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What is a vessel aneurysm?

Aneurysm – local ( saccular) protrusion of the wall or diffuse ( circular, spindle-shaped) an increase in the lumen of the vessel several times as a result of structural disturbances during inflammatory processes, mechanical damage to the vessel, congenital and acquired pathologies ( Marfan syndrome, atherosclerosis, syphilis).

Aneurysms of the thoracic aorta are classified depending on its location, shape, etiology ( causes), clinical course and other factors. When formulating a diagnosis, classification is used to describe the pathology in more detail.

Causes of aortic aneurysm disease include:

• inflammatory etiology ( causes) – with syphilis, nonspecific aortoarteritis ( Takayasu's disease - an autoimmune inflammatory disease of the aorta and its branches), fungal infection and others;
• non-inflammatory etiology– for atherosclerosis, trauma, arterial hypertension;
• congenital– with Marfan syndrome ( hereditary connective tissue disease), coarctation ( congenital local narrowing of the lumen) aorta, hypoplasia ( underdevelopment of tissue or organ) and others.

An aortic aneurysm can be localized at any site - from the exit of the aorta from the left ventricle of the heart to its transition to the abdominal part of the aorta.

Depending on the location, there are:

• aortic sinus aneurysm ( sinuses of Valsalva);
• aortic sinus aneurysm ( sinuses of Valsalva) and ascending aorta ( cardio-aorta);
• aneurysm of the ascending aorta ( cardio-aorta);
• aneurysm of the ascending aorta and its arch;
• aortic arch aneurysm;
• aneurysm of the ascending aorta, arch and descending aorta;
• aneurysm of the arch and descending thoracic aorta;
• aneurysm of the descending aorta ( thoracoabdominal aneurysm).

According to the type of aneurysm, they are distinguished:

• True aneurysms ( aneurysma verum). With a true aneurysm, the expansion of the aortic lumen occurs due to thinning and protrusion of all three layers of the wall due to pathological changes in the structure. The aneurysm has a smooth expansion and its diameter is 50% or more greater than the diameter of the aorta.
• Pseudoaneurysms or false aneurysms ( aneurysma spurium). False aneurysms are not an expansion of the lumen of the vessel, but only create its “appearance”. Occur when the inner layer of the aortic wall is damaged. As a result, through the defect, blood flows out of the lumen of the vessel and accumulates in a capsule of connective tissue called a pulsating hematoma. It looks like a unilateral protrusion of the aortic wall.

According to the size of the aneurysm, there are:

• small– 4 – 5 centimeters in diameter;
• average– 5 – 7 centimeters in diameter;
• big- more than 7 centimeters.

According to the form they are distinguished:

• fusiform ( fusiformes) aneurysm– the section of the aorta is evenly expanded along its entire circumference;
• saccular ( saccular) aneurysm– protrusion of the aortic wall in the form of a sac, not exceeding half its diameter in size;
• dissecting aneurysms ( aneurysma dissecans) - characterized by the flow of blood between the internal ( tunica intima) and average ( tunica media) layers of the wall through the damaged inner shell, followed by delamination of the vessel.

Dissecting aneurysm is a very dangerous pathology. It can be an independent pathology or a complication of a true aneurysm. This process spreads along the length of the vessel and can lead to rupture of the outer layer of the wall ( tunica externa) within a few hours after aortic dissection. Rupture of an aortic aneurysm almost always leads to the death of the patient, regardless of timely surgical intervention. There are separate classifications for dissecting thoracic aortic aneurysm.

According to the DeBakey classification, aortic dissection is classified as:

• Type I– damage to the inner layer ( tunica intima) at the level of the ascending aorta ( cardio-aorta) with dissection of the wall to the level of the thoracic and abdominal aorta of the descending section;
• Type II– damage to the intima and dissection of the vessel wall in the ascending section ( cardio-aorta) or in the aortic arch, without involving the descending aorta in the process;
• III type– intimal tear and wall dissection affect the descending thoracic aorta, sometimes with the process spreading into the abdominal aorta or retrogradely in the arch and ascending aorta.

According to the Stanford classification, dissecting aortic aneurysms are:

• type A - proximal ( near) – dissection of the ascending aorta ( cardio-aorta);
• type B - distal ( remote) – dissection of the aortic arch and descending section.

According to the flow, dissecting aneurysms are:

• spicy– from several hours to several days ( 12 o'Clock in the noon) from the onset of the disease;
• subacute– from several days to several weeks ( 3 – 4 weeks) from the onset of the disease;
• chronic– several months from the onset of the disease.

Causes of aortic aneurysm

Many diseases, injuries and age-related changes can lead to changes in the structure of the aortic wall and its aneurysm. Etiological ( causal) factors and diseases are divided into two groups - congenital and acquired. Acquired diseases, in turn, are divided into diseases of inflammatory and non-inflammatory nature.

Congenital diseases include:

• Marfan syndrome. A genetic hereditary connective tissue disease that causes abnormalities of the eyes, bones, cardiovascular and skeletal systems. Manifested by chest deformation ( "chicken breast", depressed chest), abnormally long fingers ( arachnodactyly, "spider fingers"), hypermobility ( pathological increased mobility and flexibility) joints, long limbs, farsightedness or myopia and many others. Damage to the cardiovascular system is manifested by an aortic aneurysm ( more often the ascending part), aortic rupture, heart valve insufficiency, which in 90% of cases leads to death.
• Ehlers-Danlos syndrome type IV ( vascular type). A rare genetic systemic connective tissue disease caused by impaired collagen synthesis ( protein - the basis of connective tissue). There are several types of the disease, differing in symptoms and prevalence - vascular type, classical type, hypermobility type and others. The vascular type occurs in 1 person per 100,000 population. The disease manifests itself as bruising, hypermobility of the fingers and toes, pallor and thinning of the skin. As well as the fragility of the walls of blood vessels, which leads to aortic aneurysm and subsequent rupture.
• Loeys-Dietz syndrome. A hereditary genetic disease that most often affects the cardiovascular and skeletal systems. The pathology manifests itself as a triad - cleft palate ( cleft palate) or uvula, widely spaced eyes ( hypertelorism), aortic aneurysms. Other symptoms include scoliosis ( curvature of the spinal column), clubfoot ( deformation of the feet, in which they are turned inward), abnormal connection of the brain and spinal cord and others. Symptoms of damage to the cardiovascular system are similar to those of Marfan disease. But they are characterized by the development of aneurysms not only of the aorta, but also of small arteries, as well as earlier dissection and rupture of the aorta.
• Shereshevsky-Turner syndrome. Refers to chromosomal pathologies. In this syndrome, one X chromosome is missing from a pair of XX or XY chromosomes. More often the pathology occurs in females. Characterized by short stature, abnormal physique, barrel-shaped chest deformation, amenorrhea ( lack of menstrual cycle), underdevelopment of internal and external genital organs, infertility. About 75% of patients with Turner syndrome have pathologies of the cardiovascular system. Aortic aneurysm and aortic dissection are often diagnosed. Aortic dissection is 100 times more common in women with Turner syndrome compared to other women. Usually these are people aged 30–40 years.
• Arterial tortuosity syndrome. A rare genetic disease transmitted in an autosomal recessive manner, that is, when both parents are carriers of a defective gene. The vessels are affected - tortuosity, elongation, narrowing appear ( stenosis), aneurysm of the arteries, in particular the aorta. The connective tissue of the skin is affected ( excessive skin stretchability), skeleton ( chest deformation, pathological excessive joint mobility), facial features change ( elongation of the face, underdevelopment of the upper jaw, narrowing of the palpebral fissure). About 40% of patients die before the age of 5 years.
• A syndrome combining aneurysm and osteoarthritis. An inherited disease that causes joint abnormalities, aneurysm, and aortic dissection. Accounts for 2% of all hereditary aortic diseases. The patient has osteoarthritis - damage to the cartilage tissue of the surface of the joints. As well as osteochondritis dissecans or Koenig's disease - separation of part of the cartilage from the bone and displacement into the joint cavity. Excessive tortuosity of the vessel, aneurysms and dissection of the aorta appear in all its parts.
• Coarctation of the aorta. It is a congenital defect of the aorta, which is manifested by partial or complete narrowing of its lumen. The main symptoms are shortness of breath, weakness, pain in the heart, more developed upper half of the body, cold lower extremities and others. A complication of coarctation is an aneurysm ( protrusion of the walls) and bundle ( detachment of the inner membrane - intima) aorta.

Acquired diseases of inflammatory etiology include:

• Takayasu syndrome ( nonspecific aortoarteritis). This is a chronic inflammation of the walls of the aorta and its branches, followed by their narrowing ( stenosis). This syndrome can occur under other names - Takayasu's disease, nonspecific aortoarteritis, Takayasu's arteritis, aortic arch syndrome. The nature of the disease is autoimmune ( the immune system attacks the body's own cells), but recently the hypothesis of a genetic predisposition to the disease has become more relevant. In Takayasu syndrome, the aortic arch is most often affected. During inflammation, the inner surface of the vessel is damaged, and the inner and middle layers of the vessel thicken. The middle shell is destroyed and replaced by connective tissue with the appearance of granulomas ( connective tissue nodules). This leads to damage to the aortic wall in the form of stretching, bulging and thinning.
• Kawasaki syndrome. A rare inflammatory disease of arteries of various sizes. The disease most often manifests itself in children, aged from several months to five years. The disease develops when exposed to bacteria and viruses against the background of a genetic predisposition. Kawasaki syndrome is manifested by fever, swollen lymph nodes, loose stools, vomiting, heart pain and joint pain, skin rashes, inflammation of the outer membrane of the eyes ( conjunctivitis), redness of the mouth and throat ( enanthema) and other symptoms. One of the complications of this disease is an aortic aneurysm due to damage to the vessel wall by the inflammatory process.
• Adamantiadis-Behçet disease. The disease belongs to the group of systemic vasculitis ( inflammatory process in the walls of blood vessels). The disease is caused by viral and bacterial infections, toxins and autoimmune reactions. Heredity plays an important role. Patients develop ulcers in the genital area, oral mucosa, inflammation of the joints ( arthritis), inflammation of the mucous membrane and choroid of the eye, nausea, diarrhea and others. Vascular lesions manifest as stenosis ( narrowing of the lumen), thrombophlebitis ( thrombosis and inflammation of blood vessels) and aortic aneurysm.
• Specific and nonspecific aortitis. Aortitis is an inflammation of a separate layer or the entire thickness of the aortic wall, as a result of which the walls become thinner, stretched and perforated. This leads to a protrusion of the aortic wall - an aneurysm. Specific aortitis develops with certain diseases. These include syphilis ( venereal disease), tuberculosis ( infectious disease of the lungs, bones), rheumatoid arthritis ( inflammatory joint damage). Nonspecific aortitis appears after infectious diseases ( osteomyelitis, sepsis, bacterial endocarditis), fungal and allergic diseases.
• Gsell-Erdheim syndrome ( idiopathic cystic medial necrosis of the aorta). Rare disease of unknown etiology ( reasons for the appearance), in which the elastic frame of the middle shell is affected ( tunica media) walls of the aorta. Pathological changes occur in the middle shell, leading to tissue death - necrosis. Such a wall defect leads to dissection of the aorta in a limited area or throughout its entire length. Often the disease is complicated by aortic rupture localized above the aortic valves, in the aortic arch, in the area before the aortic bifurcation. The disease is more common in young and middle-aged males ( 40 – 60 years).

Acquired diseases of non-inflammatory etiology include:

• Atherosclerosis. Atherosclerosis is the main cause of aortic aneurysm. It is a chronic disease manifested by thickening of the vessel walls and narrowing of its lumen, which leads to disruption of the blood supply to organs. Calcium, cholesterol and other fats are deposited on the inner wall of the aorta in the form of plaque and plaque. The walls lose elasticity and become brittle and brittle. An aneurysm appears in the weakest and most stressed area of ​​the aorta.
• Arterial hypertension. Hypertension is a persistent increase in blood pressure ( above 140/90 millimeters of mercury). As blood pressure increases, the load on the vessel walls increases. A high risk of aortic aneurysm formation appears with prolonged arterial hypertension against the background of atherosclerosis, syphilis, Marfan syndrome and other diseases in which there are already defects in the vessel wall.
• Injuries. Chest injuries are dangerous because the consequences can appear much later. A thoracic aortic aneurysm can develop within twenty years after the injury. When hit in the chest area ( usually in a head-on collision in a car accident) various forces act on the relatively motionless parts of the aorta. This leads to displacement, compression of the vessel, and increased blood pressure. As a result, the integrity of the aortic wall is damaged, which gradually progresses into an aneurysm.
• Iatrogenesis. Iatrogenesis is the appearance of pathological processes in a patient unintentionally caused by the manipulations of medical personnel. In the case of the aorta, these may be various diagnostic procedures or surgical interventions. Damage to the aortic wall during these procedures may slowly progress to form an aneurysm. The risk is especially high in individuals with arterial hypertension, atherosclerosis and other diseases that cause pathological changes in the aortic wall.

The group at increased risk of developing an aortic aneurysm includes:

• people with a hereditary predisposition;
• men;
• persons over 60 years of age;
• hypertensive patients ( patients with high blood pressure);
• obese people;
• patients with diabetes;
• smokers;
• patients with a history of chest trauma ( medical history).

Symptoms of aortic aneurysm

Symptoms of an aortic aneurysm directly depend on its location, size and rate of progression. This is due to the fact that the aorta borders on various organs, which, when compressed, give a different clinical picture. The larger the size of the aneurysm, the more severe the symptoms will be. With the rapid progression of the pathology, the anatomical position and function of the organs will be dramatically impaired. As the aneurysm progresses slowly, the body begins to adapt to the disease to some extent. Symptoms will appear gradually and will not bother the patient much.
In this case, the aneurysm can be diagnosed at a late stage. Often, an end-stage aortic aneurysm ruptures into an adjacent hollow organ, chest or abdominal cavity.

Depending on the location of the aortic pathology, there are:

• symptoms of aortic sinus aneurysm;
• symptoms of aneurysm of the ascending aorta;
• symptoms of aortic arch aneurysm;
• symptoms of aneurysm of the descending aorta;
• symptoms of aneurysm of the thoracoabdominal aorta.

Dissecting aortic aneurysm deserves special attention, as it can reach enormous sizes in a fairly short period of time.

Symptoms of aortic sinus aneurysm

Damage to the aortic sinuses leads to insufficiency of the aortic valves or narrowing of the lumen of the coronary arteries that supply blood to the heart. These changes lead to the appearance of symptoms. Aortic valve insufficiency is characterized by its inability to prevent the backflow of blood from the aorta into the left ventricle of the heart during diastole ( relaxation of the muscles of the ventricles of the heart). This is expressed by an accelerated heartbeat, shortness of breath, pain in the heart area, dizziness, and short-term loss of consciousness. Stenosis ( narrowing) coronary arteries can lead to heart failure, coronary artery disease ( reduction of blood circulation in a certain area of ​​the organ) heart, myocardial infarction.

A small aneurysm usually goes unnoticed. Symptoms appear only if it breaks through into neighboring organs. Often, an aneurysm ruptures into the pulmonary trunk, a large blood vessel that runs from the right ventricle of the heart to the lungs. This manifests itself as chest pain, rapidly increasing shortness of breath, cyanosis ( bluishness of the skin), enlarged liver, edema, progressive left and right ventricular failure. A similar clinical picture is observed when an aortic aneurysm ruptures into the right side of the heart. Such complications lead to the rapid death of the patient.

Large aneurysms compress neighboring organs and vessels. When the pulmonary trunk, right atrium and right ventricle are compressed, subacute right ventricular failure develops. It manifests itself as swelling of the veins of the neck, enlargement of the liver and the development of edema of the lower extremities. Rapid progression of compression of the pulmonary trunk can lead to sudden death of the patient. In some cases, the aneurysm compresses the superior vena cava with the appearance of the so-called Stokes collar - swelling of the neck and head, swelling of the upper extremities and the area of ​​the shoulder blades.

Symptoms of an aneurysm of the ascending aorta

An aneurysm of the ascending aorta is distinguished by the fact that it does not lead to compression of organs and vessels and reaches a fairly large size. With this type of aneurysm, the patient may complain of dull chest pain, reflex shortness of breath, and in some cases atrophy ( exhaustion, decrease) ribs and sternum with protrusion of the chest area. When the superior vena cava is compressed, swelling of the head, neck, and arms occurs.

When an aneurysm ruptures into the superior vena cava, superior vena cava syndrome appears. The syndrome manifests itself as cyanosis ( cyanosis) skin, swelling of the face and neck, dilation of superficial veins on the face, neck, upper extremities. Some patients may experience coughing, difficulty swallowing, chest pain, esophageal and nosebleeds. Symptoms worsen when lying down, so patients take a forced semi-sitting position.

