Atherosclerosis of the aorta: diagnosis and treatment

Why is atherosclerosis of the aorta really dangerous?

The aorta is a vessel on which the blood supply and nutrition of almost all vital organs depends. From the thoracic region, where the aorta begins, leaving the heart, its branches go to the organs of the chest and the brain. From the abdominal region, where the aorta descends, branches supply all the abdominal organs, kidneys, pelvis and lower limbs. If the lumen of the aorta in the thoracic or abdominal region narrows or, worse, becomes clogged, a deficiency of blood supply develops in certain organs associated with the aorta, which can lead to life-threatening complications in all organs and systems. Did you know that...

Most often, people over 60 years of age suffer from atherosclerosis of the aorta and its branches, but you can also get sick at a young age
Sometimes the initial signs of aortic atherosclerosis are detected even in children 10-12 years old: this suggests that this disease can develop for decades without showing itself in any way
The risk of developing aortic atherosclerosis is approximately twice as high if you are over 40, smoke, drink alcohol, are sedentary, and consume unhealthy foods such as fast food
No one is immune from atherosclerosis: even if you have been taking care of your health since childhood and feel great, it is not a fact that you do not have this disease

Remember: to find out for sure how healthy your blood vessels are, contact our specialists who will conduct an accurate diagnosis and assess your risks. Sign up now.

How to determine pathology

To suspect aortic thickening, it is important to listen carefully to the patient's complaints. To determine the possible cause, I ask in detail when the symptoms appeared, whether the body temperature is rising, whether the joints hurt, whether everything is in order with digestion, with stool, whether the patient has lost weight recently, etc. It is important that the person remembers not whether he suffered from rheumatism in childhood, whether he was registered with a dermatovenerologist for syphilis.

Next I move on to a general inspection. With diseases of the aorta, sometimes I can feel increased pulsation or trembling of the chest. The auscultation method is very helpful. With a stethoscope, I often hear murmurs on the aortic valve or in the jugular fossa (the small depression between the two collarbones). It is imperative to measure blood pressure in both arms: in some pathologies (Takayasu's disease), the readings can be very different.

After this, I schedule an additional examination. First, a blood test is taken to check cholesterol and glucose levels. Then instrumental diagnostic methods are carried out:

X-ray is often a low-informative method of research. You can only see a pronounced deformation or aneurysm.
Echocardiography (ultrasound of the heart) is an excellent diagnostic test, especially if the patient has aortic valve (AV) defects. Damage, calcification of the valve leaflets, regurgitation (backflow of blood), narrowing of the openings, expansion of the root and thickening of the walls are detected.
Computed tomography allows you to make a three-dimensional (3D) reconstruction of the entire aorta and evaluate its condition at any site.
Aortography is visualization of the largest artery by injecting a contrast agent directly into the vessel, which is very informative. In addition to the structure, it is possible to assess the patency of the aorta, identify aneurysms and mural thrombi along its entire length.

A disability group for aortic atherosclerosis is not established.

An example of aortography. The arrow indicates a saccular protrusion (aneurysm)

Stages of development of aortic atherosclerosis

Ischemic – manifested by attacks of angina, claudication, abdominal pain, increased blood pressure
Thrombonecrotic – stage of life-threatening complications, including myocardial infarction, stroke, gangrene, renal failure and others
Fibrous - when the disease develops over a long period of time, fibrous tissue replaces other types of tissue and disrupts the normal functioning of the relevant organs

Please note: symptoms of aortic atherosclerosis begin to appear when the disease progresses and ischemia (lack of blood supply) develops in one of the areas of the blood supply to the organ.

Signs of atherosclerosis of the aorta

Symptoms of aortic atherosclerosis vary - it all depends on which area is affected and how advanced the disease is.

Signs of atherosclerosis of the aorta: thoracic region

Severe chest pain (aortalgia) - lasts several hours and even days, the pain is burning, pressing, radiates to the left and right arm, shoulder, neck, spine, interscapular area, while nitroglycerin does not help
Heart failure with attacks of suffocation - occurs because the affected aorta increases the load on the heart
Increased blood pressure
Difficulty swallowing, hoarseness of voice
Retrosternal attacks of angina - pain radiates to the left arm and left half of the chest
Shortness of breath and palpitations
Dizziness, short-term fainting, pallor of the face, headaches with high blood pressure, memory impairment, increased fatigue, pulsation between the ribs to the right of the sternum, convulsions when turning the head - all these symptoms are caused by a lack of blood supply to the brain

Atherosclerosis of the abdominal aorta: symptoms

Atherosclerosis of the abdominal aorta disrupts the blood supply to the internal organs and lower extremities, which is why the symptoms can be very diverse:

Pain in the navel area is an intermittent “wandering” character, accompanied by bloating and constipation
Increased blood pressure as a result of renal ischemia
Weight loss – occurs due to disturbances in the digestive system
No pulsation in the navel area, under the knees and on the back of the feet
Problems with sexual life in men, infertility
Pain in calves when walking that goes away when you stop
Intermittent lameness
Numb feet
Cold feet
Swelling and redness of the legs and feet
Necrotic ulcers on the skin of the legs - occur in the last stages of the disease

Remember: aortic atherosclerosis is a dangerous disease that can develop for years without symptoms. If symptoms appear, it means that the disease is progressing and can at any time lead to complications that could cost you your life.

