Aortic aneurysm – limited saccular edema of the aortic wall or expansion of the entire aorta by more than one and a half times the norm. This pathology is the second most common aortic disease after atherosclerosis.
The main classification is the division of pathology according to the place of origin:
- aneurysm of the thoracic aorta;
- abdominal aneurysm.
Each of them is also divided into subdivisions that correspond to the anatomical characteristics of the aorta itself and the branches extending from it. It is on the basis of this classification that the tactics of managing the patient is largely built.
In addition, aneurysms differ due to:
- Atherosclerotic aortic aneurysm develops as a result of the breakdown of atherosclerotic plaques and sclerosis of the aortic wall; usually located in the abdominal aorta.
- Post-traumatic aortic aneurysm is a false aortic aneurysm, which develops as a result of the healing of the walls of the bruise that was formed when an aortic wall was wounded. The typical location is the aortic isthmus.
- Congenital diseases are caused by the presence of connective tissue diseases in the patient ( Marfan syndrome , fibromuscular dysplasia, etc.)
- Inflammatory aneurysms form a separate atherosclerotic cohort and are formed as a result of an excessive response of the body’s immune system to the atherosclerotic process in the aortic wall.
- Syphilitic aortic aneurysm develops in the tertiary period of syphilis ; located usually in the ascending part or the aortic arch.
There is a clinical classification:
- uncomplicated, proceeding almost imperceptibly with minimal symptoms;
- Complicated (rupture) – the most formidable course of the disease with a rupture of the aortic wall and the flow of blood into the abdominal or chest cavity. This type of aneurysm rarely ends with a positive outcome;
- dissecting aortic aneurysm develops as a result of a defect in its inner lining and separation of the wall by blood entering under pressure through the defect; bruising and intravascular canal. This channel can communicate with the true lumen of the aorta at several points. Stratification of the aortic wall is possible in any part of it, but more often over 5 cm from the aortic valve and immediately after the site of the left subclavian artery.
The clinical picture of the disease depends on the location of the aneurysm and the degree of expansion of the aortic wall. With the expansion of the aorta in the ascending part – aortic insufficiency is the main manifestation of the disease.
Symptoms of her 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;
- displacement of the larynx due to the transmission of the pulsation of the aneurysm to the bronchi, trachea and larynx;
- shortness of breath due to compression of the trachea and bronchi by aneurysm;
- patients occupy a forced position – lying on their side with their heads and shoulders raised high;
- possible compression of the lung with the development of pneumonia.
When the aneurysm is located in the descending part of the thoracic aorta, the following manifestations may occur:
- chest pain caused by stretching of the aortic nerve plexus; unlike angina , they are less intense, more prolonged and do not disappear after taking nitroglycerin;
- a violation of swallowing occurs when aneurysm squeezes the lower esophagus.
If the expansion of the aorta occurred in the abdominal part, then the detection most often becomes an accidental finding, since it did not give any symptoms. Sometimes you can still suspect the pathology of such manifestations:
- constant dull persistent pain often in the lower abdomen, lower back, not associated with movements of the body;
- feeling the patient pulsating or pulsating education in the abdomen;
- as the aneurysm increases, the pains sharply increase and begin to bear a burning, unbearable character.
Aneurysm rupture is accompanied by sharp intense pain with the development of shock from blood loss.
Special laboratory diagnosis of aneurysms do not require. However, using standard tests (general, biochemical blood tests), one can suspect the cause of the pathology (during inflammatory processes, ESR, leukocytes, C-reactive protein will be increased; with atherosclerotic – corresponding changes in the lipid spectrum and increased total cholesterol).
Instrumental diagnosis of an aortic aneurysm is performed using:
- X-ray of the chest;
- Echocardiography (ultrasound of the heart);
- Abdominal ultrasound;
- Computed tomography;
- Magnetic resonance imaging;
- Radiopaque angiography ( aortography );
- Intravascular ultrasound (rarely used due to the low availability of technology).
Specific treatment – only surgical – aortic prosthetics.
Today in World , the medical community considers it necessary to consider surgical treatment in the presence of an aneurysm with a diameter of 45-50 mm and at an aneurysm growth rate of more than 6 mm per year.
Drug therapy is used to reduce the risk of complications of aneurysms, that is, their ruptures and to improve the prognosis after surgery. Treatment in this case is aimed at comorbidities: hypertension, coronary heart disease, lung and kidney disease.
The most terrible complication is a sudden rupture with bleeding, usually into the pleural cavity or into the retroperitoneal space (rarely into the duodenum), which is capable of causing a fatal outcome.