Symptoms and treatment of abdominal aortic aneurysm

The aorta is the largest, main blood vessel in the circulatory system, smaller vessels branch from it.

The abdominal part of the aorta extends from the diaphragm to the lower back, where there is a divergence into the iliac arteries.

More than ten vital branches of the vessels that feed the organs of the abdominal cavity branch from it: kidneys, liver, spleen, stomach.

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The abdominal region continues to the thoracic, located next to the upper intestine. On the right side of it passes the inferior vena cava. Inflammation in these places can also negatively affect the walls of the aorta.

The structure of the vascular walls has three layers:

  • Outer. The adventitious layer, it consists of connective tissue.
  • Average. An elastic layer consisting of muscle and elastic fibers, which provides stretching and a return to its original state during pulsation.
  • Interior. Endothelium, a type of epithelial tissue.

Aneurysm of the abdominal aorta is most often localized in adventitia and in the middle layer.

Symptoms

Symptoms of abdominal aortic aneurysm have been absent for quite some time. It is often called a time bomb.

Diagnosis of abdominal aortic aneurysm occurs in such cases quite by accident, when examining other organs and systems (during ultrasound, radiography of the abdominal cavity or laparoscopy due to concomitant pathology of the abdominal organs).

All symptoms of protrusion of the abdominal aorta can be divided into four main groups:

  1. Abdominal symptoms – occurs when it is not the abdominal aorta that is affected, but its visceral branches. Or there is a mechanical compression of the internal organs by an excessively protruded artery wall.
  2. Radicular symptoms are associated with compression of the spine, nerve roots and nerve trunks.
  3. Urological symptoms – due to the occurrence of aneurysm of the infrarenal aorta, clamping of the renal arteries or their direct damage, as well as the displacement of one or both kidneys under the influence of aneurysm of the abdominal aorta, compression of the ureter.
  4. Symptoms of vascular lesions of the lower extremities – arises due to the difficulty of blood flow to the lower extremities, or there is a direct lesion of the femoral arteries.

The abdominal symptoms include typical dyspeptic manifestations – nausea, vomiting, belching, flatulence, constipation. Pain may appear. There are dull, aching, bursting, pulling pains in the mesogastric and epigastric regions, as well as their appearance in the left hypochondrium and lateral regions.

In the interictal periods (in the absence of pain) there is a pulsation of the abdominal aorta, a feeling of heaviness and bursting in the epigastric region.

Urological symptoms are characterized by the appearance of dysuric disorders (decreased or increased urination, pain during mycotomy (emptying of the bladder), and the appearance of blood in the urine – macrohematuria). If an aneurysm in the abdominal aorta compresses the testicular vessels, then men experience pain in the testicles, varicocele (dropsy of the testicle). Perhaps the occurrence of a pain syndrome that mimics an attack of acute renal colic.

With a sciatica complex of symptoms, the pain is primarily localized in the lumbar region, and then it radiates to the inguinal region and to the perineum. Sensitive disturbances in the lower extremities may occur in the form of loss of sensitivity or the appearance of paresthesia. And also often the appearance of impaired motor function of the lower extremities.

With damage to the vessels of the lower extremities, an intermittent claudication syndrome appears, which is characterized by the impossibility of prolonged walking. Such patients are forced to stop to rest, after which they can continue their journey. During walking and after a long pastime on the legs, there is a sharp pain in the calf muscles.

Exfoliating aneurysm is characterized by a picture of an acute abdomen. Sharp, spilled pains occur throughout the abdomen. Peritoneal symptoms are positive. Then sharp back pain and collapse occur. The patient is pale, inhibited, the pupils do not respond to light, the skin is earthy in color, covered with cold, sticky sweat. The abdominal aorta begins to pulsate intensely.

If the aneurysm was originally located high, closer to the thoracic region, then its rupture can simulate heart attacks that occur behind the sternum and radiating to the left shoulder blade, shoulder, supra-subclavian region.

If the aneurysm bursts into the inferior vena cava, then a clinic of acute heart failure occurs. Swelling of the lower extremities appears, patients are pale, they have tachycardia, shortness of breath, blood pressure decreases. There are pains in the abdomen and lumbar region. When viewed in the abdomen, a pulsating formation is observed, during its auscultation, systolic-diastolic murmur is heard.