Therefore, do not delay your visit to the doctor. Make an appointment now.

Treatment methods

I strongly recommend that all patients with atherosclerotic lesions of the aorta quit smoking if such a problem exists. It is important to change your diet by increasing the amount of fish, vegetables and fruits and reducing the amount of fatty meat, lard, and butter. Patients suffering from diabetes need to significantly limit the amount of carbohydrates consumed and control blood glucose levels.

Medicines: what and for how long

Depending on what caused aortic sclerosis, I use different medications:

Treatment of atherosclerosis requires reducing the concentration of cholesterol in the blood with the help of statins (Rosuvastatin, Atorvastatin). In order to reduce the risk of thrombosis, I prescribe antiplatelet agents (Acetylsalicylic acid, Clopidogrel).
Infectious diseases may be a reason to prescribe antibiotics. For syphilis - Penicillin, for brucellosis - Doxycycline. Tuberculosis requires the use of special anti-tuberculosis drugs - Isoniazid, Ethambutol.
Rheumatological diseases and systemic vasculitis. In the case of autoimmune pathologies, to suppress severe inflammation in the aortic wall, I use glucocorticosteroids (Methylprednisolone) or more powerful immunosuppressants (Cyclophosphamide, Methotrexate).

I would like to note that, regardless of the cause of aortic sclerosis, I prescribe antihypertensive medications for high blood pressure:

for isolated systolic arterial hypertension (high pulse pressure) - calcium channel blockers (Amlodipine) or diuretics (Indapamide, Hydrochlorothiazide);
in the presence of CHF - ACE inhibitors (Perindopril, Ramipril) or sartans (Losartan, Valsartan);
in the presence of coronary heart disease - beta-blockers (Metoprolol, Bisoprolol).

Surgical interventions

Surgical treatment methods are used only when an aneurysm has developed. This is necessary to prevent its further growth and its worst consequence - rupture.

The operation is indicated if the aortic diameter exceeds 55 mm.

There are 2 methods of surgical treatment of aortic aneurysm:

Installation of a stent graft (a metal wire cylinder), which allows to level blood pressure on the weakened walls of the aneurysm, thereby preventing its rupture. The operation is performed under local or general anesthesia. The device is inserted through the femoral vessel and, under X-ray control, reaches the affected area.
Prosthetics with a conduit (a special tube made of pericardial tissue or synthetic material). When replacing the root and ascending portion, the aortic valve is often also replaced. The operation is performed under general anesthesia on an open chest.

Are folk remedies effective?

On the Internet, by searching “folk remedies for treatment of atherosclerosis of the aorta of the heart,” you can find a lot of alternative medicine recipes that promise not only an improvement in the patient’s condition, but also a complete cleansing of all the vessels of the body. Unfortunately, none of them has an evidence base. Their use, at best, will be simply useless, and at worst, harmful and even life-threatening.

Many components of herbs can interact with medications prescribed by a doctor (for hypertension, to lower blood cholesterol, etc.). This leads to the fact that either the therapeutic effect of the drug will worsen, or the likelihood of adverse reactions, sometimes very severe, will increase.

Atherosclerosis of the aorta: complications

As a rule, complications with aortic atherosclerosis develop if the disease is left untreated for years or treated incorrectly.

Intestinal gangrene, which occurs when blood access through the mesenteric artery is cut off: manifests itself as severe abdominal pain, tension in the abdominal muscles, and increasing intoxication
Thrombosis of the superior mesenteric artery - profuse vomiting and profuse feces
Thrombosis of the inferior mesenteric artery – intestinal obstruction and rectal bleeding
Gangrene of the legs due to thrombosis of the femoral artery
Thoracic or abdominal aneurysm - acute bleeding that can quickly lead to death

And a number of other life-threatening complications that can lead to death.

What changes occur in the vessel when it is compacted?

The aorta is an elastic type vessel, that is, its wall contains a large number of connective tissue fibers. She needs this to perform two main functions. Firstly, it stretches quite well, which allows you to maintain diastolic pressure.

It is because of the distensibility of the aorta that blood flows not in spurts, but in a continuous stream, which allows blood to be supplied to the internal organs. This is especially true for the myocardium, which is 85% supplied in the diastole phase.

Secondly, the high content of elastic fibers allows the aorta to withstand the enormous pressure that the blood ejected from the left ventricle exerts on it.