Symptoms of aortic arch aneurysm

An aortic arch aneurysm increasing in size compresses the trachea, bronchi and nerves, which is manifested by a variety of symptoms.

When the bronchi, trachea, and lungs are compressed, shortness of breath appears ( frequent, difficult breathing), which is more pronounced when inhaling. Hemoptysis may also occur, which usually precedes the rupture of an aneurysm. In severe cases, stridor breathing may occur - noisy wheezing. When the aneurysm is located in the terminal part of the aortic arch, compression of the left bronchus occurs. The left bronchus is narrower and longer, so when it is compressed, air will not flow into the lung. This may lead to a decline ( atelectasis) lung and the absence of gas exchange in it. This condition is manifested by pain in the area of ​​the collapsed lung, bluishness of the skin, shortness of breath, increased heart rate and arterial hypotension ( low blood pressure).

When the left inferior laryngeal nerve is compressed ( the right inferior laryngeal nerve is most often affected) the timbre of the voice changes, coughing and choking appear ( more often when inhaling). When the veins are compressed by an aneurysm, swelling and cyanosis appear ( cyanosis) face, swelling of neck veins.

An aortic arch aneurysm may be complicated by a rupture into the esophagus or trachea. First, hemoptysis appears, scanty vomiting with blood, and then profuse bleeding.

Symptoms of aneurysm of the descending aorta

The anatomical location of the aneurysm of the descending aorta leads to compression of the nerve roots, thoracic vertebral bodies, left lung and esophagus.

When the aneurysm puts pressure on the nerve roots, the patient experiences severe and excruciating pain in the corresponding parts that cannot be treated with painkillers. The thoracic vertebral bodies can become deformed and collapse under the constant pressure of aortic protrusion. In severe cases, this can lead to loss of voluntary movement of the lower extremities.

Collapse of the lung, pulmonary hemorrhage, development of pneumonia ( pneumonia) - all this is the result of compression of the lung by an aortic aneurysm.

When an aneurysm ruptures into the lung tissue, bronchus, or pleural cavity ( space between the lung and its membrane) hemoptysis, shortness of breath, cyanotic skin, and accumulation of blood in the pleural cavity appear.

Symptoms of aneurysm of the thoracoabdominal aorta

Thoracoabdominal aneurysm is rare. With this location of the pathology, the esophagus, stomach, and large blood vessels are affected. The patient will complain of difficulty swallowing, frequent belching, pain in the stomach, vomiting, and weight loss.

In case of compression of blood vessels ( celiac trunk, superior mesenteric artery) collaterals are formed - lateral bypass vessels that ensure normal blood supply to organs. Therefore, the internal organs will not suffer from a lack of oxygen and nutrients, but the patient will experience excruciating pressing pain in the abdominal area ( abdominal toad). If the aneurysm is large, the renal arteries are compressed, which can lead to a persistent increase in blood pressure.

Symptoms of dissecting aortic aneurysm

Symptoms of dissecting aortic aneurysm depend on the location, extent and size of the pathology. Dissecting aortic aneurysm may manifest as a large hematoma ( accumulation of blood), breakthrough of the aneurysm into the lumen of the vessel or into the surrounding space. Aortic rupture occurs without wall dissection.

A dissecting aneurysm appears suddenly and mimics the symptoms of neurological, cardiovascular and urological diseases. A sharp, unbearable, increasing pain appears along the course of aortic dissection, which spreads to various areas ( along the spine, behind the sternum, between the shoulder blades, in the lower back and others). The patient's blood pressure first increases and then decreases sharply. There is asymmetry of the pulse in the upper and lower extremities, severe weakness, cyanosis of the skin, and increased sweating. When the dissecting aneurysm is large, compression of the nerve roots, vessels, and neighboring organs occurs.

This appears:

• ischemia ( decreased blood supply) myocardium– pain, burning sensation in the heart area;
• ischemia of the brain or spinal cord– impaired consciousness in the form of fainting or coma, loss of sensation or movement in the lower extremities;
• compression of the mediastinal organs ( with dissecting aneurysm of the ascending aorta) – hoarseness, shortness of breath, superior vena cava syndrome and others;
• ischemia and compression of the abdominal organs ( with dissecting aneurysm of the descending aorta) – acute renal failure, hypertension, ischemia of the digestive organs and others.

When a dissecting aortic aneurysm ruptures, the patient's condition sharply worsens. There is severe weakness, loss of consciousness, pulse deficiency ( difference between heart rate and peripheral pulse). As well as a significant decrease in blood pressure, severe pain in the area of ​​the ruptured aortic aneurysm, impaired breathing and heartbeat.

Complications of aortic aneurysm

The aorta is the main largest vessel in the human body that carries blood from the heart. Large arteries branch off from the aorta and supply all organs. Therefore, the pathology of the aorta and its functional insufficiency leads to damage to other organs due to lack of oxygen and nutrients.

Complications of a thoracic aortic aneurysm are:

• cardiac, pulmonary, renal failure;
• aortic rupture;
• dissection of the aortic wall;
• blood clot formation.

According to statistics, up to 38% of patients die from complications of a thoracic aortic aneurysm within 3 years after diagnosis, and up to 58% of patients die within 5 years.

The main complications leading to death are:

• aneurysm rupture – 40% of deaths;
• heart failure – 35% of deaths;
• pulmonary failure – 15–25% of fatal cases.

Diagnosis of aortic aneurysm

Diagnosis of an aortic aneurysm begins with collecting an anamnesis - a history of the disease. The patient is asked in detail about complaints, the period of manifestation of symptoms and the duration of their course. Family history is also collected. The doctor asks about the diseases of the closest relatives. Much attention is paid to genetic diseases - Marfan syndrome, Turner syndrome, Loeys-Dietz syndrome and others. In some cases, genetic testing of patients is performed.

After the anamnesis, the doctor proceeds to examine the patient. Body type, appearance, presence of physical defects are assessed ( characteristic of genetic diseases), skin color, type of breathing ( presence of shortness of breath). Blood pressure is measured and an electrocardiogram is performed ( ECG) hearts. Most often there are no changes on the ECG. In some cases, there may be signs of myocardial infarction or angina. If there is an aortic aneurysm upon palpation ( palpation) a pulsating formation may be felt. On auscultation ( listening) vascular murmurs are heard.

The doctor may prescribe a number of laboratory tests - a general blood test and a biochemical blood test. The main attention is paid to the lipid profile ( analysis of blood lipid levels). Lipid levels allow you to assess the risk of developing atherosclerosis. The level of cholesterol, a fat-like structural component of cells, is examined. Low density lipids ( LDL - "bad" cholesterol) promote the formation of atherosclerotic plaques. High density lipids ( HDL – “good” cholesterol) prevent the formation of plaques. Blood sugar levels indicate the presence of diabetes.

All of the above methods for diagnosing a patient do not allow us to accurately diagnose an aortic aneurysm. To confirm or refute the diagnosis, the doctor prescribes instrumental methods for visualizing the aorta. This helps to study its structure in detail, detect defects, and determine the exact location and size of the aneurysm.

Instrumental methods for examining the aorta

Method	How is it carried out?	What symptoms does it reveal?
Radiography	X-rays are passed through the human body in the area being examined and projected onto special paper or film. Harder structures absorb more X-rays and appear lighter on film, while soft tissues appear darker.	Using X-rays, the contours and dimensions of the ascending and descending aorta are examined. When the aortic shadow expands and the contours of the mediastinum change, a diagnosis of aneurysm is made. Compression of surrounding organs is also typical. Therefore, an additional fluoroscopy may be prescribed ( projection of x-rays onto a screen) and radiography of the esophagus, stomach and duodenum.
Intravascular ultrasound (IVUS)	It's invasive ( with penetration into the human body) ultrasound method. A special conductor is inserted into the lumen of the aorta, at the end of which there is an ultrasound sensor. When ultrasonic waves pass through the walls of the aorta, they are reflected and captured by the sensor. The received data is converted into an image on the monitor screen. Image recording occurs throughout the entire study.	All three layers of the aortic wall reflect ultrasound waves differently due to different thicknesses and densities. This allows you to study the aortic wall layer by layer and obtain information about its thickness, shape and structure. Intravascular ultrasound can identify atherosclerotic plaques, blood clots, and damage to the aortic wall in the form of rupture or dissection. This research method is often used during surgery.
Echocardiography (transthoracic and transesophageal)	It is an ultrasound method for examining the heart and thoracic aorta. In transthoracic echocardiography, the transducer is placed on the patient's chest. The sensor emits ultrasonic waves and captures the reflected images and displays them on the screen. In transesophageal echocardiography, a transducer is inserted into the esophagus. The procedure is performed under general anesthesia.	This method allows you to study the structure of the aortic walls, identify their defect and determine the location and size of the aneurysm. It is safer and less invasive, unlike intravascular ultrasound ( IVUS).
Doppler ultrasound (USDG)	Combination of methods of ultrasound examination of blood vessels with Dopplerography. This method is based on the reflection of sound waves from a moving object ( moving red blood cells). The data is then processed by a computer and converted into an image on a monitor.	Doppler ultrasound allows you to determine the degree of damage to the aortic wall by sclerotic formations, the degree of narrowing ( stenosis) lumen of the vessel, damage and thinning of the walls of the aorta. Unlike other methods, it allows you to assess the nature of blood flow in the aorta.
CT scan (CT)	The research method is based on the passage of X-rays through the human body at different angles and from different points. The image is projected onto a computer monitor. The doctor can examine the anatomical structures layer by layer and from any angle.	This method allows you to study the structure of the aorta in detail, detect defects in the wall, determine the longitudinal and transverse diameter of the expansion and its exact location, identify parietal thrombi, calcification ( process of deposition of calcium salts).
Aortography	Aortography is a method of examining the aorta, based on the introduction of a contrast agent into the vessel and further visualization using an X-ray machine. Contrast agent ( cardiotrust, diodon) is inserted through a catheter ( phone) directly into the aorta or through large arteries - radial, brachial, carotid or femoral.	Aortography allows you to identify structural and functional changes in the aorta. When the aorta is filled with contrast, the lumen of the vessel will be clearly visible in the image. This will make it possible to diagnose wall protrusion, narrowing of the lumen, dissection of the aortic wall, since blood with contrast will flow between the layers of the vessel wall.
Computed tomography angiography (KTA)	This is a combination of computed tomography and angiography ( vessel examination using a contrast agent). Through a special catheter ( phone) a contrast agent is injected ( iodine preparations). Then X-rays are passed through. Contrast absorbs x-rays and allows the contours of the vessel to be more clearly distinguished from the background of surrounding soft tissue and bone.	The method allows one to clearly visualize the aorta and detect narrowing ( stenosis) of its lumen, protrusion of the wall into the lumen. It will also be possible to visualize a dissection of the aortic wall, a pseudoaneurysm, since blood with a contrast agent flows between the layers of the aortic wall. The boundaries of the delamination will be clearly visible in the image.
Digital subtraction angiography (CSA)	A method for examining a vessel using contrast and further computer processing. This method allows you to significantly reduce the dose of contrast agent. In the resulting image, the doctor can remove all structures that have no diagnostic value, leaving only the vasculature.	Allows you to identify structural defects of the aorta, protrusion of its wall, stenosis, and developmental anomalies.
Magnetic resonance imaging (MRI)	The principle of operation is the effect of electromagnetic waves on the atoms of hydrogen nuclei. The computer registers the electromagnetic response of atomic nuclei and converts it into an image of anatomical structures on the monitor.	Makes it possible to visualize the boundary between the blood flow and the vessel wall. This allows you to determine the diameter of the aortic expansion, its shape and degree. MRI is often performed using a contrast agent, which allows more clearly visualization of aortic pathology.
Assessment of pulse wave velocity and augmentation index	The ejection of blood from the left ventricle during systole increases pressure on the vascular wall, causing it to stretch. This pressure wave is called a pulse wave. The speed of propagation of pulse waves allows us to assess the stiffness of blood vessels. The lower the speed, the higher the degree of rigidity of the vessel wall. The speed of the pulse wave is determined by sensors located in the area of ​​the carotid and femoral arteries.	This method allows you to assess the degree of stiffness of the aortic wall. Structural changes in the aorta occur with age. As a result, its walls become fragile, which increases the risk of developing an aneurysm, rupture of the aortic wall, or pseudoaneurysm.

There are quite a few methods for instrumental examination of the aorta. Each of them has its own advantages and disadvantages, as well as contraindications. The doctor will select the necessary research methods individually for each patient. If necessary, several studies will be performed using contrast.

Treatment of aortic aneurysm

Aortic aneurysm is treated by a cardiologist and vascular surgeon. After the examinations, the doctor will determine the exact location, degree, and size of the aneurysm. This will affect the choice of treatment tactics and the future prognosis of life for the patient. Generally, the treatment of aortic aneurysm is surgical. But surgery is a complex treatment with many risks and complications. Therefore, it is carried out only in case of direct indications.

If there are no indications for surgical treatment, the doctor chooses watchful waiting and supportive drug treatment. Watchful waiting involves constant monitoring of a patient with a small aortic aneurysm. Once every six months, the patient must undergo diagnostic examinations to monitor changes in the aorta over time.

Maintenance drug treatment is aimed at eliminating the causes of the aneurysm and maintaining concomitant diseases in the compensation stage, that is, minimal negative impact of the pathology on the body. Also, drug treatment is aimed at reducing the effect of deforming force on the aortic walls by reducing blood pressure and contractile function of the heart.

The goal of maintenance drug therapy is:

• Blood pressure control. The optimal blood pressure values ​​for patients with concomitant diabetes mellitus and chronic kidney disease are 130/80 millimeters of mercury. For others, 140/90 millimeters of mercury is allowed. α-receptor blockers are used - prazosin, urapidil, phentolamine, β-receptor blockers - bisoprolol, metoprolol, nebivolol, angiotensin-converting enzyme inhibitors ( APF) - captopril, enalapril, lisinopril.
• Decreased contractility of the heart. Drugs from the group of β-receptor blockers are used ( atenolol, propranolol), which reduce myocardial contractility, its oxygen demand and heart rate.
• Normalization of lipid levels. Dyslipidemia ( lipid metabolism disorder) leads to atherosclerosis - deposition of cholesterol and lipoproteins ( complexes of proteins and fats) on the wall of the vessel. To normalize lipid levels, drugs from the statin group are used ( simvastatin, rosuvastatin, atorvastatin).

Patients with an aortic aneurysm should also change their usual lifestyle. It is necessary to stop smoking, as it provokes an acceleration of the expansion of the aortic aneurysm. Intense physical activity, stress and injury should be avoided.

When is surgery necessary for an aortic aneurysm?

Surgical treatment is divided into planned and emergency. Planned surgical intervention is performed when the size of the aortic aneurysm increases, in case of circulatory disorders, or in cases of severe symptoms. Preparing the patient for surgery can take from several days to a month. Usually, patients undergoing planned surgery are those who have been under the supervision of a doctor for a long time, periodically undergoing examinations and taking medication.

Emergency surgery is performed for life-saving reasons, regardless of concomitant diseases and the patient’s condition. Indications are the threat of rupture or dissection of the aorta, as well as a ruptured aneurysm. Preparation for the operation is carried out as quickly as possible. These may be necessary instrumental examinations, blood tests, blood group determinations, carried out directly in the operating room.

Before the operation, the patient will undergo the necessary instrumental examinations and laboratory tests. A consultation will be held with an anesthesiologist, cardiologist, cardiac surgeon, vascular surgeon, as well as other specialists in case of concomitant diseases. The anesthesiologist will select the type of anesthesia depending on the type of operation. After surgery, the patient expects a long recovery period and lifestyle changes. He will be registered with a cardiologist and periodically undergo instrumental examinations.

Indications for surgical treatment of aortic aneurysm are:

• expansion of the thoracic aorta more than 5 centimeters ( Normally the diameter does not exceed 3 centimeters), since the risk of aortic dissection or rupture increases significantly when its diameter is more than 6 centimeters for the ascending aorta and more than 7 centimeters for the descending aorta;
• expansion of the thoracic aorta up to 5 centimeters in patients with Marfan syndrome ( the risk of aortic rupture with a diameter of up to 6 centimeters in such patients is 4 times higher) and other genetic diseases that provoke the development of aneurysm;
• dissecting aortic aneurysm ( is the main cause of death and disability in patients);
• rapid growth rate of aneurysm ( more than 3 millimeters per year);
• patients with cases of ruptured aortic aneurysm in relatives;
• pronounced symptoms of aortic aneurysm;
• high risk of aneurysm rupture.