An abdominal aortic aneurysm can erupt into the duodenum. In this case, a clinic of gastrointestinal bleeding occurs: blood pressure drops, heart rate increases, the patient has melena (a dark cherry stool due to blood impurities in it), and vomiting of the color of coffee grounds. In this case, it is very important to differentiate gastrointestinal bleeding with stratified aneurysm from other etiological factors.

Not many people know where the abdominal aorta is located, but when it ruptures, the blood very often breaks into the intraperitoneal space. In cases of stratified aneurysm, a clinic of hemorrhagic shock occurs. The patient is pale, limbs feel cold, skin is covered with cold, sticky sweat. The pulse is palpated weakly, quickened, but threadlike.

Abdominal aortic aneurysms often grow slowly and are usually asymptomatic, which makes it difficult to identify them. Some aneurysms may never burst. Many are initially small in size and remain so, although many expand over time. Others expand rapidly. It is difficult to predict how quickly aortic abdominal aneurysm will increase.

As the aneurysm increases, some people may notice:

  • a feeling of ripple near the navel;
  • deep, persistent pain in the abdomen or side of the abdomen;
  • lower back pain.

Abdominal aortic aneurysm occurs due to pathologies of the vascular wall and high blood pressure.

The main reasons that can provoke its development:

  • Atherosclerosis.
  • Inflammatory diseases.
  • Traumatic factor.
  • Congenital abnormalities.

Factors contributing to the development of the disease:

  • Smoking.
  • Наследственность.
  • Hypertension.
  • Hypercholesterolemia.
  • Age over 50 years.
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Atherosclerosis

Atherosclerosis is considered the most common cause of this disease.

With its development, cholesterol, atherosclerotic plaques, blood clots are deposited on the walls of blood vessels.

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Overlapping the passageway, they reduce the lumen of the vessel, the walls lose their elasticity.

The increase in pressure leads to stretching of the walls of the arteries. The walls that have lost their elasticity do not return to their original form. According to international statistics, 9 out of 10 cases of pathology are caused by atherosclerosis.

Injuries are much less likely to cause aneurysm, since under the physical influence of the walls of the vessels more often break, rather than deform.

The list of such injuries includes:

  • Penetrating wounds: fragmentation, bullet, knife. In some cases, they lead to vascular damage or infection.
  • Closed injuries, bruises of the upper half of the body. A sharp pressure drop during a bruise stretches and weakens the vascular walls.

The traumatic factor is relatively rare in relation to the others, but the result, under certain conditions, can lead to an aneurysm. Therefore, it cannot be excluded from the general list of reasons.

The cause of the aneurysm sometimes becomes hereditary diseases in which the structure of the connective tissue, for example, Marfan syndrome, is changed, relative to the norm.

It can also form due to pathologies of fetal development. After childbirth, the disease may not manifest itself immediately, but only upon reaching a conscious age.

Inflammation, both infectious and non-infectious, can contribute to the formation of aneurysm.

Infectious aortic inflammation is called aortitis. The focus that has arisen on the vascular wall partially destroys the tissue, and aneurysms are formed in the area thus weakened.

Aortitis is caused by streptococci, staphylococci, pathogens of syphilis, tuberculosis, salmonellosis, as well as some fungi and viruses.

The infection enters the aorta with blood flow, for example, bacterial endocarditis, inflammation of the inner membranes of the heart, can become the cause of this inflammation.

In addition to infectious diseases, this dangerous defect in the arterial wall can also occur as a result of autoimmune diseases in which its own antibodies fight against the body.

Tissues of the walls of blood vessels are destroyed by:

  • Rheumatoid inflammation.
  • Ankylosing spondylitis.
  • Aortic arch syndrome.
  • Collagenosis.
  • Vasculitis.

Often this disease is asymptomatic, especially in the first stages. Usually it is detected by accident, during the diagnosis of other diseases or surgical intervention.

The absence of symptoms is very dangerous, often aneurysm becomes known only upon the rupture of the vessel, the patient can die without waiting for medical help.

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Indirect symptoms and signs of its appearance are as follows:

  • Soreness in the abdomen.
  • Ripple in the stomach.
  • Unexplained surges in blood pressure.