In various diseases, the vessel becomes denser due to the fact that the balance between elastic and collagen fibers shifts towards the latter. Also, in some pathologies, calcium begins to actively deposit in the aortic wall, making it hard.

When the aorta becomes sclerotic, its distensibility decreases, and therefore its ability to maintain diastolic blood pressure at the proper level. This leads to deterioration of blood circulation in internal organs, especially the heart. To correct this, the body has to compensatoryly increase systolic blood pressure through tachycardia and increased peripheral vascular resistance.

The result of such a chain of pathological reactions is the development of so-called isolated systolic arterial hypertension, or the aggravation of existing hypertension.

Due to the poor elasticity of the aorta, the “water hammer” of the blood is not softened, its gradual expansion (dilatation) occurs, and the risk of an aneurysm increases, which can rupture at any time and lead to death.

Atherosclerosis of the aorta: risk factors

There are many factors influencing the development of atherosclerosis. Let's talk about the main ones.

Factors that cannot be eliminated:

Age. The older you get, the higher your risk of developing atherosclerosis of the aorta. If you are over 50, diagnosis is vital – even if there are no symptoms
Floor. Men suffer from atherosclerosis in general and atherosclerosis of the aorta 4 times more often than women. After 55 years, the risk of the disease in both sexes is equalized, since in women the level of sex hormones - estrogens, which, according to scientists, has a beneficial effect on the condition and functioning of blood vessels, decreases
Heredity. If one of your close relatives has had or is suffering from aortic atherosclerosis, your risk of developing this disease is much higher

Avoidable factors:

Smoking and alcohol. Nicotine and other harmful substances contained in tobacco smoke, as well as alcohol, provoke vascular spasms, which increases the risk of narrowing the lumen significantly.
Poor nutrition. If your diet contains too much animal fat, your risk of developing atherosclerosis is higher, as it accelerates atherosclerotic changes in blood vessels.
Sedentary lifestyle. It provokes fat imbalance, which is one of the main causes of cholesterol deposits on the walls of blood vessels.

Partially avoidable factors:

Arterial hypertension. High blood pressure increases damage to the vascular wall, followed by the deposition of cholesterol in it and the formation of atherosclerotic plaques
Dyslipidemia. Impaired fat metabolism is accompanied by an increase in the level of low and very low density lipoproteins (“bad cholesterol”), which accelerates the development of atherosclerosis
Diabetes and obesity. If you are obese or diabetic, or worse, both, your risk of developing arteriosclerosis is 5-7 times higher
Intoxication, infections. Toxic substances and infections damage the walls of blood vessels, which accelerates the development of atherosclerotic changes

Atherosclerosis of the aorta: diagnosis

Diagnosis begins with a consultation. Our specialist will spend as much time as necessary for you to collect all the necessary information: what exactly are you complaining about, whether you have concomitant diseases, whether any of your close relatives have suffered or are suffering from atherosclerosis or other diseases of the cardiovascular system. A general examination, which the doctor will conduct at the appointment, will help to identify or exclude various signs of atherosclerotic vascular damage, for example, edema, trophic ulcers, weight loss or gain and a number of other signs. Auscultation (listening) of the vessels of the heart and aorta will help to identify or exclude murmurs, disturbances in arterial pulsation and other indicators. A blood test will help determine the level of cholesterol, low-density lipoproteins, and triglycerides. Doppler ultrasound will reveal signs of aortic atherosclerosis: its thickening, expansion in the abdominal or thoracic regions, aneurysms, calcification. Ultrasound scanning of the renal vessels will reveal or exclude the presence of plaques in the renal arteries. Ultrasound scanning of the vessels of the lower extremities, aorta, and carotid arteries will help determine how much the main blood flow in them is reduced, as well as identify atheromatous plaques and blood clots in the lumens of the vessels. If necessary, your doctor will refer you for a coronary angiography, which will help accurately assess the condition of the coronary arteries. Please note: only such a comprehensive diagnosis will help make an accurate diagnosis, assess the extent of vascular damage and select the optimal treatment that will really help you. Make an appointment now.

Why can the aorta become sclerotic?

Sclerosis or hardening of the aorta can develop for many reasons, which include:

Atherosclerotic lesion. This is the most common cause of aortic hardening, especially in older people.
Heart defects. In case of aortic valve defects of rheumatic or degenerative origin, the aorta, in particular its root, is also involved in the pathological process.
Various infectious diseases (syphilis, brucellosis, tuberculosis).
Rheumatological pathologies (rheumatoid arthritis, ankylosing spondylitis, reactive arthritis).
Inflammatory bowel diseases (Crohn's disease, ulcerative colitis).
Systemic vasculitis (nonspecific aortoarteritis Takayasu and giant cell (temporal) arteritis Horton.