Contraindications for surgical treatment of aortic aneurysm ( the exception is life-threatening conditions) are:

• myocardial infarction ( less than 3 months);
• severe pulmonary insufficiency;
• renal, liver failure;
• final stage malignant neoplasms;
• acute cerebrovascular accident ( ischemic, hemorrhagic stroke);
• acute infectious diseases;
• chronic diseases in the acute stage;
• inflammatory processes.

To perform surgery, it is necessary to compensate for the patient's condition. Weakened immunity, organ failure and serious underlying medical conditions can lead to serious complications and death.

Surgical operations for aortic aneurysm are divided into:

• open– aortic replacement;
• endovascular ( intravascular) – installation of a stent graft ( cylindrical metal frame);
• hybrid– combined operations.

Aortic replacement

Aortic replacement is a surgical procedure in which a damaged section of the aorta is excised and replaced with a synthetic prosthesis. Refers to open operations. To access the aorta, an opening of the chest is performed - thoracotomy, an incision in the abdominal wall - laparotomy, or a combination of thoracotomy and laparotomy.

The advantage of this treatment method is:

• good visualization and the ability to correct all disorders caused by the aneurysm;
• treatment of aneurysm of any shape and size;
• higher reliability and long-term effect.

But the open method of surgery has many disadvantages, such as:

• difficult surgical access - the need to open the chest or abdominal wall;
• long-term anesthesia - from 2 to 6 hours;
• the need for artificial circulation and cooling of the patient;
• high risk of complications during and after surgery;
• the presence of a large number of contraindications;
• long recovery period;
• large post-operative scars.

The main techniques for aortic replacement include:

• Bentalla-De Bono operation– one-stage replacement of the aortic valve, aortic root and ascending aorta, which is used for pathology of the aortic valve and ascending aorta ( with Marfan syndrome);
• David's surgery– replacement of the ascending aorta while preserving the native aortic valve;
• Borst technique– simultaneous replacement of the ascending aorta, aortic arch and descending aorta ( "elephant's trunk").

After open surgery on the aorta, with a stable course, a dynamic study is carried out every six months during the first year after surgery. Then the interval between examinations can be increased at the discretion of the doctor.

Endovascular ( intravascular) operations

Endovascular surgery involves the introduction of a special frame - an endoprosthesis or stent graft - into the lumen of the affected area of ​​the aorta. It allows you to strengthen the aortic wall and make it more resistant to external factors ( high blood pressure). The aneurysm sac is left in place, but surgery prevents it from growing further.

Endovascular surgery is minimally invasive ( minor damage to the skin). Under local anesthesia into the vessel ( usually in the femoral artery) a special catheter is inserted ( phone). Under X-ray control, a stent is delivered through this catheter to the area of ​​the aorta with the aneurysm. A stent is a cylindrical metal frame that is inserted folded and deployed at the site of the aneurysm. The patient is discharged the next day after surgery. This method has more advantages over aortic replacement.

The advantages of this operation are:

• use of local anesthesia;
• low-traumatic operation;
• no need for artificial blood circulation;
• minimal blood loss during surgery;
• possibility of carrying out in case of severe concomitant diseases;
• minimal risks and complications;
• fast rehabilitation ( up to two weeks);
• minor pain after surgery.

The disadvantage is the need for repeated surgical interventions, less visualization, limitations in manipulation, and treatment of small aneurysms.

Hybrid operation

Hybrid surgery is a modern method of surgical treatment of aneurysms. It is used when several vessels are affected. Its essence lies in the simultaneous stenting of one vessel and bypassing of another.

Shunting is the creation of a shunt ( artificial branch), providing blood flow bypassing the affected area of ​​the vessel. The advantage of this method is that it is less traumatic and allows one to avoid extensive surgical intervention and multiple stenting.

Surgical treatment of thoracic aortic aneurysm

Aorta department	Types of surgical interventions	Peculiarities	Complications
Ascending aorta	supracoronary prosthetics; reconstruction of the aorta with supracoronary replacement; aortic replacement using the Bentall-De Bono method; aortic replacement about David's technique; aortic valve replacement; aneurysmorrhaphy ( longitudinal or transverse excision of protruding sections of the aorta with subsequent suturing of the wall); stenting; prosthetics using the Borst technique.	Pathological processes can affect not only the ascending section, but also the aortic valve. This creates problems during surgery, as the surgeon must temporarily stop the heart and provide cardiopulmonary bypass, while maintaining the blood supply to the heart.	The risk of complications depends on the duration of the operation and the duration of cross-clamping of the aorta. For example, the risk of paraplegia—paralysis of both limbs—depends on these parameters. Mortality during planned replacement of the ascending aorta is 1.6 – 4.8%. These indicators are influenced by age, gender, and concomitant diseases.
Aortic arch	complete prosthetics of the aortic arch using the “end to end”, “elephant trunk” type; prosthetics of part of the aortic arch; reconstructive surgery on the aortic arch; prosthetics or reconstruction of the aortic arch with replacement of the ascending aorta.	During the operation, it is necessary to provide nutrition to the brain, since it is from the aortic arch that the arteries that supply blood to the brain arise. More often, operations on the aortic arch are repeated after emergency interventions for dissecting aneurysm.	Mortality during operations on the ascending aorta and aortic arch is 2.4 – 3.0%. For patients under 55 years of age – 1.2%, and the risk of strokes ( acute cerebral circulatory disorder) – 0,6 – 1,2%.
Descending aorta	prosthetics of the descending aorta; stenting.	During the operation, various methods of bypass circulation and artificial circulation are used.	Surgical interventions on the thoracic aorta have common complications due to traumatic access, the need for artificial circulation, and large blood loss. This can lead to neurological failure and ischemia of internal organs.
Thoracoabdominal aorta	stenting; aortic replacement.	The peculiarity of the operation on the thoracoabdominal aorta is the access - opening the chest ( thoracotomy) and abdominal wall ( laparotomy).	Complications from the heart, lungs, kidneys, intestines. The risk of paraplegia after surgery on the thoracoabdominal aorta is 6–8%.

Postoperative period for aortic aneurysm

The postoperative period is a very important and crucial stage in the treatment of aortic aneurysm. And the further prognosis of the disease depends on how seriously the patient takes it.

The patient will stay in the hospital for several days. If the attending physician notes satisfactory and stable functioning of the cardiovascular and other body systems, the patient is discharged home.

• Moderate physical activity. It is necessary to maintain physical activity as much as the patient’s well-being allows after surgery. You need to start with a short walk, then move on to light physical exercises that do not lead to pain. Early physical activity prevents the formation of blood clots in the lower extremities, improves blood circulation in organs and tissues, and improves the function of the digestive system.
• Diet. In the first days after the operation, the patient will be prescribed diet No. 0, which is used during the patient’s rehabilitation. It includes rice broths, low-fat broths, compotes. Next, the patient must follow diet No. 10, prescribed for diseases of the cardiovascular system. It consists of limiting the consumption of liquid and salt, eliminating alcohol, fatty, fried foods. It is recommended to have more fruits, vegetables, light soups, and lean fish in the diet.
• Work and rest schedule. In the first few days after surgery, it is recommended to maintain bed rest and rest. After discharge from the hospital, do not drive or lift heavy objects for a month or more ( more than 10 kilograms), take a shower instead of a bath, and follow a daily routine.
• Drug treatment. Strict adherence to the doctor’s medication prescription is necessary, aimed at maintaining normal blood pressure levels, preventing blood clots, and improving blood circulation.
• Healthy lifestyle. The patient should quit smoking, lose excess weight, eliminate alcohol, and avoid stress. Also follow all doctor’s recommendations regarding physical activity, daily routine, and diet.

The patient should carefully monitor his well-being after surgery. If the temperature rises to 38ºC, pain will appear in the legs, back, pain in the wound area with discharge ( after open type surgery), then you need to urgently seek medical help.

After the operation, the doctor will explain the need and frequency of consultations and diagnostic procedures. This is necessary for dynamic monitoring and exclusion of postoperative complications. The frequency will depend on the type of surgery performed and the individual characteristics of the patient.

The complete recovery period lasts from several weeks to 2 - 3 months, which depends on the type of aneurysm and the extent of the operation. A healthy lifestyle and regular exercise play an important role.

Prognosis for aortic aneurysm

The prognosis for an aneurysm of the thoracic part of the aorta is determined by its size, the rate of its progression and concomitant diseases of the cardiovascular and other body systems. In the absence of timely diagnosis and treatment, the prognosis of an aortic aneurysm is unfavorable. But, thanks to modern surgical treatment, it is possible to save the lives of most patients. With planned surgical treatment of an aortic aneurysm, mortality is 0–5%, in the case of aneurysm rupture - up to 80% ( regardless of the urgency of the intervention). Within 5 years, the survival rate of operated patients is 80%, and of non-operated patients - 5 - 10%.

The main causes of death with aortic aneurysm are:

• aneurysm rupture ( 35 – 50% of cases);
• cardiac ischemia ( 35-40% of cases);
• strokes ( 20% of cases).

The threat of aneurysm rupture depends on the size of the aneurysm - dilation of the vessel more than 5 centimeters is considered life-threatening for the patient. Mortality in this case is 50% of cases during the first year. An extremely unfavorable prognosis in the first days of aneurysm dissection without surgical treatment. By the end of the second day, about 50% of patients die, by the end of the first week - 30%, and by the end of the second week only 20% of patients survive.

What is the difference between a thoracic aneurysm and an abdominal aortic aneurysm?

Aneurysms of the thoracic and abdominal aorta differ in symptoms, treatment, and complications. This is due to their anatomical location.

The main differences between abdominal and thoracic aortic aneurysms are:

• Frequency of the disease. Thoracic aortic aneurysm occurs in 6–10 cases per 100,000 people per year, the ratio of men to women is 2/1, 4/1. At autopsy it occurs in 0.7% of cases. Abdominal aortic aneurysms account for 80–95% of all diagnosed aneurysms. About 200,000 cases are reported annually worldwide. The ratio of men and women is 5/1, 10/1. Abdominal aortic aneurysm upon autopsy occurs in 0.6–1.6% of people ( 5 – 6% of cases in patients over 65 years of age).
• Anatomical structure and location. The thoracic aorta includes the ascending part, the aortic arch and the descending part. The thoracic part of the aorta closely borders on the organs - the heart, bronchi and lungs, and the esophagus. This leads to the appearance of varied and quickly manifested symptoms.
• Symptoms. Due to its anatomical features, thoracic aortic aneurysm has varied and pronounced symptoms. Shortness of breath, bluish skin, difficulty swallowing, pain in the heart, rapid heartbeat, swelling of the head and neck, and others appear. An abdominal aortic aneurysm can be asymptomatic for a long time until it ruptures. The main symptoms are pain and a feeling of pulsation in the abdomen, heartburn, constipation, difficulty urinating, lower back pain, numbness in the legs, impaired movement and sensitivity in the lower extremities.
• Complications. Due to its close location to vital organs, a thoracic aortic aneurysm can lead to serious organ complications and subsequent death. With an abdominal aortic aneurysm, the most serious complication is aortic rupture.
• Treatment. Aortic aneurysms of the thoracic and abdominal sections with small sizes are treated with medication. Surgical treatment has a number of features. Surgical treatment of a thoracic aortic aneurysm is much more difficult. This is due to access to the aorta - thoracotomy, that is, an opening of the chest wall, accompanied by a violation of the integrity of the ribs. When operating on the thoracic aorta, the surgeon is significantly limited in time, since the blood supply to vital organs is affected. Access to the abdominal aorta is obtained by making an incision in the abdominal wall - laparotomy.

How often does thoracic aortic rupture occur?

On average, an aortic aneurysm expands up to 2.5 millimeters per year. Aneurysms of the descending aorta grow faster ( up to 3 millimeters per year) compared to aneurysms of the ascending aorta ( 1 millimeter per year). There is a pattern - the larger the aneurysm, the faster it grows. So, with an aneurysm size of 4 centimeters - growth is 1 - 4 millimeters per year, with a size of 4 - 6 centimeters - growth is 4 - 5 millimeters per year, with large sizes - up to 8 millimeters per year. The faster an aneurysm grows, the higher the risk of developing aortic dissection and rupture, which can be fatal. In most cases, rupture of a fusiform aneurysm is more common than a saccular aneurysm. This is due to the accumulation of thrombotic formations in the saccular expansion, which strengthen the aortic wall.

Probability of aneurysm rupture given its diameter:

• less than 5 cm– risk less than 1%;
• more than 5 cm– risk more than 10%;
• more than 7 cm– risk more than 30%.

More often, an aortic aneurysm is asymptomatic and is accidentally detected during preventive diagnostics or for another disease. In this case, the patient will undergo a planned operation. But if the patient is unaware of his pathology, then the rupture of an aneurysm can become a life-threatening complication with a fatal outcome. This condition requires emergency surgery. Minutes count, since the aorta is the largest vessel in the human body and its rupture leads to rapid and voluminous blood loss.

The main signs of aortic rupture are:

• sudden intense pain in the chest or abdomen ( may spread to the area between the shoulder blades, jaw, neck, perineum, legs);
• headache - sharp, throbbing in the back of the head;
• severe weakness;
• nausea and repeated vomiting;
• disturbance of consciousness ( short-term or long-term, mild or comatose);
• thready pulse;
• low blood pressure;
• the presence of a rapidly growing hematoma ( collections of blood);
• hyperthermia ( elevated body temperature).

Aortic replacement is the main treatment for rupture. During the operation, the integrity of the vessel and blood flow are restored, as well as the volume of blood loss through blood transfusion ( human blood transfusion). After such an operation, there is a high risk of developing serious complications, since internal organs and tissues suffer from lack of blood circulation. This can lead to kidney, heart, and pulmonary failure, neurological complications, and tissue death. Despite the successful operation, complications can lead to the death of the patient some time after the intervention. Therefore, the fatal outcome after aortic rupture is quite high - only 10% of operated patients survive.

What to do to prevent aortic rupture?

It is easier to prevent a disease than to treat it. Aortic aneurysm is often asymptomatic and is detected incidentally during medical examinations or when complications occur. The risk of aortic rupture is individual in each case.

Among the causes of aortic rupture are:

• significant increase in blood pressure;
• pregnancy and childbirth;
• psycho-emotional overexcitation;
• heavy physical activity.

You should undergo preventive medical examinations annually, regardless of your health status. Consultation with a cardiologist and instrumental examinations are especially important for patients at risk ( with arterial hypertension, atherosclerosis, family history).

Patients diagnosed with an aortic aneurysm should undergo a thorough examination. The doctor must accurately determine the type of aneurysm, its location and size, and then select treatment. The risk of aortic rupture depends not only on the size of the aneurysm, but also on the patient's comorbidities and lifestyle. In the presence of an aneurysm, the best prevention of aortic rupture is surgical treatment. The doctor may suggest more gentle operations, such as aortic stenting and hybrid operations.

To prevent aortic rupture you should:

• see a cardiologist;
• periodically undergo instrumental examinations ( EchoCG, MRI, ultrasound);
• maintain normal weight;
• maintain blood pressure within normal limits;
• eliminate atherosclerosis factors ( high cholesterol, smoking, sedentary lifestyle);
• surgery ( especially patients with genetic diseases of the aorta);
• avoid heavy physical activity ( lifting weights, flying, going to the sauna, playing sports).

How to register a disability group for an aortic aneurysm?

Disability is determined by a medical commission for labor examination, consisting of doctors of various specialties, including a cardiologist. The family doctor handles the paperwork and referrals to the commission. During the examination, the patient’s ability to self-care and perform physical activity without harm to health is assessed.

During the examination, medication and even surgical treatment, there is no talk about determining the disability group. After diagnosing an aneurysm, the patient undergoes a full course of drug therapy for several months; if necessary, surgical removal of the aneurysm is performed with a long course of rehabilitation measures. And only after this, if the patient remains persistently impaired in the functioning of the body, does it make sense to refer the patient for a medical and social examination to determine the disability group.

When establishing disability, the following are taken into account:

• the patient has heart failure due to impaired blood flow due to an aneurysm;
• the presence of concomitant diseases that prevent surgical treatment and aggravate the patient’s condition ( diabetes mellitus, renal and hepatic pathology);
• the patient's age, profession and working conditions.

Heart failure is manifested by peripheral edema, shortness of breath during exercise, a feeling of increased heartbeat and interruptions in cardiac function. The degree of heart failure is determined based on patient complaints, as well as with the help of additional instrumental examinations - electrocardiography, echocardiography and others.

What are the features of thoracic aortic aneurysm during pregnancy?