In addition, there are some sets of symptoms that vary depending on the location of the aneurysm:

  • Abdominal. Characterized by digestive problems.
  • Urological. When the position of the kidneys changes, urination is impaired, the composition of urine changes, blood appears in it, pains are observed in the lumbar spine.
  • Ischiradicular. It manifests itself when squeezing the lumbar spine. It is characterized by numbness and loss of sensation of the legs.
  • Ischemia of the lower extremities. It occurs with a decrease in the volume of blood entering the legs. Feet freeze, gait is periodically disturbed.

These are just common signs by which aneurysm can be determined. The disease manifests itself in different ways, while the symptoms do not indicate the severity of the condition.

Pressure surges

Classification and localization

Aneurysms are classified by type, shape, size, course and location.

Classification by type of education:

  • The true ones. The most frequent. They are characterized by stretching of the aortic wall and the formation of a pocket.
  • False. They are a cavity filled with arterial blood, communicating with the vessel through an opening in its wall. In this case, hemorrhage does not occur, because blood does not flow further.
  • Exfoliating. Formed with vessel defects due to cholesterol plaque or thrombus, uneven blood pressure on the walls. Between the layers appears a gap filled with blood. Exfoliating aneurysm is more dangerous than others due to rapid development.
  • Saccular or saccular. They are characterized by a distinct protrusion of the walls in one place.
  • Diffuse, fusiform, fusiform or fusiform. Expressed in an increase in the diameter of the entire aorta.

By size, they are divided into:

  • Small ones. Width 30-50 mm.
  • Medium. 50-70 mm.
  • Big ones. Exceeding 70 mm.
  • Gigantic. They are characterized by vessel expansion up to 150 mm.

According to the clinical picture of the course of the disease:

  • Complicated by rupture (exfoliating, thrombosed)
  • Uncomplicated, threatening a gap.
  • Suprarenal. Located above the branch that feeds the k >

    Total called aneurysm, in which pathology is observed throughout the abdominal aorta, and sometimes affects the thoracic.

    According to ICD 10, the international classification of diseases complicated by rupture of aneurysms of the abdominal aorta has a code of 171.3, and not complicated by 171.

    Causes and risk factors for abdominal aortic aneurysm

    Most aortic aneurysms appear in the part of the aorta that belongs to the abdominal cavity. Although the exact cause of abdominal aortic aneurysms is unknown, many factors can play a role, including:

    • Smoking tobacco. Cigarette smoking and other forms of tobacco use increase the risk of aortic aneurysms. In addition to the harmful effects of smoking directly on the arteries, smoking contributes to the accumulation of lipid plaques in the arteries (atherosclerosis) and high blood pressure. Smoking is also the reason for the rapid growth of aneurysm and further damage to the aorta.
    • Sealing of arteries (atherosclerosis). Atherosclerosis occurs when lipids and other substances are deposited on the inner wall of a blood vessel, increasing the risk of aneurysm.
    • Aortic infection (vasculitis). In rare cases, an abdominal aortic aneurysm can be caused by an infection or inflammation that weakens part of the aortic wall.
    • Aneurysms can develop anywhere throughout the aorta, but when they form in the upper part of the aorta, they are called thoracic aortic aneurysms. More often, aneurysms form in the lower part of the aorta and are called abdominal aortic aneurysms.

    The reasons for the development of abdominal aortic aneurysms are very diverse. The most common cause of aneurysm is atherosclerosis. Atherosclerotic aneurysms account for 96% of the total number of all aneurysms. In addition, the disease can be congenital (fibromuscular dysplasia, Erdheim cystic medionecrosis, Marfan syndrome, etc.

    ) and acquired (inflammatory and non-inflammatory). Aortic inflammation occurs when various microorganisms are introduced (syphilis, tuberculosis, salmonellosis, etc.) or as a result of an allergic-inflammatory process (nonspecific aortoarteritis). Non-inflammatory aneurysms most often develop with atherosclerotic lesions of the aorta. Less often are the result of trauma to its wall.

    • Arterial hypertension;
    • Smoking;
    • The presence of aneurysms in other family members. Which indicates the role of the hereditary factor in the development of this disease;
    • Gender: Men over the age of 60 (women have less frequent abdominal aortic aneurysms).

    This pathology is most often diagnosed in men after 60 years.

