Aneurysm of the ascending aorta, dilatation of the aorta

It branches like a tree, first into large branches (trunks), then into smaller branches and twigs, and is conventionally divided into several parts or sections:

1. The ascending aorta is the area from the aortic valve to the brachiocephalic trunk.
2. The aortic arch is a short section from which all the vessels supplying the arms and head (brachiocephalic arteries) depart. They anatomically form an arch connecting the ascending and descending aorta.
3. The descending (thoracic) aorta begins from the mouth of the left subclavian artery and continues to the diaphragm.
4. Below the diaphragm and before the bifurcation of the aorta (bifurcation) is the abdominal aorta.

Dividing the aorta into sections is very important for assessing risk and choosing optimal treatment tactics in patients with aortic aneurysms.

An aortic aneurysm is an area of local expansion.

Causes of aortic enlargement

Congenital systemic connective tissue diseases: Marfan syndrome, Ehlers-Danlos syndrome, caused by genetic changes in which the aortic wall has an abnormal structure, can cause the development of an aneurysm.

Acquired diseases that cause aneurysmal changes in the aortic wall: most often this is atherosclerosis. About 80% of all complicated aortic aneurysms are aneurysms caused by an atherosclerotic process, which leads to weakening of the vessel wall and the inability to withstand normal blood pressure, and as a result, to its expansion.

Less commonly, an aortic aneurysm develops in inflammatory diseases caused by external agents (syphilis, fungal infection, tuberculosis) or in autoimmune diseases (nonspecific aortoarteritis).

Prevention

There are no specific measures to prevent such pathology as thoracic aortic aneurysm. Doctors give general recommendations:

Complete cessation of smoking, including hookah and electronic cigarettes.

Complete abstinence from alcohol (the maximum allowed is 100g of medium-strength alcohol during the holidays).
Regular exercise. However, physical activity should be moderate. It is recommended to contact a rehabilitation therapist and exercise therapy specialist, who will select appropriate exercises based on the patient’s diagnosis, the presence of concomitant diseases and the current state of health.
Control of factors that can provoke a rise in blood pressure. These include stress, kidney pathologies, and prolonged exposure to the open air during the warm season.
Control of atherosclerosis. This pathology requires treatment, because it can lead to other serious complications in addition to the aneurysm.
Immediately consult a doctor in case of the slightest suspicion of malfunctions in the cardiovascular system, gastrointestinal tract or lungs. It is necessary to respond to the body's signals to prevent serious complications.

If an aortic aneurysm is already present, prevention consists of preventing the development of complications of the pathology:

Taking anticoagulants prescribed by a specialist. Such drugs are not cheap, but they are vital. They prevent the formation of blood clots in the lumen of the aneurysm.
Optimal physical activity. If the patient works in a position that involves heavy lifting or other physical labor, it is necessary to think about changing professions. Excessive force can cause rupture of the aortic wall.
Control of hypertension. It is necessary to take all medications prescribed by the doctor to avoid increasing blood flow pressure on the thinned wall of the aneurysm. The patient must be aware that it can rupture at any moment.
Control over psychological state. In medical practice, there have been cases where aortic rupture was caused by a minor stressful situation.

In order to monitor the condition of the cardiovascular system, it is necessary to visit a cardiologist annually. And do this not “for show,” but undergo a comprehensive examination. This way you can detect developing diseases in the early stages, which greatly increases the likelihood of successful treatment without incisions and pain. Take care of your health!

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Author

Salmina Daria Vladimirovna

Geneticist. Graduated from the Chelyabinsk State Medical Academy. She completed an internship at the Northwestern State Medical University named after I.I. Mechnikov.

Symptoms of aortic aneurysm

Unfortunately, the diagnosis of aortic aneurysm cannot always be established during the “cold period” (before complications develop), since this disease is usually asymptomatic. Most often, it is discovered accidentally during fluorography, ultrasound or tomography studies performed in connection with other diseases. Treatment of an aneurysm of the ascending aorta before complications develop is much safer for the patient, therefore, in the early diagnosis of an aortic aneurysm, routine medical examination is important.

It is worth noting that every hundredth patient who died suddenly dies from aortic dissection.

Complaints usually appear when the aneurysm begins to stratify or, enlarging, compresses surrounding organs and tissues. Pain or dysfunction of those organs located in the area of the aneurysm appears. At first, this is not of a bright nature and, therefore, does not alarm either the patient or the doctor.

However, the pain intensifies as these deadly complications of an aortic aneurysm develop—it is some of the most severe pain a person can experience. It is localized in the chest if the aneurysm is located in the ascending, descending sections or in its arch, or in the abdomen if it formed in the abdominal section. Characterized by severe weakness, pallor, and often the person loses consciousness.

Impaired blood supply to organs located in the area of aneurysm rupture or aortic dissection (brain or spinal cord, kidneys, intestines, upper or lower extremities) leads to loss of function of these organs, and a large volume of blood loss during aortic rupture represents the most serious danger. To save a life, minutes count. If early surgical treatment is not available, the first-day mortality rate for aortic dissection is 1% per hour (one person in a hundred dies every hour). Within the first 24 hours, 33% of patients die from aortic dissection, 50% of patients within 48 hours and 75% within two weeks. Only early surgical intervention makes it possible to save a significant proportion of patients.

Classification of the disease

Pathology is divided into 3 types depending on the extent and location:

In the ascending aorta with advancement along the arch. Occurs in 50% of the total number of recorded cases of the disease.
In the ascending aorta. Diagnosed in 35% of cases.
In the descending part of the aorta with progression down/up along the arch. Occurs in 15% of cases.

