Aortic aneurysm: symptoms, what it is, treatment and diagnosis in an article by phlebologist Yu. A. Gustelev.

Aneurysm and aortic dissection

Symptoms of aneurysm and aortic dissection

Aortic aneurysms, which appear as a result of congenital, hereditary or transferred pathology and are not associated with dissection of the vascular wall, in most cases do not have obvious clinical signs and represent an incidental finding.
Large aneurysms may be accompanied by a feeling of fullness, dull pain in the back, and symptoms of compression of neighboring organs may occur.

A dissecting aortic aneurysm has a more vivid and characteristic clinical picture. When the internal aortic wall is torn, sharp pain occurs in the chest, back or lower back (depending on the location of the damage). This pain is short-lived, but can cause a reflex drop in blood pressure and fainting.

After some time, the patient begins to experience burning pain in the chest spreading to the arms, neck, under the shoulder blades, this pain cannot be relieved by nitroglycerin, a dry cough appears, a feeling of lack of oxygen, blood pressure drops, and collapse occurs.

If the dissection occurs in the lower parts of the aorta, then pain is noted in the lower back with irradiation to the pelvis and legs. If the dissection affects the mouth of the branches extending from the aorta, symptoms of circulatory disorders in the corresponding organs are observed.

Typically, at this stage, patients are hospitalized and undergo emergency surgery.

In case of complete rupture of the aortic wall, massive bleeding and terminal shock occurs. Unfortunately, more than 90% of such patients die.

Diagnostics

Initial aortic dissection can be determined using transthoracic or transesophageal echocardiography.

One of the most reliable methods for diagnosing the entire aorta is aortography. This method allows you to see in real time defects in the aortic walls, the secondary lumen and aneurysm cavity formed as a result of dissection. If the site of the tear is closed by a blood clot, then aortography may give a false negative result.

This deficiency can be corrected by performing a vascular contrast-enhanced computed tomography scan, which can be performed at K+31.

Treatment of aneurysm and aortic dissection

For a small aneurysm that does not bother the patient, it is enough to observe. Large aneurysms are subject to planned removal followed by aortic repair .

In the case of a dissecting aortic aneurysm, the patient is given morphine for pain relief to prevent painful shock and emergency surgical treatment is performed, which usually consists of excision of the affected area of the aorta and installation of a synthetic vascular prosthesis in its place.

After such severe operations, the K+31 Clinic helps you undergo a course of rehabilitation treatment. We keep health in focus and offer patients our active participation in the prevention of recurrent aortic dissection and the occurrence of aneurysms.

What is an aneurysm

A thoracic aortic aneurysm is an abnormal bulge on the walls of the artery, formed due to intense blood pressure on a weak area of the vessel. An aneurysm can be:

fusiform - has a convex shape, protrudes from both sides of the aorta;
saccular - a rounded formation that protrudes from one side of the vessel.

A small aneurysm does not pose a health threat. However, if it is present, you must be observed by a doctor so as not to miss the moment of disease progression.

Risk factors

The pathology has a number of risk factors, the presence of which significantly increases the likelihood of its development:

Male gender. According to statistics, thoracic aneurysm is diagnosed 14 times more often in men than in women.
Smoking. Specialists from the Moscow Regional Research Institute conducted mass screening diagnostics of patients with atherosclerosis and aneurysm. It turned out that 3/4 of the patients had a smoking history of more than 25 years.
Age over 55 years. During this period, the walls of blood vessels stop producing collagen and elastin, as a result of which they become thinner.
Hereditary predisposition. 14% of patients with thoracic aortic dissection have a similar pathology in close relatives.
Insufficient physical activity. A sedentary lifestyle provokes blood stagnation in the extremities and puts a serious strain on the cardiovascular system.
Obesity. Excess body weight negatively affects the functioning of the heart and vascular patency.
Increased blood cholesterol levels. Scientists have long proven that the human body does not need cholesterol coming from outside to function properly - the liver produces it in sufficient quantities.

Symptoms of aortic aneurysm

Unfortunately, the diagnosis of aortic aneurysm cannot always be established during the “cold period” (before complications develop), since this disease is usually asymptomatic. Most often, it is discovered accidentally during fluorography, ultrasound or tomography studies performed in connection with other diseases. Treatment of an aneurysm of the ascending aorta before complications develop is much safer for the patient, therefore, in the early diagnosis of an aortic aneurysm, routine medical examination is important.

It is worth noting that every hundredth patient who died suddenly dies from aortic dissection.

Complaints usually appear when the aneurysm begins to stratify or, enlarging, compresses surrounding organs and tissues. Pain or dysfunction of those organs located in the area of the aneurysm appears. At first, this is not of a bright nature and, therefore, does not alarm either the patient or the doctor.

However, the pain intensifies as these deadly complications of an aortic aneurysm develop—it is some of the most severe pain a person can experience. It is localized in the chest if the aneurysm is located in the ascending, descending sections or in its arch, or in the abdomen if it formed in the abdominal section. Characterized by severe weakness, pallor, and often the person loses consciousness.

Impaired blood supply to organs located in the area of aneurysm rupture or aortic dissection (brain or spinal cord, kidneys, intestines, upper or lower extremities) leads to loss of function of these organs, and a large volume of blood loss during aortic rupture represents the most serious danger. To save a life, minutes count. If early surgical treatment is not available, the first-day mortality rate for aortic dissection is 1% per hour (one person in a hundred dies every hour). Within the first 24 hours, 33% of patients die from aortic dissection, 50% of patients within 48 hours and 75% within two weeks. Only early surgical intervention makes it possible to save a significant proportion of patients.