    So what are the causes of abdominal aortic aneurysm:

    1. Congenital anomalies – intrauterine malformations of the heart and blood vessels, dysplastic conditions, congenital predisposition of the vascular endothelium to bulge, fibro-muscular dysplasia.
    2. Genetic diseases – a group of pathologies characterized by damage to the connective tissue, mostly vessels. One of these conditions is Marfan syndrome, which is characterized by systemic damage to the connective tissue.
    3. Atherosclerotic lesions of the aortic wall are the most common cause of aneurysms. Due to atherosclerosis, lipoproteins, cholesterol are deposited in it and an atherosclerotic plaque is formed, which narrows the lumen of the vessel. Aneurysm is formed compensatory, due to the inability of the entire volume of blood to pass through a narrowed vessel. The predisposition of the vascular wall due to its atherogenic damage also joins this.
    4. Dull injuries and closed abdominal injuries – car accidents, falls from a height provoke the formation of protrusion.
    5. Syphilis – affects all organs and systems of a person, including blood vessels.
    6. Tuberculosis – with hematogenous spread of the pathogen, an abdominal aortic aneurysm may occur.
    7. Rheumatism and rheumatic fever are an autoimmune disease in the process of development of which immune complexes are deposited in the internal organs and vessels.
    8. Hypertension and arterial hypertension – increased pressure inside the vessel leads to bulging of its wall.
    9. Iatrogenic causes are caused by the intervention of medical professionals. Such abdominal aneurysms can occur after various reconstructive operations on the abdominal part of the vessel (stent placement, drug expansion), after X-ray examination of blood vessels.
    10. Inflammatory diseases of the vascular wall – aortoarteritis that occur in the abdominal aorta lead to aneurysms.
    11. Specific damage to the vascular wall in salmonellosis and mycoplasmosis.
    12. Chronic pulmonary hypertension.
    13. Long-term exposure to nicotine, and it does not matter at all, smoking was active or passive.

    All these factors cause the same reaction in the aortic wall. In response to the action of etiological factors, a local inflammatory reaction occurs in the artery wall. This leads to the fact that macrophages and lymphocytes begin to infiltrate the endothelium, which, in turn, stimulates the release of cytokines and increases proteolytic activity.

    Due to the above processes, the aortic matrix is ​​destroyed in the middle layer of its membrane, collagen production increases with a simultaneous decrease in elastin production. In place of smooth muscle cells and connective tissue, cystic cavities form, which reduce the strength of the aortic wall.

    Pressure surges

    According to statistics, about 80% of the number of people prone to aneurysms are hypertensive. And this is not surprising, because its formation and subsequent development leads to the appearance of another disease – arterial hypertension.

    At the same time, both of these diseases have the peculiarity of enhancing the negative effect of each other on the body.

    Pain sensations

    Pain syndrome is localized in the umbilical region and above. Determining the source of the pain can be difficult, as the pain can give off to the lower abdomen, pelvis, and lumbar spine.

    Dull, aching pain, intensifying after eating, intense exertion, is characteristic.

    This symptom is observed in almost half of patients, it is recorded in 40-60% of cases.

    Abdominal throbbing

    Some patients pay attention to the fact that the stomach pulsates with the heart. This sensation may be constant, or manifest with an increase in blood pressure, as well as with physical exertion.

    Ripple is determined in the middle of the abdomen near the navel or below the solar plexus. As a rule, this symptom manifests itself only with a sufficiently large size of the aneurysm, more than 500 mm, and is observed in only 20-30% of patients.

    The pulsating formation is very well felt in the patient’s abdomen. In this case, the doctor can make a diagnosis during the collection of complaints and examination.

    Often, due to the similarity of symptoms, aneurysm can be confused with renal colic, pancreatitis, or radiculitis.

    Sometimes pain near the chest is mistaken for heart disease.

    Before treatment, differential diagnosis of pathology with these diseases is necessary.

    Risk Factors

    Risk factors for abdominal aneurysms include:

    • Age. Aortic abdominal aneurysms appear most often in people over 65 years of age.
    • Smoking tobacco. Tobacco smoking is a significant risk factor for developing abdominal aortic aneurysm. The longer you smoked or chewed tobacco, the greater the likelihood of developing aneurysm.
    • Atherosclerosis. Atherosclerosis, the deposition of lipids and other substances that can damage the inner wall of a blood vessel, increases the likelihood of aneurysm.
    • Male gender. Men get abdominal aortic aneurysms much more often than women.
    • Family history. People who have a hereditary predisposition to abdominal aortic aneurysm are at increased risk. People who have a family history of aneurysms are prone to develop aneurysms at a younger age and are at increased risk for aneurysm rupture.

