Aneurysm of the aorta – symptoms and treatment
Aneurysm is a limited (segmental) pathological extension of the aorta and its arterial branches. Aneutysms are caused by atherosclerosis, degenerative and specific diseases (for example syphilis), and by injuries of the vessels. Men are affected by aneurysms 3 to 10 times more often than women and the diagnosis and complications occur most often between 50 and 60 years of age. In time aneurysms gradually increase, pressuring neighboring organs and tissues and causing destruction of bone tissue. Aseptic inflammation around aneurysms lead to coalescence and lethal perforation in the esophagus, intestines and from there – ruptures in the retroperitoneum, which require emergency surgery.
Symptoms of aortic aneurysm
Aneurysm of the thoracic aorta
An aneurysm of the thoracic part of the aorta is manifested by pain behind the breastbone, shortness of breath and palpitations. There is a headache and sometimes swelling of the face because of compression of the upper empty vein. Cough and hoarseness are caused by a pinched recurrent nerve and compression of the trachea or the base of the left lung. Rarely can be seen pulsations in the jugular fossa. There is detectable auscultatory systolic typical noise in 75% of patients.
In these aneurysms complaints are feeling of heaviness and pain in the epigastric area and strong pulsations in the abdomen, where is palpated tumor, which pulsations are synchronous with the heart and is ascultated systolic noise. Computer tomography and angiography specify the vascular changes.
Aneurysm of the abdominal aorta
Aneurysms of the abdominal aorta are more than 30% of aneurysms of the entire organism. Abdominal pain in them can be periodic or permanent and is often dull or occurs at night. Because of the constriction of adjacent organs occur nausea, vomiting, abdominal distension, constipation, signs of ileus. Aneurysms in sizes up to 3-4 cm in obese patients might be asymptomatic and cannot be palpated. Typical for the aneurysms is pulsating abdominal tumor. Pulsations are transmitted in all directions. By placing a hand between the upperpole of the aneurysm and the arc of the chest - a symptom of De Bakey, can be determined whether the aneurysm is below the renal arteries.
An important feature is the systolic noise under the aneurysm, which is detectable in 50% of cases and in thrombosis of aneurysms disappears. The most dramatic are ruptured abdominal aneurysms where there is an increase or a sudden sharp pain, often accompanied by shock and signs of increasing anemia. The tumor mass in the abdomen has vague frontiers, the pulse is fast with a fall in blood pressure. Diagnostic tests are ultrasound, radiography (butt and profile), computer tomography, the most accurate are digital subtraction aortography and angiography. Differential diagnosis is made with tumor processes in the abdomen or retroperitoneum, echinococcus of the liver, cysts of the pancreas and in ruptured abdominal aneurysms- with all diseases leading to acute surgical abdomen.
Treatment of aneurysms of the aorta
It is only surgical and if possible at the earliest stage when aneurysm are detected as asincidental finding or by screening methods. Ruptured aneurysms have a mortality of 100%, if not operated in the early hours. The aortic aneurysm is surgically resected with using of transplant and this is accompanied by restoration of the circulation of its branches in the chest (carotid and subclavian arteries) and the toracic-abdominal segment (visceral, renal and pelvic arteries).