Abdominal Aortic Aneurysm - Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Abdominal aortic aneurysm

An abdominal aortic aneurysm is a bulging or diffuse expansion of the wall of the aorta located in the peritoneum. The aorta is the largest vessel in the human body. Its diameter in the abdominal region ranges from 15 to 32 mm. Pathological expansion of the aorta can occur for a number of reasons, the main of which is atherosclerosis.

According to statistics, aneurysm of the abdominal aorta in men over 60 years old occurs in 2-5% of cases. In children, this pathology is less common and is predominantly congenital. In general, the prevalence of this disease is quite high. When opening an abdominal aortic aneurysm, it is diagnosed in people of both sexes in 0.6-1.6% of cases (for people over 55-60 years old). Moreover, the death of a person does not always occur precisely because of this defect in the aortic wall. But, despite this, doctors put abdominal aortic aneurysm in 15th place among the most common causes of death in the population.

The problem of the development of an aneurysm of the aorta of the abdominal cavity is quite acute in cardiology and in angiosurgery, since the disease threatens with serious complications, up to and including death. However, until the moment of rupture of the aneurysm, the person most often does not even suspect that he has such a problem. The fact is that the aneurysm does not give itself out in any way and can exist asymptomatically for several years. Rupture of the aneurysm most often ends in death, which even with timely hospitalization reaches 40%. In the postoperative period, this figure is 60% or more. Such high risks of death of patients determine the need for surgical removal of the aneurysm immediately after its detection.

Content:

• Classification
• What can provoke the development of a peritoneal aortic aneurysm?
• How does peritoneal aortic aneurysm manifest itself?
• Diagnostics
• Peritoneal aortic aneurysm treatment
• Disease prognosis

Classification

There are several classifications that consider different types of peritoneal aortic aneurysm, depending on its location, size, clinical course, etc.

At the location of the peritoneal aortic aneurysm, there may be:

• Suprarenal or total. This aneurysm is located above the location of the renal arteries.

• Infrarenal. This aneurysm is located in the aorta, below where the renal arteries branch off. As a rule, it is these abdominal aneurysms that are diagnosed in 95% of cases.

The size of the aortic aneurysm can be:

• Small - no more than 5 cm in diameter.
• Medium - no more than 7 cm in diameter.
• Large - more than 7 cm in diameter.
• Giant - much larger than the diameter of the vessel itself.

By its shape, an aneurysm located in the abdominal cavity can be of two types:

• Fusiform aneurysm. In this case, the wall of the aorta bulges out practically along its entire diameter.
• Saccular aneurysm. Such a bulge is located on one side of the aorta, at the site of its defect. In shape, it resembles a bag with a narrow neck and a wide bottom. This sac is filled with blood.
• Depending on the course of the disease, the peritoneal aortic aneurysm can be:

• Not complicated

• Complicated by rupture, thrombosis, or delamination

According to the structure of the wall of the protrusion, such aneurysms are distinguished as:

• A true aneurysm is one that is represented by the wall of the vessel itself.
• A pseudo-aneurysm is one that is represented by scar tissue. It replaces the normal tissue of the aorta after the defect has occurred.
• A dissecting aneurysm is a defect resulting from the dehiscence of the vascular wall, which is filled with blood.

What can provoke the development of a peritoneal aortic aneurysm?

Atherosclerosis all over the world is considered to be the leading cause of abdominal aortic aneurysm formation. Atherosclerotic vascular disease accounts for 80-90% of all cases.

Less commonly, various inflammatory processes act as the reasons for the formation of an aneurysm. A defect can occur against the background of pathogenic microorganisms (bacteria that cause syphilis, tuberculosis, salmonellosis, mycoplasmosis) entering the vessel wall. Rheumatic disease and nonspecific aortoarteritis sometimes act as etiological factors in the development of aneurysm.

Congenital diseases such as fibromuscular dysplasia and Marfan syndrome, as they progress, can provoke the formation of an aneurysm.

Sometimes the abdominal aorta suffers from traumatic effects on it from the outside. A person can receive such injuries during an angiography, during a vascular operation. The formation of an abdominal aortic aneurysm is not excluded when severe bruises are received in the abdomen or lower back.

There are risk factors that indirectly affect the formation of a defect in the vascular wall.

These include:

• Tobacco smoking. It was found that 75% of patients with diagnosed peritoneal aortic aneurysm are smokers. Moreover, the longer a person smokes and the more he smokes cigarettes per day, the higher the risk that he will develop this pathology.
• Belonging to the male sex and age over 55-60 years can also be attributed to risk factors for the development of this pathology.
• If an aortic aneurysm of the abdominal cavity was diagnosed in the next of kin, then the risks of its development increase 5 times.
• Against the background of HIV infection, the risk of fungal infection of the aortic wall increases with the subsequent formation of an aneurysm.
• Dangerous in this regard, transferred sepsis, when pathogenic microorganisms enter the blood.
• Additional risk factors are frequent stress, obesity, diabetes, unhealthy diet.
• Separately, it is worth noting race as a risk factor for aneurysm formation. It has been established that this pathology is most often diagnosed in representatives of the Caucasian race.
• Hypertensive disease, accompanied by hypertensive crises, contributes to the fact that the aortic wall will gradually wear out as a result of hyperextension. As a result, a defect may form on it, which is transformed into an aneurysm.

How does peritoneal aortic aneurysm manifest itself?

If the aneurysm has an uncomplicated course, then the person will in no way suspect that he has such a defect. This is the main insidiousness of the disease. An aneurysm can be detected by chance, during examination for the presence of other diseases.