    Complications

    Exfoliating aneurysm rupture of the aortic wall (dissection) is the main complication of aortic aneurysm of the abdominal cavity.

    A torn aortic aneurysm can lead to life-threatening internal bleeding. In general, the greater the aneurysm, the greater the risk of rupture.

    Signs and symptoms suggesting aneurysm rupture:

    • sudden intense and constant pain in the abdominal cavity or lower back;
    • pain that radiates to the back or legs;
    • sweating;
    • sticky sweat;
    • dizziness;
    • nausea;
    • vomiting;
    • low pressure;
    • rapid pulse;
    • loss of consciousness;
    • dyspnea.

    Another complication of aortic aneurysms is the risk of thrombosis. Small thrombi may develop in the aortic aneurysm. If a blood clot comes off the inner wall of the aneurysm and closes the blood vessel elsewhere in your body, it can cause pain or block blood flow to the legs, toes, kidneys, or abdominal organs.

    Modern approaches to the treatment of abdominal aortic aneurysms

    • An abdominal aortic aneurysm is detected annually in approximately 12 to 15 out of 100,000 people, and because of the potential for rupture, it increases mortality;
    • Ultrasound or CT screening is recommended for smoking men over 65 years old, and for men over 50 years old and women over 60 years old whose parents or siblings had an aortic aneurysm;
    • It is recommended to operate aneurysms with a diameter of more than 5 cm in women and 5.5 cm in men, or if the aneurysm increased by 5 mm (or more) in less than 6 months;
    • endovascular abdominal aortic aneurysm surgery is the treatment of choice for patients over 65, at high risk due to other diseases, and in previous aortic surgery.

    In the hands of experienced surgeons, an open operation on an aortic aneurysm is in most cases safe and provides long-term results, and is well suited for young patients. During this operation, the aorta is pinched above and below the aneurysm, and the changed area is replaced by a polyester patch.

    Perioperative complications (including cardiac and pulmonary complications, postoperative hernias, sexual dysfunction, paralysis of the lower extremities and death) and recovery time when choosing traditional open surgery can give the worst result in elderly patients or with high operational risk.

    Endovascular treatment of an aortic aneurysm using an implantable stent is a safer alternative to open surgery. This procedure gives excellent results in patients with a suitable anatomical structure.

    Diagnostic methods

    There are several treatments for aortic aneurysms. It is important to know the advantages and disadvantages of each of these techniques. Approaches to the treatment of abdominal aortic aneurysms:

    Dynamic patient monitoring

    When the size of the aneurysm is less than 4,5 cm in diameter, the patient is recommended to observe a vascular surgeon, because the risk of surgery exceeds the risk of rupture of the aortic aneurysm. Such patients should undergo repeated ultrasound examinations and / or computed tomography at least 1 time in 6 months.

    When the diameter of the aneurysm is more than 5 cm, surgery becomes preferable, since with an increase in the size of the aneurysm, the risk of rupture of the aneurysm increases.

    If the size of the aneurysm increases by more than 1 cm per year, the risk of rupture increases and surgical treatment also becomes preferred.

    Open Surgery: Aneurysm resection and aortic prosthetics

    Surgical treatment is aimed at preventing life-threatening complications. The risk of surgery is associated with possible complications, including heart attack, stroke, limb loss, acute intestinal ischemia, male sexual dysfunction, embolization, prosthetic infection, and kidney failure.

    The operation is performed under general anesthesia. The essence of the operation is to remove the aneurysmal expansion and replace it with a synthetic prosthesis. The average mortality rate for open interventions is 3-5%. However, it may be higher when the renal and / or iliac arteries are involved in the aneurysm, as well as due to the patient’s concomitant pathology. Observation in the postoperative period is carried out once a year. Long-term treatment results are good.

    Endovascular prosthetics for aortic aneurysm: stent graft placement

    Endoprosthetics for aortic aneurysms are a modern alternative to open surgery. The operation is performed under spinal or local anesthesia through small incisions / punctures in the inguinal areas. Through the above approaches, catheters are inserted into the femoral artery under x-ray control. According to which, in the future, the endoprosthesis will be brought to aneurysmal expansion. The endoprosthesis or stent-graft of the abdominal aorta is a mesh frame made of a special alloy and wrapped with synthetic material. The last stage of the operation is the installation of a stent graft in the place of aneurysmal expansion of the aorta.