Diagnostics

The first thing a patient needs to do is make an appointment with a therapist. He will conduct an examination, collect anamnesis and issue a referral to a specialist.

In 50% of cases, pathology is discovered accidentally during an X-ray examination of the lungs. In 70% of cases, the aneurysm is audible with a phonendoscope and manifests itself in the form of characteristic noise. The problem can also be identified during an ultrasound examination of the heart.

Specific methods for diagnosing an aneurysm are:

Magnetic resonance imaging;
CT scan;
angiography.

Based on the data obtained during the examination, the doctor decides on the most appropriate treatment method.

Potential Complications

The most common complication of the disease is rupture of a thoracic aortic aneurysm. In this case, blood flows freely into the chest, abdominal cavity, pericardium, and esophagus. This condition requires emergency hospitalization and surgery. A ruptured aneurysm in the thoracic aorta without medical assistance will invariably lead to the death of the patient.

Other complications of the pathology are:

Compression, erosion of adjacent structures;
Thromboembolism;
Coronary artery occlusion.

These conditions are deadly. The aneurysm itself is a favorable environment for the formation of blood clots, which under pressure from the bloodstream can break off at any time. If a blood clot enters the lungs, heart or brain, the patient has a more than 90% chance of death. That is why it is so important to consult a doctor at the first symptoms of the disease, who will conduct a diagnosis and select the correct treatment tactics.

Endovascular intervention

If the shape and location of the aneurysm are not critical, the endoprosthesis replacement technique is used. The operation proceeds as follows:

a puncture is made on the patient’s thigh, through which a conductor (narrow silicone tube) is inserted into the aorta;
A vascular prosthesis is inserted through a conductor into the damaged aorta, which is fixed to the normal parts of the vessel above and below the location of the aneurysm.

The intervention is classified as minimally invasive. It does not require abdominal access, making the operation much easier for the patient to tolerate. The rehabilitation period is 2-3 days. During the day after the operation, the patient is under the supervision of a doctor.

Forecast

If an aneurysm is detected, the patient needs constant monitoring by doctors. Even after surgery, it is necessary to undergo regular examinations to monitor the condition of the blood vessels. Today, no intervention provides a 100% guarantee that the aneurysm will not reappear in another part of the aorta. Therefore, you should take responsibility for your own health and not neglect regular visits to a specialist.

Statistics on aneurysm operations say that the mortality rate of patients six months after surgery and aortic replacement is 10-15%. Within 10 years from the date of surgery, this figure increases to 40%. This is due to the fact that most patients have concomitant chronic diseases.

In case of endovascular intervention, the prognosis is more favorable. The probability of complications and re-formation of an aneurysm is only 10%, while patient death occurs in only 2% of cases.

Reasons for development

A disease such as thoracic aortic aneurysm develops as a result of:

Atherosclerosis. It is this pathology that in 90% of cases is the cause of aneurysm formation;

Traumatic damage to a vessel. Occurs most often as a result of an accident, a fall from a great height, or a strong blow to the chest.
Congenital pathologies. When a patient has a systemic connective tissue disease, the walls of blood vessels are in a chronically inflamed state.
Complications after medical procedures. These include reconstructive operations on the aorta, cardiac catheterization and other interventions in the cardiovascular system.
Infectious diseases. An aneurysm can develop in patients with tuberculosis, sepsis, syphilis, osteomyelitis, and pericarditis.

Previously, the pathology was diagnosed mainly in patients over 50 years of age. However, every year the disease becomes younger. Already today, young people aged 25-30 years often turn to doctors when an examination reveals a thoracic aneurysm.

Prevention

There are no specific measures to prevent such pathology as thoracic aortic aneurysm. Doctors give general recommendations:

Complete cessation of smoking, including hookah and electronic cigarettes.

Complete abstinence from alcohol (the maximum allowed is 100g of medium-strength alcohol during the holidays).
Regular exercise. However, physical activity should be moderate. It is recommended to contact a rehabilitation therapist and exercise therapy specialist, who will select appropriate exercises based on the patient’s diagnosis, the presence of concomitant diseases and the current state of health.
Control of factors that can provoke a rise in blood pressure. These include stress, kidney pathologies, and prolonged exposure to the open air during the warm season.
Control of atherosclerosis. This pathology requires treatment, because it can lead to other serious complications in addition to the aneurysm.
Immediately consult a doctor in case of the slightest suspicion of malfunctions in the cardiovascular system, gastrointestinal tract or lungs. It is necessary to respond to the body's signals to prevent serious complications.

If an aortic aneurysm is already present, prevention consists of preventing the development of complications of the pathology:

Taking anticoagulants prescribed by a specialist. Such drugs are not cheap, but they are vital. They prevent the formation of blood clots in the lumen of the aneurysm.
Optimal physical activity. If the patient works in a position that involves heavy lifting or other physical labor, it is necessary to think about changing professions. Excessive force can cause rupture of the aortic wall.
Control of hypertension. It is necessary to take all medications prescribed by the doctor to avoid increasing blood flow pressure on the thinned wall of the aneurysm. The patient must be aware that it can rupture at any moment.
Control over psychological state. In medical practice, there have been cases where aortic rupture was caused by a minor stressful situation.

In order to monitor the condition of the cardiovascular system, it is necessary to visit a cardiologist annually. And do this not “for show,” but undergo a comprehensive examination. This way you can detect developing diseases in the early stages, which greatly increases the likelihood of successful treatment without incisions and pain. Take care of your health!