Pregnancy is a serious test for a woman's body. At this time, chronic diseases may manifest or worsen, as well as new pathological conditions, in particular, aortic aneurysm. This is due to hormonal changes throughout the body - increased levels of estrogen and progesterone play an important pathological role in disrupting the structure and loss of elasticity of the aorta.

During pregnancy, the load on the initial parts of the aorta also increases, cardiac output of blood increases, with a subsequent increase in heart rate and circulating blood volume, especially in the last trimester of pregnancy.
All this can ultimately lead to the formation of an aortic aneurysm or expansion with dissection of an existing aneurysm.

The causes of aortic aneurysm during pregnancy do not differ from the main causes. These can also be congenital and acquired diseases. Of the congenital pathologies accompanied by the formation and dissection of the aorta, the most studied is Marfan syndrome ( congenital pathology of connective tissue), occurring with a frequency of 1/3000 – 1/5000.

The causes of acquired aortic aneurysm are:

• hereditary predisposition;
• injuries, road accidents;
• arterial hypertension;
• vascular atherosclerosis;
• syphilis in an advanced stage with a violation of the architectonics of the vascular wall;
• poor lifestyle of women, obesity, smoking.

Symptoms of an aneurysm in pregnant women often appear fairly quickly and depend on the location and size of the aneurysm.

With a thoracic aortic aneurysm, a pregnant woman may complain of:

• back pain, worse when inhaling;
• labored breathing;
• feeling of a lump in the throat with difficulty swallowing;
• snoring in your sleep.

An aneurysm of the abdominal aorta is characterized by:

• a feeling of numbness in the fingers and toes with chilliness due to poor circulation;
• pain in the abdomen and lower back;
• feeling of pulsation in the abdomen;
• fainting;
• surges in blood pressure.

For a pregnant woman with an aortic aneurysm, dangerous complications are:

• Ruptured aortic aneurysm. This is an extremely dangerous condition for a woman’s life. If the aneurysm is small, then the pregnant woman must follow a certain work and rest schedule and diet.
• High risk of thrombosis. This is due to a disruption of normal blood circulation in the aneurysm cavity. Blood clots can clog arteries and veins, and in some cases travel through the circulatory system and enter the heart valves, causing the heart to stop.
• Spontaneous abortion. Termination of pregnancy can be caused by insufficient blood circulation to the fetus due to compression of blood vessels by an aneurysm.
• Placental abruption followed by severe uterine bleeding. This complication often leads to the death of the fetus and mother.

There are no specific methods for studying aortic aneurysm during pregnancy.

According to vital indications the following is carried out:

• chest x-ray;
• computed tomography with contrast ( administration of a contrast agent intravenously), allowing to trace the accumulation of contrast in the aneurysm;
• aortography with contrast;
• Ultrasound of the abdominal and thoracic cavity.

Depending on the size and location of the aneurysm, various treatment methods are used. If a large aneurysm is detected with a risk of rupture, then doctors resort to urgent surgical intervention. A woman is forced to give birth prematurely or undergo a cesarean section, so removing an aneurysm while the fetus is in the womb is very dangerous. If the aneurysm is small and there is no threat of rupture, then its removal is postponed until delivery. After the birth of a child, the woman must undergo surgery to prevent the growth and rupture of the aneurysm.

The basis for preventing the formation of an aneurysm is timely medical monitoring of blood pressure, the coagulation and anticoagulation systems of the body, as well as maintaining a healthy lifestyle with proper nutrition and moderate physical activity.

In medical practice, there are rarely cases of aortic aneurysm during pregnancy with the ensuing serious complications.

Is aortic aneurysm common in children?

Aortic aneurysm in children is extremely rare. It can develop in the womb or appear after birth. For children, the location of the aneurysm is typical at the bend of the aorta. The main cause of protrusion of the aortic wall is genetic diseases and congenital defects of the aorta.

Aortic aneurysm in children is caused by:

• Marfan syndrome;
• Ehlers-Danlos syndrome;
• Turner syndrome;
• Loeys-Dietz syndrome;
• congenital disorder of connective tissue formation ( gene defect, magnesium deficiency, collagen deficiency);
• coarctation of the aorta;
• arterial tortuosity syndrome;
• Kawasaki syndrome.

Diseases such as syphilis, arterial hypertension, and atherosclerosis are very rare in children. Therefore, these pathologies are rarely the cause of aortic aneurysm. Also, sports injuries and injuries after an accident can lead to damage to the aortic wall and its aneurysm.

The symptoms of aortic aneurysm in children do not differ from those in adults. This is a cough, hoarseness, difficulty breathing, pain in the chest area with irradiation ( return) in the back. The difficulty in diagnosing an aneurysm in children is that the child cannot always explain what is bothering him. This is especially true for newborns.
Diagnosis of aortic aneurysm in children consists of genetic and instrumental examination ( x-ray, MRI, CT, ultrasound, echocardiography).

Treatment of aortic aneurysm in children is usually surgical. The dilated section of the aorta is cut out and replaced with a prosthesis. After the operation there is a long rehabilitation period and regular preventive examination by a doctor. Life prognosis for aortic aneurysm ( even after her surgical treatment) is often unfavorable. This is due to severe concomitant pathologies ( heart valve insufficiency, heart and aortic defects, collagen deficiency) and complications ( aortic rupture).

Is it possible to treat an aortic aneurysm using traditional methods?

Aortic aneurysm cannot be treated with traditional methods. This is a very serious and dangerous disease. In advanced cases, the aneurysm ruptures with severe bleeding, leading to death in 90% of cases. The disease is asymptomatic for a long time and is often an incidental finding on ultrasound and MRI examination of the abdominal and thoracic cavity.

The doctor selects treatment tactics individually for each patient. Treatment can be surgical or drug-only, depending on the size and location of the aneurysm, as well as the risk of complications. In any case, supportive drug therapy is prescribed, which can be combined with traditional medicine. But you should not self-medicate and before using folk remedies, you should definitely consult with your doctor.

Medicinal herbs are used to strengthen the vascular wall, regulate blood pressure, and reduce cholesterol levels.

These include:

• infusion of jaundice levkoy– 2 tablespoons of dry herb, pour a glass of boiling water, leave for 30 minutes and strain, take 4-5 times a day, 1 tablespoon;
• hawthorn infusion- 4 tablespoons of dried and crushed fruits, pour 3 cups of boiling water, leave for 30 minutes, strain and drink 200 milliliters three times a day before meals;
• dill infusion - Pour 1 tablespoon of dry herb into 1 cup of boiling water, leave for 15-20 minutes, strain and take 1/3 cup 3 times a day before meals;
• infusion of Siberian elderberry - Pour 1 tablespoon with 200 milliliters of boiling water, leave for 30 minutes, strain and take 1 tablespoon once a day;
• decoction of yarrow, St. John's wort and mountain arnica– dry the leaves of yarrow, St. John's wort and arnica in a ratio of 4/3/1, grind and pour 200 milliliters of cold water for 4 hours, then cook for 5 minutes, cool, strain and take 3 times a day in equal portions.

During treatment with folk remedies, it is important to monitor the general condition, monitor blood pressure and blood sugar levels. Do not be mistaken that medicinal herbs can replace pills.

Can you fly on an airplane if you have an aortic aneurysm?

If you have a thoracic aortic aneurysm, air travel is contraindicated. When flying, the body experiences increased stress. Thus, during takeoff and landing, significant pressure drops occur, which negatively affect the functioning of blood vessels and the heart. In addition to physiological blood pressure, other forces act on the vessels. Healthy vessels are able to withstand this pressure, since their anatomical structure allows them to stretch under the influence of external forces and then return to their normal state. In case of thinning of the vessel wall, atherosclerosis, loss of elasticity, existing aneurysm, or arterial hypertension, a rupture may occur in this area. Therefore, it is extremely dangerous for patients with aortic aneurysm to fly on airplanes. This does not depend on the size and type of aneurysm, since aneurysm rupture can occur even if it is small.

With an aortic aneurysm, blood clots can form. They can be attached to the vessel wall and not disturb the patient. But during a flight under pressure, a blood clot can break off and be carried through the bloodstream throughout the human body. This is extremely dangerous as it can lead to pulmonary embolism ( blockage of a blood vessel by a thrombus), ischemic stroke ( acute cerebral circulatory disorder due to blockage of a vessel by a thrombus) and death. A long flight, immobility, a sitting position, and pressure changes lead to a narrowing of blood vessels in the lower extremities, slowing blood flow and increasing blood viscosity. All this significantly increases the risk of thrombosis.

Also, as you rise to altitude, atmospheric pressure drops, which leads to a decrease in the oxygen concentration in the aircraft. For people with a diseased heart and blood vessels, this is extremely dangerous, as it can lead to a heart attack. Such patients require an additional source of oxygen. But due to the explosive nature of oxygen, not all aircraft allow oxygen on board.

During an air flight, it is impossible to provide the patient with the necessary medical care. Especially in critical conditions requiring immediate surgical intervention ( ruptured aortic aneurysm). This may lead to the death of the patient.

Before flying, a patient with an aortic aneurysm or cardiovascular disease should:

• consult a cardiologist;
• undergo instrumental examinations;
• carry out the necessary medical treatment;
• read the airline rules ( find out what medications you can take with you, whether you are allowed to take oxygen on board the plane).

Air travel can be dangerous for patients:

• recently suffered a stroke or myocardial infarction ( less than six months);
• with a medium and large aortic aneurysm;
• with dissecting aneurysm ( increased pressure contributes to even greater stratification of the vessel wall);
• with an increased risk of aneurysm formation, blood clots;
• with a risk of aneurysm rupture;
• with arterial hypertension;
• with heart disease;
• after surgery on the aorta or heart ( the period after surgery is less than a month or six months, depending on the operation).

To minimize the negative impact of air travel, you should:

• try to move more ( get up every 30 minutes and do leg exercises);
• provide additional oxygen inhalations;
• take medications to reduce anxiety, blood pressure, to prevent blood clots, and others.

How long do people live with an aortic aneurysm?

It is impossible to unequivocally answer the question about life expectancy with an aortic aneurysm. An aortic aneurysm is called a “ticking time bomb.” In any case, without appropriate monitoring and treatment, the prognosis is poor.

Not all patients are diagnosed with an aortic aneurysm on time. In this case, an aneurysm can develop asymptomatically for a long time. The patient, unaware of his illness, continues to smoke, work physically hard, and does not monitor his blood pressure. This causes the aortic wall to bulge in size and increase the risk of rupture and death for the patient. Also, not all patients can undergo surgical treatment.
This is due to the general condition and severe concomitant diseases, in which the patient may not survive anesthesia and surgery.

Aortic rupture and dissection can occur at any time, regardless of the size and location of the aneurysm. Survival rate in such cases is low - from 20% to 50% of patients.

After a diagnosis of aortic aneurysm is made, the life expectancy of patients depends on:

• Patient's age. Patients under 50 years of age have fewer concomitant diseases, but at the same time, they are more susceptible to stress and heavy physical activity.
• Causes of aortic aneurysm. With genetic diseases of the aorta, life expectancy is short, since genetic diseases are often accompanied by complications incompatible with life and lack of treatment. After chest trauma, it is possible for decades to develop a thoracic aortic aneurysm. In hypertension and atherosclerosis, the aneurysm progresses in proportion to the progression of these diseases. Life expectancy in these cases depends on compensation of diseases.
• The size of the aneurysm and the rate of its increase. Larger aneurysms increase the risk of rupture. Also, the rapid progression of an aneurysm can lead to complications that are incompatible with life.
• Lifestyle and bad habits. Excess weight, heavy physical activity ( some sports, weight lifting), smoking leads to accelerated development of aortic aneurysm. For example, smoking increases the growth rate of an aortic aneurysm by up to 35 millimeters per year.
• Concomitant diseases. Diabetes mellitus, arterial hypertension, atherosclerosis and other diseases that cause pathological changes in the vessel wall significantly accelerate the development of aortic aneurysm.
• Supportive treatment and regular medical examinations. The patient's life expectancy significantly depends on treatment and monitoring. This way, the doctor can detect an aortic aneurysm at the earliest stage of its development and delay the time of surgical treatment for many years thanks to supportive drug treatment and correction of the patient’s lifestyle. Regular medical examinations will also help prevent dangerous complications such as aortic rupture and aortic dissection.

Under certain conditions, you can live with an aortic aneurysm for years. But the percentage of such people is very small. In 7% of deceased patients, an aortic aneurysm is found, which is not the cause of death. Any time ( in case of impact, car accident, physical stress) aortic rupture may occur, followed by death. To increase life expectancy, it is necessary to undergo regular examinations, maintain a correct lifestyle and undergo surgical treatment on time ( also for preventive purposes).

A dissecting aortic aneurysm is a damage to the inner lining of the enlarged aorta, which is accompanied by the appearance of hematomas and a false opening. This disease is characterized by longitudinal separation of the aortic walls of varying lengths. In medicine, this pathology is often called a more abbreviated version - “aortic dissection.”

Often, the aorta can dissect in the most hemodynamically weak areas, which include the area of ​​the ascending aorta, the aortic arch and the descending zone. In cardiology, an aneurysm is one of the group of severe pathologies that can cause significant inconvenience and threaten a person’s life. If you do not consult a doctor in a timely manner, the patient may experience bleeding from aortic rupture or acute ischemia.

As a rule, the disease develops in older people over 60 years of age. Doctors diagnose pathology more often in men than in women. The larger a person's aneurysm, the more progressively it enlarges and the chances of it rupturing increase. Accordingly, the risk of rupture increases with the size of the aneurysm, which can be several times larger than the normal diameter of the aortic lumen.

Etiology

Aneurysm dissection can occur for a variety of reasons. The main factor leading to the development of the disease is damage to the walls. With this pathology, specific plaques begin to form in the human aorta, which can serve as a provoking factor. These tumors are composed of cholesterol, calcium and fibrous tissue. With the progression of atherosclerosis, the number of plaques increases, which leads to a decrease in the lumen in the vessel. As a result, the walls lose their elasticity and become weaker. Clinicians also identify other factors leading to dissecting aortic aneurysm:

• excess weight;
• heredity;
• elevated blood pressure;
• nicotine consumption.

Pathology can develop under the influence of various other diseases. People with the following diseases may have a high chance of developing an aneurysm:

Quite rarely, the disease is diagnosed due to mechanical damage.

Classification

Classification of the disease consists in determining the types of the disease according to the characteristics of the course and the localization of the disease. According to the first criterion, doctors identified a rather conventional systematization, which is divided into the following forms:

• chronic – can last for months;
• subacute – the process lasts about 4 weeks;
• acute - death occurs a couple of hours after the exacerbation.

According to the location of the disease, the classification of the disease consists of 3 types:

• Type 1 – dissection occurs in the area of ​​the ascending aorta, and smoothly passes to the thoracic and abdominal region;
• Type 2 – damage is localized exclusively in the ascending section;
• Type 3 – from the descending zone the lesion moves to the area of ​​the abdominal aorta.

Symptoms

In the development of the clinical picture of pathology, doctors distinguish two stages of formation. With dissecting aortic aneurysm at the initial stage, the disease manifests itself in the three above-mentioned forms of the disease - acute, subacute, chronic.

During an acute attack of wall dissection, the patient is overcome by the following symptoms:

Dissecting aortic aneurysm is a disease that quickly subsides, but can provoke a reflex decrease in blood pressure and fainting. After a while, the patient begins to experience severe burning pain in the sternum, arms, neck, and shoulder blades. During moments of exacerbation, the patient also exhibits other symptoms: dry cough, feeling of lack of air, decreased blood pressure, collapse.

Diagnostics

The development of aortic disease with wall dissection can only be determined by instrumental examination. To accurately determine the cause of the development of pathology, the patient is prescribed to undergo research using such methods;

• radiography;
• tomography;
• angiography.

Thanks to an examination using an ECG, the doctor can rule out myocardial ischemia, which also provokes pain in the chest. X-ray helps to identify sudden changes in the structure of the vessel - an increase in the lumen and upper mediastinum, changes in contours, the presence of pleural effusion, a decrease in the pulse in the dilated part.

The patient is prescribed constant monitoring of blood pressure, diuresis and monitoring of ECG changes. To determine the dynamics of aneurysm progression and the presence of fluid in the pericardium and pleural cavities, the patient undergoes radiography.

It is important to perform tomography to identify intramural hematoma and penetration of atherosclerotic ulcers of the thoracic aorta.

In diagnosing the disease, it is also important to conduct a differential examination and distinguish a dissecting aneurysm from the following ailments:

• occlusion of mesenteric vessels;
• spicy ;
• aorta;
• without delamination of walls;
• mediastinal tumor.