    Ultimately, the aneurysm “turns off” from the bloodstream and the risk of rupture becomes unlikely. After aortic replacement, the patient is observed in the hospital for 2-4 days and is discharged.

    This technique allows to reduce the incidence of early complications, reduce the length of hospital stay of patients and reduce the mortality rate to 1-2%. Monitoring in the postoperative period is carried out every 4-6 months using ultrasound techniques, CT angiography, X-ray angiography. The endovascular treatment is certainly less traumatic. Annually, in the USA alone, about 40 such operations are carried out.

    Thus, the choice of treatment methods for abdominal aortic aneurysms is based on the individual characteristics of the patient.

    Diagnostic procedures are carried out not only to establish a diagnosis, but also to collect information about the location, type and other characteristics of the aneurysm and indications for surgery.

    The primary diagnosis, the study of external signs and palpation is carried out by the surgeon.

    Clarify details using ultrasound, CT, MRI, spiral computed tomography, angiography, x-ray. The patient undergoes general and biochemical blood tests to study the macro product. Since aneurysmal expansion of the abdominal aorta leads to kidney problems, the patient gives urine for examination.

    Ultrasound and tomography

    Ultrasound examination is the simplest and most common method in which you can check for the presence of aneurysm and its anatomy. By examining the visualization of the reflected sound waves, you can establish the diameter of the aorta, the size of the aneurysm, identify the place of separation, according to the results of which the uzist doctor makes a conclusion.

    MRI of the abdominal aorta is performed as a qualifying procedure after ultrasound. Also, with the help of CT and SKT, they get a clear image of the growth, its characteristics, identify the threat of a gap.

    Angiography

    Angiography is an auxiliary method of contrast study of blood vessels in radiography and tomography.

    The contrast agent introduced into the circulatory system is clearly visible in the pictures, which makes it possible to clearly trace the boundaries of blood vessels, to recognize the presence of formations on their walls (parietal thrombosis). Below you can see how the aneurysm looks in the angiography picture.

    Angiography is contraindicated if the patient is diagnosed with liver or heart disease, renal failure, an allergy to the substance and infectious aneurysms.

    An outdated examination method that allows you to confidently diagnose a defect in the vascular wall only with a contrast agent introduced.

    Control and treatment

    • aneurysms are often asymptomatic;
    • abdominal aortic aneurysms are often detected by chance when examining the abdomen when performing x-ray, computed tomography, ultrasound, performed for another purpose;
    • if the aneurysm is small (4.5 cm in diameter) and there are no symptoms, an annual duplex ultrasound examination is recommended;
    • smoking cessation and control of hypertension – optimal prevention of the appearance and growth of aneurysms;
    • It is recommended to operate aneurysms with a diameter of more than 5 cm in women and 5.5 cm in men, or if the aneurysm increased by 5 mm (or more) in less than 6 months.

    The procedure is performed through small incisions in the femoral arteries. After puncture of the femoral artery, the conductor is passed through the enlarged part of the aorta, then the stent moves along the conductor. After the stent is correctly positioned, the balloon expands and the stent extends the vessel wall to prevent the aneurysm from spreading below the renal arteries.

    To ensure proper sealing between the implantable stent and the aorta, most currently available stents require that the aneurysm have a proximal isthmus at least 1.0–1.5 cm below the renal arteries. However, surgery can be performed on patients with aneurysms in which the aneurysm isthmuses are shorter or completely absent by implanting a stent with numerous openings and branches to the arteries of the kidneys or intestines.

    A suitable condition for the iliac arteries is required to conduct the conductor, but the possible insertion of a stent through a small retroperitoneal incision has increased the number of candidates for endovascular surgery

    Compared to traditional open surgery, the endovascular has several advantages:

    • reduction of operation time;
    • decrease in blood loss and the need for infusion;
    • reduction of treatment time in the intensive care unit and hospital stay;
    • reduced risk of complications;
    • less contrast is used, and often less than 60 ml of contrast is required during the procedure;
    • intraoperative and early (up to 30 days) mortality is also less for endovascular operations than for open ones.

    The average stay after an open operation in the intensive care unit is approximately 3 days, then 7-10 days in the department, recovery takes 8-12 weeks.

