What is aortic aneurysm?
The aorta is the largest artery of the human body, starts from the heart (from the left ventricle specifically), permeates the chest and abdomen and reaches to the umbilical cord, where it is divided into the so -called iliac arteries (right and left). Its average normal diameter in the chest (thoracic aorta) is up to 28 mm, while in the abdomen (abdominal aorta) about 20 mm. When the diameter of an vessel exceeds the maximum normal diameter by 1.5 times then we talk about aneurysm. This is when the diameter of the thoracic aorta passes 4.5 cm (45 mm) and the abdominal aorta 3 cm (30 mm).
The majority of aneurysms are located in the abdominal aorta . These in turn are distinguished in supernatural when they start more central to the renal arteries, paranoia when they start just below the kidney arteries and subdivided when they start under the outbreak of the kidney arteries and between them and the aneurysm. The latter are all 95% of abdominal aortic aneurysms.
What are the risk factors for aortic aneurysm?
Aortic aneurysm is more common in men than in women. Also, the risk of occurrence increases with age . It is sufficient to mention, for example, that in men aged 65-80 years the percentage of those with abdominal aortic aneurysm is 2-5%. In women of the same age the percentage is up to 1%. Other important risk factor are smoking, unsecured arterial hypertension and a history of aneurysm in first -degree relatives. It is also important to note that patients with peripheral arterial disease or heart disease have an increased risk of aortic aneurysm.
What are the symptoms of aortic aneurysms?
Aortic aneurysms are mostly asymptomatic and are often discovered by accident when examinations are done for other reasons. Unfortunately, sometimes the aneurysm is perceived when it is ruptured, which can often be fatal to the patient. For this reason, simple ultrasound testing is recommended in people over 60 years.
Among the symptoms that patients may feel are a severe feeling of pulse in the abdomen , as well as abdominal pain Rarely, small fragments can be cut from the throbed wall of the aneurysm and symptoms of embolism in the small peripheral vessels causing the so -called "blue finger syndrome" where parts of the toes of the feet gain blue color and color. An extremely rare type of an aneurysm is the inflammatory anneurysm of the abdominal aorta , characterized by retroperitoneal fibrosis and can cause obstruction of urinctules with hydrover and pain.
is broken then we talk about aneurysm aneurysm rupture and the symptoms are usually dramatic with chest , back , waist or abdomen pain , depending on where the aneurysm is detected. Severe bleeding can lead to a sharp decline in pressure and rising heart rate, loss of consciousness and circulatory shock (circulatory shock) . The rupture of an aneurysm is associated with high mortality.
How is aortic aneurysms diagnosed?
Diagnosis and monitoring of abdominal aortic aneurysms is done with a simple ultrasound. If the diagnosis is made, then the examination can be framed with a color ultrasonic arteriography the well -known triplex with the examination of the arteries . When the prospect of defining a strategic treatment is arising, it is necessary to depict all the aorta, which is done with axial or magnetic angiography. This examination is also important for the exclusion of an accompanying chest aneurysm. Thoracic angiography is also done when the heart ultrasound expresses the suspicion of a thoracic aortic aneurysm. Finally, the ultrasound examination of the arteries, that is, the arteries that pass behind the knee, is also important, because it is known that about 50% of patients with aortic aneurysms have some kind of aneurysm in these arteries. The importance of detecting the aneurysm of the sinus arteries does not result from the risk of rupture, but of thrombotic obstruction with the risk of ischemia of the lower extremity and amputation.
What is the treatment of aortic aneurysms?
The main reason for the treatment of an aortic aneurysm is to avoid rupture that has very high mortality. Because the probability of rupture is directly linked to the size of the aneurysm, the indicator limits have been determined on the basis of it. The indication of surgery always occurs when the likelihood of complications of a surgery is less than the possibility of complications if the patient is not operated within a year, as long as he has a life expectancy of more than 2 years.
So when the thoracic aorta exceeds 6 cm in diameter and the abdominal aorta 5.5 cm in men and 5 cm in women there is an indication for treatment. Another indication for surgical treatment is the rapid increase in aortic diameter of 0.5 cm in six months, regardless of size. In the case of aneurysms with particular asymmetric morphology or pseudo -irritation that has an increased risk of rupture, treatment indicator can be put upon even before the aforementioned sizes.
Symptomatic aneurysms have an indication of immediate surgical treatment. An aneurysm of the common arteries over 3 cm needs surgical treatment, in this case the concomitant aneurysm of the abdominal aorta is also treated even if there is no indication.
Aortic aneurysm treatment is done both endovascular with stent and the classic open method (see treatments). The appropriate method depends on the morphology of the aneurysm, the general condition of the patient and his life expectancy. The vascular surgeon will advise and inform the patient of all methods with the corresponding advantages and disadvantages to choose the best possible method with the least complications and the best possible long -term results.