Treatment

If a patient has been diagnosed with an abdominal or thoracic aortic aneurysm, he is prescribed therapy depending on the type of dissection and the presence of consequences.

Drug therapy is used in the treatment of various forms of aneurysms. Medicines are the initial stage of eliminating the symptoms and causes of the disease. The patient is then scheduled for aortography and surgery.

Treatment with medications is based on the following goals:

• prevention of the development of further aortic dissection;
• normalization of hemodynamics and homeostasis;
• decrease in blood pressure indicators.

Doctors prescribe treatment of pathology with drugs from the following groups - beta-blockers, calcium antagonists, ACE inhibitors, nitroglycerin.

If conservative treatment turns out to be ineffective, then the patient is prescribed surgical intervention. It is based on resection of the affected area of ​​the aorta, eliminating the false lumen and restoring the damaged parts of the aorta. To achieve these goals, doctors use prosthetics or remove the defective area and stitch the ends of the healthy aorta.

Emergency surgical care is needed only for those patients who are at risk of aortic rupture - with severe vascular insufficiency, progressive dissection, with a saccular aneurysm, with ineffective therapy with conservative methods. Urgent surgical care is also provided if the patient has a hemorrhage in the pericardium or pleural cavity.

Often such operations are performed using artificial circulation. After surgical treatment, the patient begins the stage of rehabilitation in the hospital.

Complications

Complications can develop if a dissecting aortic aneurysm develops too quickly or the patient seeks medical attention too late. The most common consequences of the disease include such pathologies as myocardial infarction, stroke, and often aneurysm rupture and death.

Forecast

For people with this diagnosis, the outcome may be poor. A significant proportion of patients die during surgery or during the recovery period. Doctors have found that with emergency treatment of an acute aneurysm on the operating table, death occurs in 25% of cases, and with treatment of a chronic form of the disease in 17%.

Prevention

Dissecting aortic aneurysm is a severe form of the disease that is important to recognize early in its development. To reduce the chances of developing the disease, doctors advise periodically checking your blood pressure. If a patient has a high level of lipids in the blood, then for preventive purposes he is prescribed diet therapy and lipid-lowering drugs.

Doctors also advise all people to exercise, watch their diet and adhere to a healthy lifestyle.

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Diagnosis of dissecting aortic aneurysm begins with a preliminary diagnosis based on clinical data, which is considered an extremely important stage in recognizing this life-threatening condition. Currently available instrumental diagnostic methods include aortography, contrast CT, MRI, transthoracic or transesophageal echocardiography (Table 1).

Firstly, the most important feature of instrumental diagnosis is the need to confirm or exclude the diagnosis of dissecting aortic aneurysm using any of the listed studies. Second, the diagnostic study must clearly show whether the area of ​​dissection involves the ascending aorta or whether the dissection is limited to the descending aorta and aortic arch. Thirdly, during the study it is necessary to establish the anatomical features of the dissecting aneurysm, namely: length, sites of entry and return entry, the presence of a thrombus in the false lumen, involvement of aortic branches in the area of ​​dissection, the presence or absence of pericardial effusion and the degree of involvement of the coronary arteries. Unfortunately, performing only one research method does not provide all the necessary information. The diagnosis should be made quickly and reliably, preferably using readily available and non-invasive methods.

Based on the results of laboratory studies, it was found that two thirds of patients experience mild or moderate leukocytosis, and anemia may occur due to bleeding or accumulation of blood in the false lumen. A marked increase in blood D-dimer is possible, especially characteristic of an acute dissecting aneurysm, reaching a level typical of PE. Dissecting aortic aneurysm causes severe damage to medial smooth muscle cells, resulting in the release of smooth muscle cell structural proteins, including myosin heavy chains, into the circulation. The most common ECG sign is LV hypertrophy as a result of arterial hypertension. Acute ECG changes occur in 55% of patients and can manifest as ST segment depression, T wave changes, and in some cases ST segment elevation. MI occurs in 1-2% of patients due to obstruction of the ostia of the coronary arteries due to a hematoma or intimal flap.

Table 1

Comparative utility of radiological methods for diagnosing aortic dissection

Signs	Gastrodigestion water echocardiography	CT	MRI	Aorto- graph and I
Sensitivity
Specificity
Determining the type of delamination
Identification of the intimal flap
Aortic valve insufficiency
Pericardial effusion
Involvement of vascular branches
Coronary artery involvement

Source: Erbel R., Alfonso F., Boileau C. et al. Task force on aortic dissection of the European society of cardiology. Diagnosis and management of aortic dissection // Eur. Heart J. - 2001. - Vol. 22. - P. 1642-1681.

Chest X-ray is one of the main methods of examining a patient with acute chest pain in the emergency department. Moreover, pathological changes of the aorta on a plain chest radiograph are found in 56% of patients with suspected dissecting aortic aneurysm.

The classic radiographic sign that makes it possible to suspect aortic dissection is a widening of the mediastinal shadow. Other signs that may also occur include changes in aortic configuration, a limited hump-shaped protrusion on the aortic arch, dilatation of the aortic bulb distal to the origin of the left subclavian artery, thickening of the aortic wall (assessed by the width of the aortic shadow) that does not correspond to the usual intimal calcification, and displacement of the area of ​​calcification in aortic bulb.

For type A dissecting aneurysm, the sensitivity of transthoracic echocardiography is about 60%, the specificity is 83%; the method also makes it possible to detect AV insufficiency, the presence of pleural effusion and pericardial effusion, and cardiac tamponade. EchoCG with color Doppler mapping allows you to remove the limitations inherent in the conventional research technique (sensitivity when determining the intimal flap is 94-100%, when determining the entry site - 77-87%). In this case, the specificity is in the range of 77-97%. In addition to excellent imaging of the thoracic aorta, transesophageal echocardiography provides excellent images of the pericardium and assessment of aortic function.

A significant advantage of this research method is its accessibility, allowing for rapid diagnosis at the patient’s bedside. For this reason, transesophageal echocardiography is especially useful in the evaluation of patients with circulatory disorders and suspected dissecting aortic aneurysm.

MSCT is used in many hospitals and is usually used in emergency cases. This examination method provides complete information about the anatomical features of the aorta, including the involvement of the lateral branches in the area of ​​dissection, and makes it possible to image the orifices and proximal parts of both coronary arteries. In the diagnosis of dissecting aneurysm, the sensitivity of this research method is 83-100%, specificity - 90-100%.

According to the results of randomized studies, cardiac MRI is a more accurate method compared to transesophageal echocardiography and CT (specificity for dissecting aortic aneurysm is 100%). For establishing the site of entry, the sensitivity of MRI is 85% and the specificity is 100%. Aortography is no longer used to diagnose dissecting aneurysms, since the sensitivity and specificity of this research method is lower than other, less invasive methods.

In the case of the same degree of contrast between the true and false lumens, as well as in the case of a significant degree of thrombosis of the latter, which prevents the flow of contrast, false negative results can be obtained. Aortography is an invasive procedure, the results of which depend on the experience of the surgeon. It does not allow the detection of intramural hematomas of the aorta and requires the use of a nephrotoxic contrast agent. Coronary angiography does not provide additional information for decision making and is generally not indicated for type A dissecting aneurysms.

In a large study of the International Aortic Dissection Registry, the first diagnostic test was transthoracic and transesophageal echocardiography in 33% of patients, CT in 61%, MRI in 2%, and angiography in 4%. The second diagnostic study in 56% of patients was transthoracic and transesophageal echocardiography, 18% CT, 9% MRI and 17% angiography. Thus, an average of 1.8 methods were used to diagnose dissecting aneurysm.

Christoph A. Nienaber, Ibrahim Akin, Raimund Erbel and Axel Haverich

Aortic diseases. Injuries of the heart and aorta

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Complications of aortic aneurysm

Aortic aneurysms can be asymptomatic for a long time, without leading to any symptoms or disorders. However, you always have to take into account the complications that an aneurysm can cause. The most dangerous is, of course, a rupture of an aneurysm, which should be discussed separately. However, besides the gap, there are quite a lot of different violations. Like the symptoms, they are caused by two main reasons - impaired blood flow and compression of adjacent anatomical structures.

In the absence of timely treatment, patients with an aortic aneurysm may experience the following complications:

• Blood clot formation. In the cavity of the aneurysm, whether it is spindle-shaped or sac-shaped, the normal flow of blood is disrupted. It creates turbulence, which can lead to blood clots. The thrombus in this case will be sticky platelets. Being in the cavity of the aneurysm, the thrombus does not particularly interfere with blood flow. However, after leaving the aneurysm, the clot can become stuck in vessels of smaller diameter. It is almost impossible to predict where exactly thrombosis will occur. A cerebral artery (with a picture of an ischemic stroke), an artery of the kidney, liver, or extremities may be blocked. Thrombosis stops the flow of arterial blood to the corresponding organ, which leads to rapid tissue death. Thrombosis often ends in the death of the patient. The problem is that the aneurysm may not manifest itself in any way, and the patient is not aware of the presence of the disease. At the same time, blood flow disturbances already exist, and a stroke, for example, will be the first (and often the last) manifestation of the disease.
• Pneumonia. Pneumonia can be a consequence of a thoracic aortic aneurysm if the latter compresses the bronchi or puts pressure on the trachea. Normally, the epithelium of the airways secretes a certain amount of mucus, which cleanses the bronchi and humidifies the air. Compression leads to mucus accumulating in a certain part of the lung. Here favorable conditions are created for the development of infection. If it gets in, pneumonia develops.
• Compression of the bile ducts. Aneurysms in the upper abdominal aorta are adjacent to many different organs. A large aneurysm can, for example, compress the bile ducts that run from the gallbladder to the duodenum. In this case, firstly, the outflow of bile from the gallbladder is disrupted, and, secondly, the digestion process worsens. The risk of cholecystitis and pancreatitis increases, and the patient may suffer from diarrhea, constipation, and flatulence.
• Risk of heart disease. A thoracic aortic aneurysm of significant size can compress the nerve plexuses that regulate the functioning of the heart. Because of this, patients sometimes experience persistent bradycardia or tachycardia. In addition, the pressure in the thoracic aorta itself often increases, which creates additional stress on the left ventricle. As a result, irreversible changes may occur in the aortic valve of the heart or in the heart muscle. Even after removal of the aneurysm and normalization of pressure, disturbances in the functioning of the heart may remain.
• Ischemia of the lower extremities. Ischemia is called oxygen starvation of tissues. Arterial blood may reach the lower extremities in smaller quantities due to an infrarenal aortic aneurysm (located below the origin of the renal arteries). Lack of oxygen leads to deterioration of cell recovery. The risk of frostbite, trophic ulcers (due to lack of nutrition) and other soft tissue damage increases. In this case, the aneurysm will play the role of a provoking factor.

Ruptured aortic aneurysm

Aneurysm rupture is by far the most dangerous of the complications. It is the risk of rupture that explains the need to surgically solve the problem at the first opportunity. Because the walls of an aneurysm are thinner and less elastic than other parts of the vessel, even minor increases in blood pressure or trauma can cause a rupture. The consequences of a rupture almost always lead to death. The aorta has a large diameter, and a significant amount of blood passes through it in a short period of time. Through the defect formed when the aneurysm ruptures, blood begins to enter the free chest or abdominal cavity (depending on the location of the aneurysm). Massive internal bleeding often does not give doctors time to even take the patient to the operating room.

Rupture of an existing aortic aneurysm can be caused by the following factors:

injuries and falls;

taking certain medications (especially those that increase blood pressure);

psycho-emotional stress.

Dissecting aortic aneurysms rupture most often and quickly, since their wall has less strength. However, even such formations rarely rupture at rest.

When an aortic aneurysm ruptures, the patient may experience the following symptoms:

• sudden weakness;
• sudden pain;
• rapid paleness of the skin;
• the appearance of a dark spot on the skin of the abdomen (with the accumulation of a large amount of blood in the abdominal or retroperitoneal cavity).

A patient with a ruptured aortic aneurysm requires urgent surgical intervention to eliminate bleeding and resuscitation measures to maintain vital processes.

Diagnosis of aortic aneurysm

Diagnosing a thoracic or abdominal aortic aneurysm can be very difficult for several reasons. Firstly, the disease often does not manifest itself with any symptoms, and even a preventative visit to the doctor does not always reveal any abnormalities. Secondly, the symptoms of an aortic aneurysm are very similar to a number of other diseases. The appearance of such general complaints as a dry cough or chest discomfort makes you think, first of all, about other pathologies. Thirdly, aortic aneurysm itself does not occur very often in medical practice, so many doctors simply do not think about it when analyzing the patient’s first complaints.

If you suspect an aortic aneurysm, you should contact your family physician or cardiologist. They are the ones who can competently conduct an initial examination and prescribe further tests and examinations. A targeted search for a thoracic or abdominal aortic aneurysm is successful in most cases. Doctors manage to detect the formation itself, as well as collect all the necessary data (shape, type, size, etc.).

When diagnosing an aortic aneurysm, the following research methods may be prescribed:

• physical examination;
• X-ray examination;
• magnetic resonance imaging (MRI) and computed tomography (CT);
• lab tests.

Physical examination for aortic aneurysm

The purpose of examining a patient is to collect information without using additional examination methods. The doctor tries to identify visible abnormalities and deviations from the norm. This examination sometimes makes it possible to make a correct diagnosis with a high degree of probability, even without the involvement of additional funds.

During a physical examination, the following research methods are used:

• Visual inspection. Visually, very little information can be obtained for aortic aneurysms. Any changes in the shape of the chest are observed extremely rarely and only in cases where the patient has lived with a large aneurysm of the thoracic aorta for at least several years. With a large abdominal aortic aneurysm, pulsation can sometimes be observed, which is transmitted to the anterior abdominal wall. In addition, when an aneurysm ruptures, purple spots can sometimes be observed on the abdominal wall - a sign of massive internal bleeding. However, this symptom almost never appears on the anterior abdominal wall (usually on the side), since the aorta is located retroperitoneally (separated from the intestines, stomach and other organs by the posterior layer of the peritoneum), and hemorrhage occurs primarily in the retroperitoneal space.
• Percussion. Percussion involves tapping body cavities to determine the boundaries of different organs by ear. With an abdominal aortic aneurysm, the approximate size and location of the formation can be determined in this way. Often the area of ​​dullness of percussion sound coincides with the area of ​​the “vascular bundle”. Then, according to percussion data, this zone will be expanded. In addition, with a large aneurysm of the thoracic aorta, the borders of the heart or mediastinum may be slightly shifted. With an abdominal aortic aneurysm, percussion is less informative, since the vessel passes along the posterior wall of the abdominal cavity. Palpation in this case will be more informative.
• Palpation. Palpation of the thoracic cavity is almost impossible due to the rib frame, therefore palpation is almost never used in the diagnosis of thoracic aortic aneurysm. With an abdominal aneurysm, you can often find a formation pulsating in time with the heart. This speaks volumes about the presence of an aneurysm, since such formations do not occur in other diseases. In addition, palpation can include detection of the pulse. If the frequency or filling of the pulse is different in different arms or in the carotid arteries, this may indicate the presence of an aortic arch aneurysm. Weak or absent pulsations in the femoral arteries (or different rates in different legs) may indicate an infrarenal aneurysm.
• Auscultation. Listening with a stethoscope (listener) is a very common and valuable diagnostic method. With an abdominal aortic aneurysm, by applying a stethoscope to the site of the aneurysm projection, you can hear an increased noise of blood flow. With an aneurysm of the thoracic aorta, pathological changes can be different - a metallic accent of the second tone above the aorta, systolic murmur at the Botkin point, etc.
• Pressure measurement. The most common finding in patients with an aneurysm is hypertension (high blood pressure). With large aortic arch aneurysms, the pressure on different arms may be different (the difference is more than 10 mm Hg).

If characteristic symptoms are detected during a physical examination, the doctor prescribes other diagnostic measures to confirm the diagnosis.

X-ray for aortic aneurysm

X-ray is the most common method of imaging the abdominal or thoracic organs. X-rays passing through tissue are blocked by them in different ways. This is how borders appear in the photo. They talk about areas (organs, tissues, formations) with different densities. With a thoracic aortic aneurysm, it is often possible to see either one of the edges of the aneurysm cavity (for example, a bulging of the aortic arch) or the entire dilatation of the vessel. This depends on the quality of the image and the location of the aneurysm.

X-rays can also be used to study with contrast (aortography). In this case, a special substance is injected into the aorta, which intensely stains the vessel in the image. Thus, the doctor receives clear boundaries of the vessel and its main branches. The shape and size of the aneurysm and its location are well determined. In practice, however, contrast studies are rarely used. Firstly, this is an invasive (traumatic) procedure, since it is necessary to insert a special catheter into the aorta through the femoral artery. Because of this, there is a risk of bleeding, infection, etc. Secondly, if there is an aneurysm (especially a dissecting one), there is a high risk of causing a rupture during the study. Therefore, this procedure is performed only for special indications.