    Most patients after endovascular surgery do not require hospitalization in the IT department and can be released home the day after surgery. A larger percentage of patients who underwent endovascular surgery are immediately sent home, and not to rehabilitation sanatoriums. These patients return to their normal level of physical activity faster, the rehabilitation period is 1-2 weeks.

    In patients with a minor concomitant pathology, which may have endovascular intervention, some complications specific to this method may also occur. It is extremely rare to switch to an open operation. Problems associated with stent placement occur in 5-10% of patients and require CT or ultrasound monitoring

    Stent displacement is rarely possible, as new generation stents have hooks and they open above the level of the renal arteries for better fixation. “Leaking” – when blood penetrates between the stent and the wall of the aorta – occurs in 5-10% of cases. Most of them – type II “leakage” – blood continues to accumulate in the aneurysm from the lumbar artery.

    When properly observed, the risk of subsequent rupture is extremely low. Therefore, patients should be prepared to perform further examination, which includes computed tomography of the endovascular stent 4-6 months after surgery and then annually. Other less common complications are destruction or infection of the stent.

    The current prognosis for healthy patients who undergo surgery for aneurysm is excellent. Endovascular surgery is an amazing advance in treating patients with a suitable anatomy and is the preferred treatment for high-risk patients and the elderly.

    How is the treatment carried out?

    Aneurysm is almost always subject to surgical removal. Aneurysm resection eliminates the possibility of rupture and can significantly improve patient survival rates. Conservative drug treatment is prescribed only if there are contraindications to surgery and to slow its growth rate.

    Removal operations are divided into emergency and scheduled:

    • Emergencies are performed during tears or in the treatment of dissecting aneurysms. In emergency surgery, the risk to the patient is quite high.
    • Having discovered the pathology in time, the patient is prescribed a scheduled operation. Before it, additional examinations are carried out, the patient is prepared, to reduce the risk of complications.

    The traditional procedure is performed by open surgical method under general anesthesia, by cutting the abdominal wall.

    After gaining access to the proposed location for the operation, the vessel is opened, the aneurysm is excised and resected.

    A tube, graft is inserted into the aortic cavity. Then the edges are stitched together. Bleeding is restored, blood pressure falls on the graft.

    Benefits of classic intervention:

    • The ability to operate on an aneurysm of any size and shape.
    • The ability to examine the internal organs adjacent to the aorta for pathology.
    • Reliability of graft installation.

    The disadvantages of the traditional method:

    • Injury.
    • Risk of infection.
    • Long operation time, more than 2 hours.
    • Lack of blood supply to the lower body during exercise.
    • The stitches placed during the operation may subsequently diverge.

    Immediately after removal of the defect and stenting, the patient is placed in intensive care, from there he is transferred to a hospital with positive dynamics. The total hospitalization in the postoperative period is from one to two weeks.

    It is difficult for elderly patients to undergo abdominal surgery, mortality is high.

    In Russia, this operation can be done on the pole of the compulsory medical insurance in the hospital according to the state quota. For this, it is necessary to undergo a thorough examination and submit documents for consideration by a medical commission. The maximum processing time for an application is 26 business days. If the decision is positive, the date of planned hospitalization is assigned.

    If you can’t get the quota, you can contact a commercial clinic. The average cost of an operation for aortic rupture in Russian clinics exceeds 200 rubles; resection of an unexploded aneurysm is cheaper, from 000 rubles.

    For wealthy citizens there is the opportunity to operate abroad. In Germany, aneurysm removal operation will cost 14-000 euros, in Israel the amount will be an average of $ 16.

    This method of operation differs from the traditional one in that the incision, instead of the abdominal cavity, is carried out on the thigh.

    The algorithm for the implementation of endovascular prosthetics is as follows:

    • A small incision is made on the thigh, then a tube with a folded stent graft is inserted into the femoral artery. A stent is a metal hard folding prosthesis frame, and a graft is a soft, PTFE tube, which is made manually for each individual case.
    • Under observation, through X-ray television, the catheter is inserted through the arteries to the aneurysm.
    • The endoprosthesis is positioned so that it captures the entire area of ​​the lesion.
    • The stent is opened, fixed in the aorta.
    • The tube is removed, the artery and incision are sutured.

    After removal of the aneurysm, blood flow is restored.

    In order for the endoprosthetics to be successful, it is necessary to precisely establish the location, size, shape and structure of the defect.