If the aneurysm reaches a large size, then it can give itself out with aching and pulling pains, which are localized in the left side or in the stomach (mainly in its lower part). Such painful sensations are explained by the fact that the aneurysm begins to put pressure on the nerve roots of the organs located in the abdominal cavity. In this case, the pain can radiate to the back, lower back, groin. Sometimes it reaches peak values and resembles the pain that occurs against the background of acute pancreatitis or an attack of sciatica.

Often, an aneurysm of the abdominal aorta is disguised as diseases of the gastrointestinal tract. It can periodically manifest itself with heaviness and bloating, constipation, belching, nausea and even vomiting.

If the ureter is pinched by the aneurysm, then the patient has blood in the urine, and a variety of urinary disorders occur. Large protrusions can lead to displacement of the kidney.

The lower extremities suffer from the presence of an aortic aneurysm in the abdominal cavity. A person develops ischemic leg disease, which is expressed in trophic lesions of soft tissues and in intermittent claudication. It is necessary to pay attention to the cooling of the extremities, unjustified by external factors, to the numbness of the legs, accompanied by pain in the lumbar region.

Signs of ruptured aneurysm. Against the background of a ruptured abdominal aortic aneurysm, internal bleeding is very severe and often leads to the rapid death of the victim.

Three main symptoms that indicate a vascular catastrophe that has occurred:

• Severe abdominal and lumbar pains.
• Pronounced pulsation in the peritoneal region.
• A sharp drop in blood pressure is a collapse.

At the same time, the symptoms of massive internal bleeding increase very quickly. The person turns pale, cold sweat breaks through him, weakness instantly increases, the pulse is barely audible, shortness of breath joins. If such symptoms were noticed, then it is necessary to immediately call the ambulance brigade. Only in this case there is a chance to save a person's life.

Diagnostics

Sometimes it is possible to diagnose the existing defect during the examination of the patient with the help of palpation of the peritoneum. In this case, the doctor gropes for a painful and throbbing seal. Detection of such a formation requires an immediate and more thorough examination of the patient. Instrumental methods that allow to identify an aneurysm of the aorta of the abdominal cavity are as follows:

• Ultrasound of the abdominal aorta. In this case, you can see the protrusion, determine its exact location, diagnose atherosclerotic changes in the vascular wall and the presence of blood clots.
• CT and MRI of the peritoneum. These two methods make it possible to clarify the location of the aneurysm and provide information on whether the daughter aortic arteries have undergone pathological changes.
• If it is not possible to make an accurate diagnosis using ultrasound and MRI, then the patient is referred for angiography. In this case, a contrast agent is injected intravenously to him, which becomes visible under the influence of X-rays.
• An abdominal x-ray can be informative when calcium salts are deposited on the walls of the aneurysm. In this case, a characteristic darkening will appear on the picture.

Peritoneal aortic aneurysm treatment

It is impossible to get rid of an abdominal aortic aneurysm with the help of drugs. Nevertheless, doctors recommend their prophylactic intake in order to prevent the development of complications, and first of all, rupture of the aneurysm.

Therefore, until a person is operated on, the following medications may be prescribed:

• Drugs with cardiotropic activity - Recardium, Verapamil, Prestarium, etc.
• To prevent the formation of blood clots, Warfarin, Cardiomagnil, Clopidogrel, etc. can be prescribed.
• To normalize the level of cholesterol in the blood, it is recommended to take Atorvastatin and Rosuvastatin.

Other auxiliary drugs are drugs for the treatment of diabetes mellitus, NSAID drugs, antibiotics, antimycotics, etc. Their appointment depends on whether the patient has any concomitant pathologies.

As for the surgical intervention, until the person begins to develop complications of the aortic aneurysm, it can be performed routinely. The indication for its implementation is the presence of an aneurysm more than 5 cm in diameter. Emergency surgery is performed if a patient is admitted to the hospital with a ruptured aneurysm.

Both operations require general anesthesia. The patient is cut through the anterior wall of the peritoneum to gain access to the aorta. Then the surgeon puts clamps on the upper and lower parts of the aneurysm, excises the pathological area and replaces it with a prosthesis. The artificial vessel itself is a tube made of synthetic materials. It takes root well in the body and does not require replacement until the end of the patient's life. This is a complex, many hours operation, after which the patient is sent to intensive care.

High-tech surgical interventions include the endovascular stenting procedure. In this case, an abdominal incision is not required, and the stent itself is inserted inside the aorta, overlapping the existing defect from the inside. The stent enters the vessel through the femoral artery. The whole procedure is carried out under the control of X-ray television. This method is not widespread in Russia due to its high cost and the need to make a custom-made stent.

Disease prognosis

If an abdominal aortic aneurysm is left untreated, it threatens the development of serious complications that will definitely lead to the death of the patient. Here are the tough statistics: rupture of an aneurysm 5-9 cm in diameter occurs in 75% of patients within a year. If the size of the aneurysm does not reach 5 cm, then the risk of its rupture within a year decreases to 5%. Moreover, after the rupture of the aneurysm, 100% of patients die without medical assistance, and after the operation, no more than 10% of patients remain alive after the first two months.

If the operation is carried out as planned, then the five-year survival rate of such patients is about 70%, which is very encouraging for people with a diagnosed aneurysm.

The author of the article: Molchanov Sergey Nikolaevich | Cardiologist

Education: Diploma in "Cardiology" received at the PMGMU. I. M. Sechenov (2015). Here I completed my postgraduate studies and received a diploma "Cardiologist".