Ultrasound for aortic aneurysm

Ultrasound examination is based on the passage of sound waves through tissue. When reflected, these waves are captured by a special sensor, and a computer, based on the information received, constructs an image that is understandable to the doctor. In medical practice for aortic aneurysms, ultrasound is one of the most common diagnostic procedures. This is because in Doppler mode the ultrasound machine can also measure the speed of blood flow. This information is very important in the case of aneurysms, since they cause turbulence in the flow, and some vessels do not receive enough blood.

Ultrasound for patients with aortic aneurysm has the following advantages:

• relatively low cost;
• painless and safe for the patient examination;
• immediate results;
• the duration of the study is only 10 – 15 minutes;
• the ability to determine the shape and size of the aneurysm;
• the ability to detect some complications of an aneurysm;
• the ability to assess blood flow in the aorta and its branches;
• the ability to detect forming blood clots.

In general, ultrasound is more common in the diagnosis of abdominal aortic aneurysm. The abdominal wall is thinner, and the picture the doctor receives is more accurate. When examining a thoracic aortic aneurysm, a number of pathologies of the heart and lungs can also be detected, which is also important for treatment. The method of examining the organs of the chest cavity using ultrasound waves is called echocardiography (EchoCG).

MRI and CT for aortic aneurysm

Magnetic resonance imaging and computed tomography are different diagnostic methods in their operating principles, but in general they have much in common. Both procedures are very informative, but also expensive, so they are not prescribed to all patients. Often these research methods are used before a planned operation to remove an aortic aneurysm. In this case, it is necessary to collect as much information about education as possible.

MRI uses a special property of nuclear magnetic resonance. The image is obtained by placing the patient in a powerful electromagnetic field, in which a computer detects the movements of hydrogen nuclei. A high-precision image is formed, which shows not only the volumetric shape of the aneurysm, but even the thickness of its walls. All this is very important when making a prognosis for the patient and for deciding on surgical treatment. The examination lasts approximately 15–20 minutes, during which the patient cannot move.

MRI has the following contraindications:

• ear implants and built-in hearing aids;
• the presence of metal pins or plates after operations;
• presence of a pacemaker;
• some types of prosthetic heart valves.

An important advantage of MRI is that this procedure also allows one to evaluate blood flow in individual vessels, and not just obtain an image of the aneurysm itself. Doctors are able to evaluate circulatory disorders and suspect a number of associated disorders.

With computed tomography, the method of obtaining the image is slightly different. As with radiography, we are talking about differences in the absorption of x-rays in different tissues of the body. In modern tomographs, the radiation source rotates around the patient, taking a series of images. The computer then simulates the result. The result is a series of high-precision cross-sectional images. Based on the results of computed tomography, an experienced doctor can not only detect changes in the structure of the aorta, but also determine their size, position and other features. The possibility of using contrast makes CT even more informative. The introduction of a contrast agent into the vessel allows you to obtain a computer model of the patient’s vessels in 3D format. The intensity of X-ray radiation during the procedure remains low, despite the series of images taken. An absolute contraindication for this procedure is pregnancy (there is a risk to the fetus).

ECG for aortic aneurysm

Electrocardiography is an inexpensive and painless research method that is aimed at assessing the electrical activity of the heart. If a thoracic or abdominal aortic aneurysm is suspected, it is recommended to take an electrocardiogram for several reasons. First, in patients with chest pain, it will help differentiate aortalgia from anginal pain (coronary artery disease), which can be easily confused. Secondly, atherosclerosis, which is the most common cause of aortic aneurysm, often affects the coronary vessels, increasing the risk of heart attack. It is advisable to identify these disorders using an ECG before starting treatment. Thirdly, sometimes specific changes that are characteristic of an aortic aneurysm can be seen on the ECG. Also, with the help of this study, changes in the functioning of the heart are sometimes detected, which are complications of an aneurysm. Before and during surgery to remove an aneurysm, an ECG is taken continuously.

The main advantages of ECG are the speed of the study (the standard procedure lasts about 10 minutes), safety for the patient (the procedure has no absolute contraindications) and immediate results. The resulting record should be carefully studied by a cardiologist, who can use it to obtain a variety of information about the functioning of the heart.

Lab tests

In most cases, a blood test or urine test in patients with an aortic aneurysm will not show any specific changes. A standard general and biochemical blood test is prescribed rather to identify the possible cause of the formation of an aneurysm after the aneurysm itself has been detected.

In patients with an aortic aneurysm, the following changes in laboratory tests may be detected:

• Changes in leukocyte levels. It can be observed with certain infections, which, in turn, cause the development of an aneurysm. The level of leukocytes usually increases during acute infectious processes and decreases during chronic ones. In chronic cases, the proportion of non-segmented neutrophils in the leukocyte formula also increases.
• Changes in blood clotting. The study of platelet levels, clotting factors and a number of other indicators often changes if blood clots form in the aneurysm cavity.
• Increased cholesterol levels. Hypercholesterolemia is an increase in blood cholesterol levels to 5 mmol/l or more. Most often this indicates atherosclerotic damage to the aorta. This is also indirectly indicated by elevated levels of triglycerides or low-density lipoproteins (even if total cholesterol is normal).
• In rare cases, urinalysis may detect blood impurities (microhematuria), which are detected during a specific analysis.

However, all these changes are optional; they are not found at all stages of the disease and not in all patients.

Treatment of aortic aneurysm

Treatment for an aortic aneurysm almost always involves surgery. A deformed vessel wall cannot restore its shape with the help of medications. At the same time, there is always a risk of rupture with massive internal bleeding. Therefore, at first, the patient is carefully examined, the extent and possibility of surgical treatment is assessed, and preliminary medicinal (conservative) therapy is prescribed.

An important part of treatment is preventing aneurysm rupture. It includes changes in lifestyle, nutrition, and some of the patient’s habits. Compliance with preventive measures will allow the patient to better prepare for surgical treatment (it will not be urgent due to dissection or rupture, but planned).

Prevention of aneurysm formation and rupture includes the following recommendations:

• stopping smoking is perhaps the most important measure both to prevent the development of an aneurysm and to delay the increase in the diameter of an existing thoracic aortic aneurysm;
• normalization of blood pressure (including with the help of medications);
• normalization of body weight, if necessary with the help of a nutritionist;
• following a low-cholesterol diet to prevent atherosclerosis;
• refusal of serious physical activity;
• prevention of psycho-emotional stress (including taking sedatives).

Given that the causes of aortic aneurysm can vary, other preventative measures may be required. They are determined and explained to the patient by the attending physician after the examination.

Medicines for aortic aneurysm

The natural course of such a disease as aortic aneurysm is a steady and progressive increase in the diameter of the aneurysm, followed by its rupture. At the moment, there are no sufficiently reliable medications in medicine that could prevent the development of degenerative processes in the aortic wall and further growth of the aneurysm. Accordingly, adequate treatment can only be surgical intervention with resection (removal) of the affected area and its replacement.

But in the following cases, it is necessary to resort to medications in order to delay the growth of the aneurysm for as long as possible and alleviate the symptoms of the disease:

• With a small diameter of the pathological area in the aorta (up to 5 cm) during the period of dynamic observation of a patient with a thoracic aortic aneurysm.
• In case of severe concomitant diseases, when the risk from the operation exceeds the risk of rupture of the aneurysm itself. These conditions include acute coronary circulatory disorders, acute cerebral circulatory disorders, and heart failure of II – III degrees.
• During the period of preparation for surgery.

For each patient, the attending physician selects his own treatment regimen depending on the type and size of the formation, as well as depending on the patient’s symptoms and complaints. However, there are several groups of drugs that are prescribed most often.

For aneurysms of the thoracic or abdominal aorta, medications with the following effect can be prescribed:

• drugs that reduce heart rate (heart rate);
• drugs to lower blood pressure;
• cholesterol-lowering drugs.

To reduce heart rate, beta-blockers are most often used, affecting the innervation of the heart. If the use of beta blockers is contraindicated, verapamil from the group of calcium channel blockers can be prescribed. It is necessary to slow down the heart rate to 50 - 60 beats per minute. This significantly reduces the load on the aortic walls and reduces the likelihood of complications.

Drugs to lower heart rate in patients with aortic aneurysm

Drug name	Composition and release form	Dosage and regimen
Propranolol (anaprilin, obzidan)	Tablets 10 mg, 40 mg	The initial dose is 20 mg, the average dose is 40 - 80 mg 2 - 3 times a day.
Metoprolol (egilok, betalok, corvitol)	Tablets 25 mg, 50 mg, 100 mg	50 or 100 mg 1 - 2 times a day.
Bisoprolol (concor, coronal, cordinorm)	Tablets 2.5 mg, 5 mg, 10 mg	The daily dose is from 2.5 to 10 mg at a time.
Nebivolol (nebilet, nevotenz)	Tablets 2.5 mg, 5 mg, 10 mg	2.5 mg, 5 mg or 10 mg once a day.
Verapamil (isoptin, finoptin)	Tablets 40 mg, 80 mg	40 - 80 mg 3 times a day.

Blood pressure also needs to be reduced to reduce tension in the aortic wall. For these purposes, calcium channel blockers and ACE inhibitors (angiotensin-converting enzyme inhibitors) are used. For each patient, the attending physician selects drugs from the group that best suits him. In some cases, a combination of drugs is possible. The purpose depends on the causes that cause hypertension.

Drugs to lower blood pressure in patients with aortic aneurysm

Drug name	Composition and release form	Dosage and regimen
Amlodipine (Norvasc, Tenox)	Tablets 5 mg and 10 mg	Daily dose 5 mg or 10 mg once.
Enalapril (Renitec, Berlipril)	Tablets 5 mg, 10 mg, 20 mg	5 mg, 10 mg, 20 mg 2 times a day.
Lisinopril (diroton, lysinoton)	Tablets 5 mg, 10 mg, 20 mg	5 mg, 10 mg, 20 mg once.
Ramipril (hartil, tritatse)	Tablets 2.5 mg, 5 mg, 10 mg	2.5 mg, 5 mg, 10 mg 1 time per day.
Perindopril (prestarium)	Tablets 2 mg, 4 mg, 8 mg, 10 mg	2 - 10 mg 1 time per day.

Atherosclerosis is a risk factor for rapid aneurysm growth, contributing to weakening of the vessel wall. Timely treatment can delay the progression of the process for a long time. Drugs from the group of statins, fibrates, and bile acid sequestrants are used. The doctor chooses the drug for the treatment of a particular patient, based on the test results.

Drugs to lower cholesterol in patients with aortic aneurysm

Drug name	Composition and release form	Dosage and regimen
Simvastatin (vasilip, simgal)	Tablets 10 mg, 20 mg, 40 mg	10 - 80 mg at a time, taken once in the evening.
Atorvastatin (atorvox, atoris)	Tablets 10 mg, 20 mg, 40 mg	10 - 80 mg at a time in the evening.
Rosuvastatin (crestor, roseart)	Tablets 10 mg, 20 mg, 40 mg	10 - 80 mg 1 time in the evening.
Fenofibrate (traikor, lipantil)	Tablets 145 mg, 160 mg, 200 mg, 250 mg	145 - 250 mg 1 time per day.
Cholestyramine		12 - 16 g per day in 3 - 4 doses.

For various complications of an aortic aneurysm or concomitant disorders, the patient may require other medications. For example, if an aortic aneurysm appears against the background of a systemic infection, a course of treatment with antibiotics is necessary, which are effective against the causative microbe. Various vitamin complexes, drugs to strengthen the vascular wall, and drugs against the formation of blood clots may also be prescribed. However, there are no uniform standards of treatment. The specialist navigates the situation based on the disorders found in the patient. Self-medication with the above drugs without consulting a doctor is very dangerous. Incorrect dose selection can accelerate the rupture of the aneurysm or put excessive strain on other internal organs.

Surgical treatment of aortic aneurysm

The very presence of an aortic aneurysm is already an indication for surgery to eliminate this problem. Surgery, as noted above, is the only effective treatment for such patients. Whether surgical treatment will be performed depends on what contraindications the patient has. The operation to remove an aneurysm of both the thoracic and abdominal aorta is very extensive and complex. In some patients with serious chronic diseases, the risks of the operation itself may outweigh the possible benefits. In such cases, surgery is not performed.

Currently, the following contraindications to surgical treatment of aortic aneurysm are identified:

• acute circulatory disorders in the vessels of the heart;
• circulatory failure II or III degree;
• serious problems with blood circulation in the vessels of the brain (if there are corresponding neurological problems);
• impossibility of adequate revascularization of at least the deep arteries of the femur (after the operation there will be insufficient blood circulation).

A previous myocardial infarction with a stable electrocardiogram for three months or a stroke six weeks ago (in the absence of neurological disorders) are not contraindications. Such patients may undergo surgical removal of the aneurysm.

In general, in each individual case the possibility of surgical treatment and its plan are considered separately. The duration of the operation and its complexity are influenced by the type of aneurysm, its location, and the presence of complications.

To detect contraindications and complete preoperative examination of the patient, the following procedures are prescribed:

• detailed examination of the state of the respiratory system (spirography);
• assessment of the condition of the kidneys, in order to exclude hidden renal failure;
• It is mandatory to assess the condition of the blood vessels of the lower extremities, as well as the coronary arteries and arteries of the pulmonary circulation;
• determination of sensitivity to antibiotics prescribed for staphylococci and Escherichia coli (these microorganisms most often cause postoperative complications).

Regardless of the type of aneurysm, antibiotic therapy is prescribed in advance (usually 24 hours before surgery) to prevent postoperative complications. Within a day, a sufficient concentration of antibiotic appears in the blood to prevent the proliferation of pathogenic (disease-causing) bacteria.

Currently, there are several options for surgical treatment of aortic aneurysm:

• Classic surgery. Classic intervention is understood as a large-scale abdominal operation with general anesthesia and wide tissue dissection. The goal is to remove the section of the aorta with the aneurysm and replace it (usually with a graft). As a result, blood flow through the aorta is completely restored. The big disadvantage of this operation is its traumatic nature. There is a high risk of complications during and after surgery. Even in the absence of complications, the patient usually takes a long time to recover and loses his ability to work for a long time.
• Endovascular surgery. Endovascular surgery is understood as a set of methods in which large-scale tissue dissection does not occur. All necessary instruments are brought to the aneurysm through other vessels (often through the femoral artery). Depending on the type and size of the aneurysm, there are several intervention options. Sometimes a special reinforcing mesh is installed into the lumen of the vessel, which prevents the growth or separation of the formation. For small saccular aneurysms, sometimes they resort to “sealing” the mouth. Currently, there is a fairly wide range of manipulations through endovascular access. However, all of them are performed, as a rule, for small saccular aneurysms, when there is no serious threat of rupture.

If we are talking about aneurysm dissection, rupture or other complications, or the risk of rupture, according to doctors, is very high, only conventional surgery is performed. It gives more extensive access to the aorta, allows you to more reliably eliminate the problem and clearly examine other weak areas of the vessel, if any. Also, classical surgery is the only treatment option for large and giant fusiform aneurysms.

Traditional treatment of aortic aneurysm

Since the main method of treating aneurysm is surgery, no folk remedy can completely cure this disease. Their use is possible only as a preventive symptomatic treatment. For example, some folk remedies have a good calming effect (important for preventing stress), others lower blood pressure. However, in most cases, there are more effective pharmaceutical analogues that have a more pronounced and faster effect. It is reasonable to turn to folk remedies if there are contraindications or if you are intolerant to drugs.

As an alternative to drug treatment, the following folk remedies are sometimes used:

• Dill infusion. Infuse one tablespoon of finely chopped dill in 400 ml of boiling water. Divide this portion into 3 parts and drink throughout the day.
• Hawthorn infusion. Dry and chop the red hawthorn fruits well. To prepare the infusion, you need two spoons of the resulting powder. Pour the powder into 300 ml of boiling water and leave for half an hour. Divide into three parts and consume 30 minutes before meals.
• Infusion of gillyflower. This infusion is prepared from two tablespoons of jaundice. Pour in 150 ml of boiling water. Drink 15 ml 5 times a day. You can add sugar to the prepared infusion to improve the taste.
• Elderberry decoction. To prepare this decoction you need Siberian elderberry root. Boil 200 ml of water, add chopped elderberry root, let simmer over low heat for 15 minutes. Remove from heat and leave for another 30 minutes. Strain the resulting broth and pour into a glass container. Drink one tablespoon 3 times a day.