    The operation is performed under local anesthesia, its duration is from one to three hours.

    Compared with the traditional method of surgery, endovascular surgery has several advantages:

    • Minimal blood loss.
    • Minimal risk of infection.
    • Short rehabilitation period.

    But she also has its drawbacks:

    • Exfoliating aneurysms are not treatable in this way.
    • After the operation, constant medical supervision is required.
    • The high cost of the procedure. It costs an average of more than 300000 rubles.

    Unlike classical surgical intervention, arthroplasty does not remove the aneurysm, but isolates it.

    The presence of this pathology imposes some restrictions on a person. In addition to regular medical examinations, it is necessary to comply with all the recommendations of the doctor, carry out the prescribed therapy.

    It must be remembered that only taking medications – it is impossible to get rid of the aneurysm, you can only try to prevent complications and pathological development of the disease.

    Hypertensive patients need to monitor the pressure, try not to allow its drops.

    It is better to avoid excessive physical exertion, abandon bad habits: smoking and drinking alcohol.

    Patients with atherosclerosis need to follow a diet, excluding animal fats, margarine, eggs from the diet. Starving in this case is not worth it. It is better to supplement your diet with fish, cereals, vegetables, fruits.

    High-fat dairy products are best replaced with non-fat counterparts. Some of these foods help lower cholesterol by providing a splitting effect on it.

    Treatment and drugs

    Here are general guidelines for treating abdominal aortic aneurysms.

    Little aneurysm

    If you have a small aortic abdominal aneurysm — about 4 cm in diameter or less — and you have no symptoms, your doctor may suggest follow-up tactics rather than surgical treatment. In general, small aneurysms do not need surgery because the risk of surgery may outweigh the risk of rupture.

    If you choose this approach, then your doctor will monitor your aneurysm with periodic ultrasound scans, usually every 6-12 months; you must immediately report if you feel pain in the abdominal cavity or lower back pain – potential signs of a rupture.

    Average aneurysm

    The average aneurysm has a size between 4 and 5.3 cm. One cannot say exactly in the case of an aortic aneurysm of the abdominal cavity of medium size about the ratio of the risk of rupture and surgery. You will need to discuss the pros and cons and make a decision with your doctor. If you choose follow-up, you will need to do an ultrasound every 6 to 12 months to monitor your aneurysm.

    A large, fast-growing or “leaking” aneurysm. If you have an aneurysm that is large (larger than 5.6 cm) or rapidly growing (grows more than 0.5 cm in six months), then you will likely need surgery. In addition, a “leak”, a thinned, or painful aneurysm requires treatment. There are two types of surgery for aortic abdominal aneurysms.

    An open operation on the abdominal cavity on the abdominal aortic aneurysm involves the removal of the damaged portion of the aorta and replacing it with a synthetic tube (prosthesis), which replaces the damaged area through open access to the abdominal cavity. With this type of intervention, you probably need a month or more to rehabilitate.

    Endovascular surgery is a less aggressive procedure, in some cases it can be used for aneurysm surgery. The doctor uses a synthetic implant, which is carried out through the artery on the thigh into the aorta using a guide (catheter). The implant – a tissue tube covered with a metal supporting mesh – is placed at the site of the aneurysm and secured with small hooks. Tissue implant strengthens the weakened part of the aorta, prevents rupture of the aneurysm.

    Recovery time for people who undergo endovascular surgery is shorter than for people after open surgery on the abdominal cavity. However, more frequent examinations will be required in the future, because an endovascular implant may leak. Subsequent ultrasounds should be performed every six months during the first year, and then once a year thereafter. Long-term survival rates are similar for both endovascular surgery and open surgery.

    The treatment options for your aneurysm will depend on many factors, including the location of the aneurysm, your age, kidney function, and other conditions that may increase your risk of endovascular or open surgery.

    Lifestyle & Home Remedies

    The best way to prevent aortic aneurysms is to keep your blood vessels as healthy as possible. To do this, you can take the following steps:

    • quit smoking;
    • keep your blood pressure under control;
    • be examined regularly;
    • reduce the amount of cholesterol and fat in your diet.

    If you suspect that you may have an abdominal aortic aneurysm, or are worried about your risk of aneurysm due to a hereditary predisposition, visit your doctor. If an aneurysm is detected at an early stage, treatment can be easier and more effective.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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