Stretching of the vessel occurs quickly - it does not require weeks. The process can be compared to inflating a balloon, which expands several times when filled with air.

Depending on the duration of the process, an aneurysm can be:

acute – 1-2 days have occurred since the formation of aortic dissection;
subacute – the endothelial defect appeared 2-4 weeks ago;
chronic – the aneurysm formed 4 or more weeks ago.

Some patients ignore the symptoms of the disease and do not see a doctor for years. But the fact that the thoracic aortic aneurysm does not rupture is pure chance and luck. This can happen at any time, and in 90% of cases the person will die.

Diagnosis of aortic aneurysm

In the diagnosis of aortic aneurysms, the so-called imaging techniques (ultrasound, MRI, CT, AG) are of greatest importance. In the ascending aorta, its arch and in the abdominal section, an aneurysm can be detected using ultrasound methods (ultrasound). To diagnose an aneurysm of the descending (thoracic) aorta, X-ray methods (x-ray, computed tomography) are required. To establish a final diagnosis and select a treatment method, contrast research methods are performed. Currently, the optimal diagnostic method, which provides the most complete information about the location, extent, diameter of the aneurysm and its relationship to nearby organs, is multislice computed tomography - aortography.

Treatment methods for aortic aneurysm

The main method of treating an aneurysm of any part of the aorta is surgical. The point of the method is to replace the dilated section of the aorta in order to prevent its further stretching and rupture. To replace the aorta, two methods are used - the endovascular (intravascular) method using a special intravascular prosthesis (stent graft), and open surgery - aortic replacement.

Each method has its own indications, and each of them has its own advantages and disadvantages.

The advantages of the surgical method lie in its versatility, that is, the ability to correct all disorders associated with an aortic aneurysm, regardless of the department and nature of the lesion. For example, in case of an aneurysm of the ascending aorta and damage to the aortic valve, aortic and aortic valve replacement is performed in combination with coronary bypass surgery.

To perform surgery on the ascending aorta and its arch, it is necessary to use artificial circulation, systemic hypothermia, and often complete circulatory arrest.

Indications for surgical treatment

transverse size of the aneurysm,
aneurysm growth rate;
the formation of complications of this disease.

For each section of the aorta, there is a cutoff limit for the transverse size of the aorta, after which the risk of aortic rupture statistically significantly increases. Thus, for the ascending and abdominal aorta, the transverse diameter of the aneurysm is 5 cm dangerous in terms of rupture, for the thoracic aorta - 6 cm. If the diameter of the aneurysm increases by more than 6 mm in 6 months, then this is also an indication for surgery. Also threatening in terms of rupture and dissection of the aorta are the saccular form of the aneurysm and expansion of the aorta, which is smaller than the diameter that is the indication for surgery, but accompanied by pain at the site of expansion and dysfunction of the presenting organs. Dissections and completed ruptures of aneurysms are absolute indications for emergency surgery.

Forecast

If an aneurysm is detected, the patient needs constant monitoring by doctors. Even after surgery, it is necessary to undergo regular examinations to monitor the condition of the blood vessels. Today, no intervention provides a 100% guarantee that the aneurysm will not reappear in another part of the aorta. Therefore, you should take responsibility for your own health and not neglect regular visits to a specialist.

Statistics on aneurysm operations say that the mortality rate of patients six months after surgery and aortic replacement is 10-15%. Within 10 years from the date of surgery, this figure increases to 40%. This is due to the fact that most patients have concomitant chronic diseases.

In case of endovascular intervention, the prognosis is more favorable. The probability of complications and re-formation of an aneurysm is only 10%, while patient death occurs in only 2% of cases.

Types of open surgical operations for aortic aneurysms:

Bentalla-De Bono operation (replacement of the ascending aorta with a valve-containing conduit with a mechanical prosthetic aortic valve);
David's operation (replacement of the ascending aorta while preserving the native aortic valve);

Supracoronary aortic replacement;

Prosthetics of the ascending aorta and its arch (Borst technique, the use of oblique aggressive anastomosis and other techniques);

Thoracic aortic replacement;
Abdominal aortic replacement.

Endovascular interventions

They allow you to dramatically reduce the amount of surgical trauma, shorten hospitalization periods and reduce the inevitable suffering of the patient associated with surgical approaches. One of the main disadvantages of the method is the need for repeated interventions.

Types of endovascular operations for aortic aneurysm:

implantation of a stent graft into the abdominal aorta,
implantation of a stent graft into the ascending (thoracic) aorta.

The most modern method of treating aortic aneurysm is a hybrid method, which allows achieving optimal treatment results with the least surgical trauma.

Hybrid surgeries combine the advantages of open and endovascular interventions.

To prevent the development of aortic aneurysms, the most important thing is the need to control risk factors, namely arterial hypertension. In addition to arterial hypertension, the most significant risk factors are age (over 55 years), male gender, smoking, the presence of aneurysms in direct relatives, and high cholesterol levels.

Potential Complications

The most common complication of the disease is rupture of a thoracic aortic aneurysm. In this case, blood flows freely into the chest, abdominal cavity, pericardium, and esophagus. This condition requires emergency hospitalization and surgery. A ruptured aneurysm in the thoracic aorta without medical assistance will invariably lead to the death of the patient.

Other complications of the pathology are:

Compression, erosion of adjacent structures;
Thromboembolism;
Coronary artery occlusion.

These conditions are deadly. The aneurysm itself is a favorable environment for the formation of blood clots, which under pressure from the bloodstream can break off at any time. If a blood clot enters the lungs, heart or brain, the patient has a more than 90% chance of death. That is why it is so important to consult a doctor at the first symptoms of the disease, who will conduct a diagnosis and select the correct treatment tactics.