It is necessary to understand that none of the remedies recommended above will have the most important effect - slowing down the growth of the aneurysm. When using traditional medicine, only temporary relief of symptoms of the disease, such as shortness of breath or swelling, is possible. Therefore, relying on herbal recipes is completely unacceptable. Complete cure can only be guaranteed by timely consultation with doctors and surgical treatment.

Prognosis for aortic aneurysm

The prognosis for patients with an aortic aneurysm depends on a number of different factors. They try to identify them upon patient admission in order to understand how urgently treatment is needed. Determine the type and size of the aneurysm as accurately as possible. After this, the attending physician (usually a surgeon) draws up a rough plan for further research and treatment.

The prognosis for aortic aneurysm is influenced by the following factors and indicators:

• Aneurysm shape. As a rule, dissecting aneurysms are the most dangerous. The best prognosis is often for fusiform true aneurysms, the walls of which are stronger.
• Reason for formation. Aneurysms that appear against the background of atherosclerosis grow more slowly. With syphilis, the prognosis is worse, since the disease that has reached the aortic wall is already at a late stage, and other organs may be affected. Congenital connective tissue diseases generally have a poor prognosis because there is no effective treatment.
• Aneurysm size. Larger aneurysms often cause more symptoms and are more likely to rupture. The prognosis for them will be worse.
• Patient's age. Atherosclerotic aneurysms usually form in people over 40 years of age. At the same time, they may have various concomitant diseases - coronary heart disease, kidney or liver problems, etc. All this can become a relative or even absolute contraindication to surgical treatment. The prognosis, of course, is getting worse.
• Stage of the disease. Fresh aneurysms that form within the last few weeks have a worse prognosis because it is more difficult for doctors to assess the risk of rupture. Subacute aneurysms have a better prognosis.
• Location of the aneurysm. It is difficult to say which aneurysms are more dangerous - the thoracic or abdominal aorta. In both cases, rupture most often leads to the death of the patient. An important factor is which branches of the aorta are affected by the aneurysm. This largely determines the volume and complexity of surgical intervention (especially when it comes to prosthetics). The worst prognosis will be for multiple aortic aneurysms located in both the thoracic and abdominal cavities.

In general, aortic aneurysm without surgical treatment is considered a disease with a poor prognosis. The very presence of an aneurysm indicates the possibility of its rupture with lethal internal bleeding. The possibilities of preventive methods and drug therapy are not limitless. If the patient has undergone successful surgical treatment, the prognosis is favorable. Re-formation of an aneurysm or other complications after surgery are possible, but they no longer pose such a serious danger. In this case, the prognosis will depend more on the patient himself (whether he will conscientiously follow the doctors’ instructions).

Is there any disability for an aortic aneurysm?

The disability group is assigned by a medical and social examination consisting of specialists in several fields. In principle, each case is considered individually. The main criterion for obtaining a group is ability to work - the ability to perform various workloads without serious harm to health and the ability to self-care in everyday life. If the patient is unable to work or care for himself, doctors assess the severity of the situation and determine the disability group.

With an aneurysm of the thoracic or abdominal aorta, at first there is no talk of disability. First, you need to undergo a full course of treatment, which includes surgical correction of this pathology. In other words, while doctors have treatment options, the patient is not referred for a medical and social examination.

After surgical treatment, a certain time must pass - usually from six months to 1 - 2 years. During this period, the patient visits rehabilitation centers, which do everything possible to restore health. In the absence of complications or serious consequences of the disease (or surgery), the patient is considered healthy. Of course, the question of obtaining a disability group does not arise again.

If the patient, after a course of rehabilitation, does not get rid of the serious consequences of the operation or illness, he is referred for a medical and social examination. With an aneurysm of the abdominal or thoracic aorta, such consequences can be, for example, disruption of the heart, deterioration of the blood supply to individual organs. Sometimes the diseases that led to the formation of an aneurysm (Marfan syndrome and a number of other congenital diseases) progress, and the patient receives a group not so much because of the aneurysm, but because of the underlying pathology. With Marfan syndrome, for example, there is joint weakness, severe visual impairment, and heart defects. The medical and social examination will consider these manifestations together.

An unoperated aortic aneurysm can also become a reason for receiving a disability group. For example, if the patient has an aneurysm, but there are serious contraindications to surgery (disorders of the heart, lungs, kidneys, liver and other concomitant pathologies). All this confuses doctors, since it becomes impossible to solve the problem surgically. The risk of surgery becomes too high. Because the patient has to constantly reckon with the risk of aneurysm rupture and other complications, he is forced to frequently visit doctors and regularly take various medications. This may be a reason to refer him for a medical and social examination.

Before use, you should consult a specialist.

The basis for diagnosing an aortic aneurysm is X-ray (radiography of the chest and abdominal cavity, aortography) and ultrasound methods (ultrasound, ultrasonography of the thoracic/abdominal aorta). Surgical treatment of an aneurysm involves its resection with aortic replacement or closed endoluminal replacement of the aneurysm with a special endoprosthesis.

Aortic aneurysm

Aortic aneurysm is characterized by irreversible expansion of the lumen of the arterial trunk in a limited area. The ratio of aortic aneurysms of different locations is approximately the following: aneurysms of the abdominal aorta account for 37% of cases, ascending aorta – 23%, aortic arch – 19%, descending thoracic aorta – 19.5%. Thus, aneurysms of the thoracic aorta in cardiology account for almost 2/3 of all pathology. Aneurysms of the thoracic aorta are often combined with other aortic defects - aortic insufficiency and coarctation of the aorta.

Classification of aortic aneurysms

In vascular surgery, several classifications of aortic aneurysms have been proposed, taking into account their localization by segment, shape, wall structure, and etiology. In accordance with the segmental classification, there are: sinus of Valsalva aneurysm, ascending aortic aneurysm, aortic arch aneurysm, descending aortic aneurysm, abdominal aortic aneurysm, aneurysm of combined localization - thoracoabdominal aorta.

Assessment of the morphological structure of aortic aneurysms allows us to subdivide them into true and false (pseudoaneurysms). A true aneurysm is characterized by thinning and protrusion outward of all layers of the aorta. According to etiology, true aortic aneurysms are usually atherosclerotic or syphilitic. The wall of the false aneurysm is represented by connective tissue formed as a result of the organization of a pulsating hematoma; the own walls of the aorta are not involved in the formation of a false aneurysm. Pseudoaneurysms are more often traumatic and postoperative in origin.

In shape, there are saccular and fusiform aortic aneurysms: the former are characterized by local protrusion of the wall, the latter by diffuse expansion of the entire diameter of the aorta. Normally, in adults, the diameter of the ascending aorta is about 3 cm, the descending thoracic aorta is 2.5 cm, and the abdominal aorta is 2 cm. An aortic aneurysm is said to occur when the diameter of the vessel in a limited area increases by 2 or more times.

Taking into account the clinical course, uncomplicated, complicated, and dissecting aortic aneurysms are distinguished. Specific complications of aortic aneurysms include ruptures of the aneurysmal sac, accompanied by massive internal bleeding and the formation of hematomas; aneurysm thrombosis and arterial thromboembolism; phlegmon of surrounding tissues due to infection of the aneurysm. A special type is a dissecting aortic aneurysm, when, through a rupture in the inner lining, blood penetrates between the layers of the artery wall and spreads under pressure along the vessel, gradually dissecting it.

The etiological classification of aortic aneurysms is described in detail when considering the causes of the disease.

Causes of aortic aneurysm

According to etiology, all aortic aneurysms can be divided into congenital and acquired. The formation of congenital aneurysms is associated with hereditary diseases of the aortic wall - Marfan syndrome, fibrous dysplasia, Ehlers-Danlos syndrome, Erdheim syndrome, hereditary elastin deficiency, etc.

Acquired aortic aneurysms of inflammatory etiology occur as a result of specific and nonspecific aortitis due to fungal infections of the aorta, syphilis, and postoperative infections. Non-inflammatory or degenerative aortic aneurysms include cases of the disease caused by atherosclerosis, defects in suture material and prostheses. Mechanical damage to the aorta leads to the formation of hemodynamically post-stenotic and traumatic aneurysms. Idiopathic aneurysms develop with medianecrosis of the aorta.

Risk factors for the formation of aortic aneurysms are considered to be old age, male gender, arterial hypertension, smoking and alcohol abuse, and hereditary history.

Pathogenesis of aortic aneurysms

In addition to the defectiveness of the aortic wall, mechanical and hemodynamic factors take part in the formation of an aneurysm. Aortic aneurysms often occur in functionally stressed areas that experience increased stress due to high blood flow speed, the steepness of the pulse wave and its shape. Chronic trauma to the aorta, as well as increased activity of proteolytic enzymes, cause destruction of the elastic framework and nonspecific degenerative changes in the vessel wall.

The formed aortic aneurysm progressively increases in size, since the stress on its walls increases in proportion to the expansion of the diameter. Blood flow in the aneurysmal sac slows down and becomes turbulent. Only about 45% of the blood volume in the aneurysm enters the distal arterial bed. This is due to the fact that, upon entering the aneurysmal cavity, blood rushes along the walls, and the central flow is restrained by the mechanism of turbulence and the presence of thrombotic masses in the aneurysm. The presence of thrombi in the aneurysm cavity is a risk factor for thromboembolism of the distal branches of the aorta.

Symptoms of aortic aneurysm

Clinical manifestations of aortic aneurysms are variable and are determined by the location, size of the aneurysmal sac, its length, and the etiology of the disease. Aortic aneurysms can be asymptomatic or accompanied by scant symptoms and are detected during routine examinations. The leading manifestation of an aortic aneurysm is pain caused by damage to the aortic wall, its stretching or compression syndrome.

The clinical picture of an abdominal aortic aneurysm is manifested by transient or constant diffuse pain, discomfort in the abdomen, belching, heaviness in the epigastrium, a feeling of fullness in the stomach, nausea, vomiting, intestinal dysfunction, and weight loss. Symptoms may be associated with compression of the cardiac part of the stomach, duodenum, and involvement of the visceral arteries. Often patients independently determine the presence of increased pulsation in the abdomen. On palpation, a tense, dense, painful pulsating formation is determined.

For an aneurysm of the ascending aorta, pain in the region of the heart or behind the sternum is typical, caused by compression or stenosis of the coronary arteries. Patients with aortic insufficiency are concerned about shortness of breath, tachycardia, and dizziness. Large aneurysms cause the development of superior vena cava syndrome with headaches, swelling of the face and upper half of the body.

Aneurysm of the aortic arch leads to compression of the esophagus with symptoms of dysphagia; if the recurrent nerve is compressed, hoarseness (dysphonia) and dry cough occur; involvement of the vagus nerve is accompanied by bradycardia and drooling. With compression of the trachea and bronchi, shortness of breath and stridor breathing develop; when the root of the lung is compressed, congestion and frequent pneumonia occur.

When the periaortic sympathetic plexus is irritated by the aneurysm of the descending aorta, pain occurs in the left arm and scapula. If the intercostal arteries are involved, spinal cord ischemia, paraparesis and paraplegia may develop. Compression of the vertebrae is accompanied by their usuration, degeneration and displacement with the formation of kyphosis; Compression of blood vessels and nerves is clinically manifested by radicular and intercostal neuralgia.

Complications of aortic aneurysm

Aortic aneurysms can be complicated by rupture with the development of massive bleeding, collapse, shock and acute heart failure. An aneurysm can rupture into the superior vena cava system, the pericardial and pleural cavity, the esophagus, and the abdominal cavity. In this case, severe, sometimes fatal conditions develop - superior vena cava syndrome, hemopericardium, cardiac tamponade, hemothorax, pulmonary, gastrointestinal or intra-abdominal bleeding.

When thrombotic masses are separated from the aneurysmal cavity, a picture of acute occlusion of the vessels of the extremities develops: cyanosis and soreness of the toes, livedo on the skin of the extremities, intermittent claudication. With thrombosis of the renal arteries, renovascular arterial hypertension and renal failure occur; with damage to the cerebral arteries - stroke.

Diagnosis of aortic aneurysm

The diagnostic search for aortic aneurysm includes assessment of subjective and objective data, X-ray, ultrasound and tomographic studies. An auscultatory sign of an aneurysm is the presence of a systolic murmur in the projection of the aortic dilatation. Abdominal aortic aneurysms are detected upon palpation of the abdomen in the form of a tumor-like pulsating formation.

The X-ray examination plan for patients with a thoracic or abdominal aortic aneurysm includes fluoroscopy and chest radiography, plain radiography of the abdominal cavity, radiography of the esophagus and stomach. When recognizing aneurysms of the ascending aorta, echocardiography is used; in other cases, ultrasound dopplerography (USD) of the thoracic/abdominal aorta is performed.

Computed tomography (MSCT) of the thoracic/abdominal aorta makes it possible to accurately and visually represent aneurysmal dilatation, identify the presence of dissection and thrombotic masses, para-aortic hematoma, and foci of calcification. At the final stage of the examination, aortography is performed, according to which the location, size, extent of the aortic aneurysm and its relationship to neighboring anatomical structures are clarified. Based on the results of a comprehensive instrumental examination, a decision is made on the indications for surgical treatment of an aortic aneurysm.

Aneurysm of the thoracic aorta should be differentiated from tumors of the lungs and mediastinum; abdominal aortic aneurysm - from space-occupying formations of the abdominal cavity, lesions of the mesenteric lymph nodes, retroperitoneal tumors.

Treatment of aortic aneurysm

In case of asymptomatic, non-progressive course of aortic aneurysm, dynamic observation by a vascular surgeon and x-ray control are limited. To reduce the risk of possible complications, antihypertensive and anticoagulant therapy and cholesterol reduction are carried out.

Surgical intervention is indicated for abdominal aortic aneurysms with a diameter of more than 4 cm; aneurysms of the thoracic aorta with a diameter of 5.5-6.0 cm or when smaller aneurysms increase by more than 0.5 cm over six months. When an aortic aneurysm ruptures, the indications for emergency surgery are absolute.

Surgical treatment of an aortic aneurysm involves excision of the aneurysmally altered portion of the vessel, suturing the defect, or replacing it with a vascular prosthesis. Taking into account the anatomical location, resection of aneurysms of the abdominal aorta, thoracic aorta, aortic arch, thoracoabdominal aorta, and subrenal aorta is performed.

In case of hemodynamically significant aortic insufficiency, resection of the ascending thoracic aorta is combined with aortic valve replacement. An alternative to open vascular intervention is endovascular replacement of an aortic aneurysm with installation of a stent.

Prognosis and prevention of aortic aneurysm

The prognosis of an aortic aneurysm is mainly determined by its size and concomitant atherosclerotic damage to the cardiovascular system. In general, the natural history of aneurysm is unfavorable and is associated with a high risk of death from aortic rupture or thromboembolic complications. The probability of rupture of an aortic aneurysm with a diameter of 6 cm or more is 50% per year, and for a smaller diameter - 20% per year. Early detection and planned surgical treatment of aortic aneurysms is justified by low intraoperative (5%) mortality and good long-term results.

Preventive recommendations include monitoring blood pressure, organizing a healthy lifestyle, regular monitoring by a cardiologist and angiosurgeon, and drug therapy for concomitant pathologies. Individuals at risk for developing an aortic aneurysm should undergo screening ultrasound examination.

