course of the pathology obesity, heavy physical labor, smoking);
• presence of other diseases (diabetes mellitus, hypertension, vascular pathologies).

Some people who are diagnosed with an aneurysm of the ascending aorta live for years and die of completely different causes. However, such cases are unfortunately few. A damaged artery can rupture almost at any second - during a fall, physical exertion, and so on. To increase the chances of a long life, patients are advised to systematically visit doctors for diagnosis, lead a healthy lifestyle, and if indicated, accept the help of surgeons.