Aortic aneurysm – causes, symptoms, treatment

Aneurysms are limited (segmental) pathological expansions of the aorta or other arterial vessel. 

Aneurysm definition

Men are 3 to 10 times more likely to develop aneurysms than women. With advancing age, the frequency of aneurysms gradually increases. Rupture of the dilated and thinned vessel wall in the area of the aneurysm often results in massive life-threatening hemorrhages. Through their pulsations, aneurysms can cause atrophic changes in the surrounding tissues, even destruction of bones – the so-called lacerations. 

Causes of aneurysms 

Aneurysms are most often due to severe atherosclerosis, degenerative changes or inflammatory processes in the vessel wall, as well as vessel injuries. Various pathological processes destroy the elastic membranes in the wall of the aorta, this section weakens and during the pulsations, the wall gradually expands permanently and an aneurysm is formed. 

Abdominal aortic aneurysm is due to atherosclerosis and occurs in elderly patients. In the abdominal aorta, atherosclerotic plaques are the most numerous, destroy the elastic membranes of the vascular wall, and in this section the aorta in some patients expands, which is also a prerequisite for rupture with massive hemorrhage. 

Aneurysm of the thoracic aorta is typical of the late stage of syphilis and affects mostly young people. Cases of destruction of the sternum from the continuous pulsations of the aortic wall have been described in the medical literature. In some patients in the past, when syphilis was a widespread disease, the aneurysm destroyed the sternum and pulsated under the skin of the breast. At some point, a fountain of blood gushes from the patient’s chest, as a result of the rupture of the aneurysm, and he dies dramatically. 

Thoracic aortic aneurysm symptoms 

Syphilitic aneurysm

Aneurysm of the thoracic part of the aorta presents with pain behind the sternum, shortness of breath and palpitations. There is headache and sometimes swelling of the face from compression of the superior vena cava. The cough and hoarse voice are caused by compression of the return nerve and the trachea or base of the left lung. During auscultation, a typical systolic murmur is detected in 75% of patients.

Symptoms of aneurysm of the thoraco-abdominal aorta 

With these aneurysms, the complaints are a feeling of heaviness and pain in the epigastrium and increased pulsations in the upper part of the abdomen, where a pulsating swelling can be felt. Pulsations are synchronous with cardiac activity and a systolic murmur is heard. Computed tomography and angiography specify changes in the aorta. 

Abdominal aortic aneurysm symptoms 

Aneurysms of the abdominal part of the aorta are more than 30% of the aneurysms of the whole organism. Abdominal pain in them can be periodic or constant, often dull or appearing at night. Nausea, vomiting, abdominal distension, constipation, manifestations of ileus are observed due to compression of adjacent organs. Aneurysms up to 3-4 cm in size in healthy patients can be asymptomatic. Palpation of a pulsating formation in the abdomen is characteristic of the aneurysm of the abdominal aorta. An important symptom is the systolic murmur below the aneurysm, which is detected in 50% of cases and is absent in thrombosed aneurysms. The most severe are ruptured abdominal aneurysms, in which there is growth or sudden sharp pain, accompanied by signs of shock and increasing anemia. The tumor-like mass in the abdomen acquires indistinct boundaries, the pulse increases with a drop in blood pressure. Diagnostic tests are ultrasound, X-ray, computed tomography. 

Aneurysm of the abdominal aorta must be distinguished from various tumor processes in the abdomen, canine tapeworm (echinococcal cyst) of the liver, cysts of the pancreas (pancreas), and in the case of ruptured aneurysms of the abdominal aorta – with all diseases leading to an acute surgical abdomen .

Aortic aneurysm treatment 

Treatment is operative and successful in the initial stage, before complications of the aneurysm have occurred. Ruptured aneurysms have a mortality rate of up to 100% if not operated on within the first hours after rupture. During the operation, the enlarged segment of the aorta is cut out. This is followed by replacement of the aneurysmal expansion with a graft and restoration of blood circulation of arterial branches of the aorta in the region of the chest (carotid and subclavian arteries) and the thoraco-abdominal segment (visceral, renal and iliac arteries). 

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