Aortic aneurysm - treatment in Moscow

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Aortic aneurysm. Complications, diagnosis and treatment

Complications of aortic aneurysm

• Blood clot formation. In the cavity of the aneurysm, whether it is spindle-shaped or sac-shaped, the normal flow of blood is disrupted. It creates turbulence, which can lead to blood clots. The thrombus in this case will be sticky platelets. Being in the cavity of the aneurysm, the thrombus does not particularly interfere with blood flow. However, after leaving the aneurysm, the clot can become stuck in vessels of smaller diameter. It is almost impossible to predict where exactly thrombosis will occur. A cerebral artery (with a picture of an ischemic stroke), an artery of the kidney, liver, or extremities may be blocked. Thrombosis stops the flow of arterial blood to the corresponding organ, which leads to rapid tissue death. Thrombosis often ends in the death of the patient. The problem is that the aneurysm may not manifest itself in any way, and the patient is not aware of the presence of the disease. At the same time, blood flow disturbances already exist, and a stroke, for example, will be the first (and often the last) manifestation of the disease.
• Pneumonia. Pneumonia can be a consequence of a thoracic aortic aneurysm if the latter compresses the bronchi or puts pressure on the trachea. Normally, the epithelium of the airways secretes a certain amount of mucus, which cleanses the bronchi and humidifies the air. Compression leads to mucus accumulating in a certain part of the lung. Here favorable conditions are created for the development of infection. If it gets in, pneumonia develops.
• Compression of the bile ducts. Aneurysms in the upper abdominal aorta are adjacent to many different organs. A large aneurysm can, for example, compress the bile ducts that run from the gallbladder to the duodenum. In this case, firstly, the outflow of bile from the gallbladder is disrupted, and, secondly, the digestion process worsens. The risk of cholecystitis and pancreatitis increases, and the patient may suffer from diarrhea, constipation, and flatulence.
• Risk of heart disease. A thoracic aortic aneurysm of significant size can compress the nerve plexuses that regulate the functioning of the heart. Because of this, patients sometimes experience persistent bradycardia or tachycardia. In addition, the pressure in the thoracic aorta itself often increases, which creates additional stress on the left ventricle. As a result, irreversible changes may occur in the aortic valve of the heart or in the heart muscle. Even after removal of the aneurysm and normalization of pressure, disturbances in the functioning of the heart may remain.
• Ischemia of the lower extremities. Ischemia is called oxygen starvation of tissues. Arterial blood may reach the lower extremities in smaller quantities due to an infrarenal aortic aneurysm (located below the origin of the renal arteries). Lack of oxygen leads to deterioration of cell recovery. The risk of frostbite, trophic ulcers (due to lack of nutrition) and other soft tissue damage increases. In this case, the aneurysm will play the role of a provoking factor.

Ruptured aortic aneurysm

injuries and falls;

taking certain medications (especially those that increase blood pressure);

psycho-emotional stress.

Dissecting aortic aneurysms rupture most often and quickly, since their wall has less strength. However, even such formations rarely rupture at rest.

• sudden weakness;
• loss of consciousness;
• noise in ears;
• sudden pain;
• rapid paleness of the skin;
• the appearance of a dark spot on the skin of the abdomen (with the accumulation of a large amount of blood in the abdominal or retroperitoneal cavity).

A patient with a ruptured aortic aneurysm requires urgent surgical intervention to eliminate bleeding and resuscitation measures to maintain vital processes.

Diagnosis of aortic aneurysm

Physical examination for aortic aneurysm

• Visual inspection. Visually, very little information can be obtained for aortic aneurysms. Any changes in the shape of the chest are observed extremely rarely and only in cases where the patient has lived with a large aneurysm of the thoracic aorta for at least several years. With a large abdominal aortic aneurysm, pulsation can sometimes be observed, which is transmitted to the anterior abdominal wall. In addition, when an aneurysm ruptures, purple spots can sometimes be observed on the abdominal wall - a sign of massive internal bleeding. However, this symptom almost never appears on the anterior abdominal wall (usually on the side), since the aorta is located retroperitoneally (separated from the intestines, stomach and other organs by the posterior layer of the peritoneum), and hemorrhage occurs primarily in the retroperitoneal space.
• Percussion. Percussion involves tapping body cavities to determine the boundaries of different organs by ear. With an abdominal aortic aneurysm, the approximate size and location of the formation can be determined in this way. Often the area of ​​dullness of percussion sound coincides with the area of ​​the “vascular bundle”. Then, according to percussion data, this zone will be expanded. In addition, with a large aneurysm of the thoracic aorta, the borders of the heart or mediastinum may be slightly shifted. With an abdominal aortic aneurysm, percussion is less informative, since the vessel passes along the posterior wall of the abdominal cavity. Palpation in this case will be more informative.
• Palpation. Palpation of the thoracic cavity is almost impossible due to the rib frame, therefore palpation is almost never used in the diagnosis of thoracic aortic aneurysm. With an abdominal aneurysm, you can often find a formation pulsating in time with the heart. This speaks volumes about the presence of an aneurysm, since such formations do not occur in other diseases. In addition, palpation can include detection of the pulse. If the frequency or filling of the pulse is different in different arms or in the carotid arteries, this may indicate the presence of an aortic arch aneurysm. Weak or absent pulsations in the femoral arteries (or different rates in different legs) may indicate an infrarenal aneurysm.
• Auscultation. Listening with a stethoscope (listener) is a very common and valuable diagnostic method. With an abdominal aortic aneurysm, by applying a stethoscope to the site of the aneurysm projection, you can hear an increased noise of blood flow. With an aneurysm of the thoracic aorta, pathological changes can be different - a metallic accent of the second tone above the aorta, systolic murmur at the Botkin point, etc.
• Pressure measurement. The most common finding in patients with an aneurysm is hypertension (high blood pressure). With large aortic arch aneurysms, the pressure on different arms may be different (the difference is more than 10 mm Hg).

If characteristic symptoms are detected during a physical examination, the doctor prescribes other diagnostic measures to confirm the diagnosis.

X-ray for aortic aneurysm

Ultrasound for aortic aneurysm

• relatively low cost;
• painless and safe for the patient examination;
• immediate results;
• the duration of the study is only 10 – 15 minutes;
• the ability to determine the shape and size of the aneurysm;
• the ability to detect some complications of an aneurysm;
• the ability to assess blood flow in the aorta and its branches;
• the ability to detect forming blood clots.

In general, ultrasound is more common in the diagnosis of abdominal aortic aneurysm. The abdominal wall is thinner, and the picture the doctor receives is more accurate. When examining a thoracic aortic aneurysm, a number of pathologies of the heart and lungs can also be detected, which is also important for treatment. The method of examining the organs of the chest cavity using ultrasound waves is called echocardiography (EchoCG).

MRI and CT for aortic aneurysm

• ear implants and built-in hearing aids;
• the presence of metal pins or plates after operations;
• presence of a pacemaker;
• some types of prosthetic heart valves.

An important advantage of MRI is that this procedure also allows one to evaluate blood flow in individual vessels, and not just obtain an image of the aneurysm itself. Doctors are able to evaluate circulatory disorders and suspect a number of associated disorders.

ECG for aortic aneurysm

Lab tests

• Changes in leukocyte levels. It can be observed with certain infections, which, in turn, cause the development of an aneurysm. The level of leukocytes usually increases during acute infectious processes and decreases during chronic ones. In chronic cases, the proportion of non-segmented neutrophils in the leukocyte formula also increases.
• Changes in blood clotting. The study of platelet levels, clotting factors and a number of other indicators often changes if blood clots form in the aneurysm cavity.
• Increased cholesterol levels. Hypercholesterolemia is an increase in blood cholesterol levels to 5 mmol/l or more. Most often this indicates atherosclerotic damage to the aorta. This is also indirectly indicated by elevated levels of triglycerides or low-density lipoproteins (even if total cholesterol is normal).
• In rare cases, urinalysis may reveal blood impurities (microhematuria), which are detected during a specific analysis.

However, all these changes are optional; they are not found at all stages of the disease and not in all patients.

Treatment of aortic aneurysm

• stopping smoking is perhaps the most important measure both to prevent the development of an aneurysm and to delay the increase in the diameter of an existing thoracic aortic aneurysm;
• normalization of blood pressure (including with the help of medications);
• normalization of body weight, if necessary with the help of a nutritionist;
• following a low-cholesterol diet to prevent atherosclerosis;
• refusal of serious physical activity;
• prevention of psycho-emotional stress (including taking sedatives).

Given that the causes of aortic aneurysm can vary, other preventative measures may be required. They are determined and explained to the patient by the attending physician after the examination.

Medicines for aortic aneurysm

• With a small diameter of the pathological area in the aorta (up to 5 cm) during the period of dynamic observation of a patient with a thoracic aortic aneurysm.
• In case of severe concomitant diseases, when the risk from the operation exceeds the risk of rupture of the aneurysm itself. These conditions include acute coronary circulatory disorders, acute cerebral circulatory disorders, and heart failure of II – III degrees.
• During the period of preparation for surgery.

For each patient, the attending physician selects his own treatment regimen depending on the type and size of the formation, as well as depending on the patient’s symptoms and complaints. However, there are several groups of drugs that are prescribed most often.

• drugs that reduce heart rate (heart rate);
• drugs to lower blood pressure;
• cholesterol-lowering drugs.

To reduce heart rate, beta-blockers are most often used, which affect the innervation of the heart. If the use of beta blockers is contraindicated, verapamil from the group of calcium channel blockers can be prescribed. It is necessary to slow down the heart rate to beats per minute. This significantly reduces the load on the aortic walls and reduces the likelihood of complications.

Composition and release form

Dosage and regimen

Tablets 10 mg, 40 mg

The initial dose is 20 mg, the average dose is one dose per day.

Tablets 25 mg, 50 mg, 100 mg

50 or 100 mg times per day.

Tablets 2.5 mg, 5 mg, 10 mg

The daily dose is from 2.5 to 10 mg at a time.

Tablets 2.5 mg, 5 mg, 10 mg

2.5 mg, 5 mg or 10 mg once a day.

Tablets 40 mg, 80 mg

mg 3 times a day.

Blood pressure also needs to be reduced to reduce tension in the aortic wall. For these purposes, calcium channel blockers and ACE inhibitors (angiotensin-converting enzyme inhibitors) are used. For each patient, the attending physician selects drugs from the group that best suits him. In some cases, a combination of drugs is possible. The purpose depends on the causes that cause hypertension.

Composition and release form

Dosage and regimen

Tablets 5 mg and 10 mg

Daily dose 5 mg or 10 mg once.

Tablets 5 mg, 10 mg, 20 mg

5 mg, 10 mg, 20 mg 2 times a day.

Tablets 5 mg, 10 mg, 20 mg

5 mg, 10 mg, 20 mg once.

Tablets 2.5 mg, 5 mg, 10 mg

2.5 mg, 5 mg, 10 mg 1 time per day.

Tablets 2 mg, 4 mg, 8 mg, 10 mg

Pomg once a day.

Atherosclerosis is a risk factor for rapid aneurysm growth, contributing to weakening of the vessel wall. Timely treatment can delay the progression of the process for a long time. Drugs from the group of statins, fibrates, and bile acid sequestrants are used. The doctor chooses the drug for the treatment of a particular patient, based on the test results.

Composition and release form

Dosage and regimen

Tablets 10 mg, 20 mg, 40 mg

Pomg at a time, take once in the evening.

Tablets 10 mg, 20 mg, 40 mg

Pomg for 1 time in the evening.

Tablets 10 mg, 20 mg, 40 mg

Pomg once in the evening.

Tablets 145 mg, 160 mg, 200 mg, 250 mg

mg 1 time per day.

g per day of administration.

For various complications of an aortic aneurysm or concomitant disorders, the patient may require other medications. For example, if an aortic aneurysm appears against the background of a systemic infection, a course of treatment with antibiotics that are effective against the causative microbe is necessary. Various vitamin complexes, drugs to strengthen the vascular wall, and drugs against the formation of blood clots may also be prescribed. However, there are no uniform standards of treatment. The specialist navigates the situation based on the disorders found in the patient. Self-medication with the above drugs without consulting a doctor is very dangerous. Incorrect dose selection can accelerate the rupture of the aneurysm or put excessive strain on other internal organs.

Surgical treatment of aortic aneurysm

• acute circulatory disorders in the vessels of the heart;
• circulatory failure II or III degree;
• serious problems with blood circulation in the vessels of the brain (if there are corresponding neurological problems);
• impossibility of adequate revascularization of at least the deep arteries of the femur (after the operation there will be insufficient blood circulation).

A previous myocardial infarction with a stable electrocardiogram for three months or a stroke six weeks ago (in the absence of neurological disorders) are not contraindications. Such patients may undergo surgical removal of the aneurysm.

• detailed examination of the state of the respiratory system (spirography);
• assessment of the condition of the kidneys in order to exclude hidden renal failure;
• It is mandatory to assess the condition of the blood vessels of the lower extremities, as well as the coronary arteries and arteries of the pulmonary circulation;
• determination of sensitivity to antibiotics prescribed for staphylococci and Escherichia coli (these microorganisms most often cause postoperative complications).

Regardless of the type of aneurysm, antibiotic therapy is prescribed in advance (usually 24 hours before surgery) to prevent postoperative complications. Within a day, a sufficient concentration of antibiotic appears in the blood to prevent the proliferation of pathogenic (disease-causing) bacteria.

• Classic surgery. Classic intervention is understood as a large-scale abdominal operation with general anesthesia and wide tissue dissection. The goal is to remove the section of the aorta with the aneurysm and replace it (usually with a graft). As a result, blood flow through the aorta is completely restored. The big disadvantage of this operation is its traumatic nature. There is a high risk of complications during and after surgery. Even in the absence of complications, the patient usually takes a long time to recover and loses his ability to work for a long time.
• Endovascular surgery. Endovascular surgery is understood as a set of methods in which large-scale tissue dissection does not occur. All necessary instruments are brought to the aneurysm through other vessels (often through the femoral artery). Depending on the type and size of the aneurysm, there are several intervention options. Sometimes a special reinforcing mesh is installed into the lumen of the vessel, which prevents the growth or separation of the formation. For small saccular aneurysms, sometimes they resort to “sealing” the mouth. Currently, there is a fairly wide range of manipulations through endovascular access. However, all of them are performed, as a rule, for small saccular aneurysms, when there is no serious threat of rupture.

If we are talking about aneurysm dissection, rupture or other complications, or the risk of rupture, according to doctors, is very high, only conventional surgery is performed. It gives more extensive access to the aorta, allows you to more reliably eliminate the problem and clearly examine other weak areas of the vessel, if any. Also, classical surgery is the only treatment option for large and giant fusiform aneurysms.

Traditional treatment of aortic aneurysm

• Dill infusion. Infuse one tablespoon of finely chopped dill in 400 ml of boiling water. Divide this portion into 3 parts and drink throughout the day.
• Hawthorn infusion. Dry and chop the red hawthorn fruits well. To prepare the infusion, you need two spoons of the resulting powder. Pour the powder into 300 ml of boiling water and leave for half an hour. Divide into three parts and consume 30 minutes before meals.
• Infusion of gillyflower. This infusion is prepared from two tablespoons of jaundice. Pour in 150 ml of boiling water. Drink 15 ml 5 times a day. You can add sugar to the prepared infusion to improve the taste.
• Elderberry decoction. To prepare this decoction you need Siberian elderberry root. Boil 200 ml of water, add chopped elderberry root, let simmer over low heat for 15 minutes. Remove from heat and leave for another 30 minutes. Strain the resulting broth and pour into a glass container. Drink one tablespoon 3 times a day.

It is necessary to understand that none of the remedies recommended above will have the most important effect - slowing down the growth of the aneurysm. When using traditional medicine, only temporary relief of symptoms of the disease, such as shortness of breath or swelling, is possible. Therefore, relying on herbal recipes is completely unacceptable. Complete cure can only be guaranteed by timely consultation with doctors and surgical treatment.

Prognosis for aortic aneurysm

• Aneurysm shape. As a rule, dissecting aneurysms are the most dangerous. The best prognosis is often for fusiform true aneurysms, the walls of which are stronger.
• Reason for formation. Aneurysms that appear against the background of atherosclerosis grow more slowly. With syphilis, the prognosis is worse, since the disease that has reached the aortic wall is already at a late stage, and other organs may be affected. Congenital connective tissue diseases generally have a poor prognosis because there is no effective treatment.
• Aneurysm size. Larger aneurysms often cause more symptoms and are more likely to rupture. The prognosis for them will be worse.
• Patient's age. Atherosclerotic aneurysms usually form in people over 40 years of age. At the same time, they may have various concomitant diseases - coronary heart disease, kidney or liver problems, etc. All this can become a relative or even absolute contraindication to surgical treatment. The prognosis, of course, is getting worse.
• Stage of the disease. Fresh aneurysms that form within the last few weeks have a worse prognosis because it is more difficult for doctors to assess the risk of rupture. Subacute aneurysms have a better prognosis.
• Location of the aneurysm. It is difficult to say which aneurysms are more dangerous - the thoracic or abdominal aorta. In both cases, rupture most often leads to the death of the patient. An important factor is which branches of the aorta are affected by the aneurysm. This largely determines the volume and complexity of surgical intervention (especially when it comes to prosthetics). The worst prognosis will be for multiple aortic aneurysms located in both the thoracic and abdominal cavities.

In general, aortic aneurysm without surgical treatment is considered a disease with a poor prognosis. The very presence of an aneurysm indicates the possibility of its rupture with lethal internal bleeding. The possibilities of preventive methods and drug therapy are not limitless. If the patient has undergone successful surgical treatment, the prognosis is favorable. Re-formation of an aneurysm or other complications after surgery are possible, but they no longer pose such a serious danger. In this case, the prognosis will depend more on the patient himself (whether he will conscientiously follow the doctors’ instructions).

Is there any disability for an aortic aneurysm?

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