Atherosclerosis of the aorta

The most common cause of hardening of the aorta is atherosclerotic lesion, which is the deposition of cholesterol in its wall. The main sources of aortic atherosclerosis are:

high blood cholesterol levels;
hypertonic disease;
smoking;
diabetes;
obesity.

In men, atherosclerosis occurs more often and begins earlier than in women. Almost always, atherosclerosis of the aorta is combined with atherosclerosis of the carotid and coronary arteries (vessels that supply the heart). Blood clots quite often form on cholesterol plaques, which can clog the vessels of the brain, kidneys, intestines, etc. and cause a heart attack of these organs.

Atherosclerosis of the aorta: treatment

Proper treatment of aortic atherosclerosis is the only condition for successful recovery. To achieve this, we approach drug therapy for aortic atherosclerosis in a comprehensive manner - as required by this disease:

We reduce the level of cholesterol entering the body with food
We remove existing cholesterol and its metabolites from the body
Blocking the formation of “bad” cholesterol in the liver

Drug treatment

Drug treatment of aortic atherosclerosis includes several groups of drugs. Let's discuss the main ones.

Nicotinic acid and its derivatives Reduce the level of triglycerides and cholesterol in the blood. They increase the level of high-density lipoproteins, which have antiatherogenic properties. Contraindicated for liver disease: if you have any, your doctor will select another medicine.
Fibrates (miscleron, gevilan, atromide) Reduce the synthesis of your own fats, but can adversely affect liver function and provoke cholelithiasis. Statins (Zocor, Mevacor, Liprimar) Reduce the amount of “bad” cholesterol produced by the liver and, as a result, reduce its level in the blood. Statins are taken at night because cholesterol is synthesized, as a rule, at night.
Bile acid sequestrants (cholestide, cholestyramine) Bind and remove bile acids, reduce the level of cholesterol and fats in the body. May cause constipation and flatulence.

Surgery

Surgeries are prescribed when drug therapy does not help. Our specialists will determine how much surgery you need and which method of surgical intervention will be effective in your case. Possible methods may include:

Stenting The surgeon will install a special stent into the lumen of the vessels, which will expand the narrowed area and ensure free blood flow
Bypass surgery The surgeon will install a shunt to bypass the narrowed area, as a result of which blood flow through the affected vessel will be restored
Plastic surgery of a segment of the aorta or its branches with an endoprosthesis

Complications

The consequences of atherosclerotic lesions of the aorta include such dangerous conditions as dissecting aortic aneurysms, renal failure, and stroke.

Aneurysms are considered one of the most serious complications of atherosclerosis. Enlarged areas appear due to weakening of the vascular wall. The danger of an aneurysm of the abdominal aorta or its thoracic region is the rupture and dissection of the artery, as a result of which the patient risks dying on the way to the hospital. We wrote more about the treatment of abdominal aortic aneurysm here.
The formation of blood clots in the aortic arch leads to cerebral ischemia and stroke.
A complication of damage to the buffering zone is the development of necrosis of leg tissue, as well as with obliterating atherosclerosis of the lower extremities. This leads to limb amputation and disability.

Atherosclerosis of the aorta: prevention

Proper prevention is one of the key conditions for successful recovery, which cannot be neglected:

Stop smoking and drinking alcohol
Avoid foods and dishes containing animal fats
Treat concomitant diseases in a timely manner if you have them: diabetes mellitus, arterial hypertension, obesity
Lead an active lifestyle, move more, play sports, but do not overwork your body
Don't be nervous about trifles
Cure infectious diseases in a timely manner
Get annual checkups and examinations, especially if you are over 40 years old

Diet for atherosclerosis of the aorta

Despite the fact that the proportion of cholesterol that we get from food is not very large (up to 25%), proper nutrition in combination with the right treatment and a healthy lifestyle will significantly increase the effectiveness of treatment.

Products we recommend excluding:

Sour cream
Mayonnaise
Sauces
Chips
Salted nuts
Cocoa and chocolate
White butter bread
Baked goods, biscuits, cakes, pastries
Butter and sour creams
Puddings and ice cream
Cheese, margarine, dairy products
Whole milk
Coconut and palm oil
Suet
Butter, animal fats
Pates, hams, smoked sausages
Fat duck or goose
By-products (brains, kidneys, liver)
Fatty meat (pork, lamb, beef)

Foods that will help lower cholesterol levels:

Green salads
Garlic
Onion
Dill
Parsley
Legumes
Fruits
Lean meat
Shellfish
Wholemeal flour
Oat groats
Bran
Fatty sea fish (herring, mackerel, sardines, salmon, tuna)
Vegetable oils

Remember: the earlier aortic atherosclerosis is detected, the higher the chance of stopping the progression of this disease and preventing life-threatening complications. Therefore, do not delay your visit to the doctor. Make an appointment now.