Abdominal aortic aneurysm: causes, signs, diagnosis, stenting

Among serious pathologies that under certain conditions can lead to death, one of the first places is occupied by an aneurysm of the abdominal aorta. The term "aneurysm" means a pathological expansion of a section of a vessel: the vascular wall is stretched and weakened, which can result in stratification and rupture of the vessel. In addition, the risk of thrombus formation in the affected largest artery remains high.

Since the aorta is one of the main vital vessels, such changes in it can cost the patient not only health, but also life.

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Epidemiology

Aortic aneurysm is one of the most dangerous pathologies. Such famous people as Albert Einstein, Charles de Gaulle, actor Andrei Mironov and singer Evgeny Belousov passed away as a result of aneurysm rupture. Moreover, none of these people suspected that they had such a serious disease.

Looking at the statistics, we can see that abdominal aortic aneurysm is diagnosed in 3-5% of cases in the male population after 60 years of age. In childhood, the disease is very rare and is associated with genetics.

In general, the disease is considered to be quite common. For example, during autopsy, an aneurysm is found in 7% of people. However, not all cases were caused by this reason. Nevertheless, abdominal aortic aneurysm is in tenth place on the list of the most common causes of death.

Among all aneurysm localizations, abdominal aortic dilation is most common – in 37% of patients. Ascending aortic aneurysm is diagnosed in 23% of patients, aortic arch aneurysm – in 19% of patients, and descending thoracic aorta aneurysm – in 19.5% of patients.

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Causes abdominal aortic aneurysms

In the vast majority of situations, the development of an abdominal aortic aneurysm is associated with atherosclerotic changes in the vessels. The mechanism is simple: the process of atherosclerotic plaque formation leads to damage to the inner vascular layer, which leads to thinning of the wall and the appearance of a bulge.

However, there are a number of other possible causes of the disease:

• inflammatory reactions in the aorta, for example, in patients with tuberculosis, syphilis, rheumatism, microbial endocarditis, mycoplasmosis, aortoarteritis of non-specific etiology;
• congenital anomalies in vascular development, which include Marfan disease and connective tissue dysplasia;
• damage to the abdominal aorta as a result of trauma to the abdominal cavity, chest or spinal column;
• postoperative complications after interventions on arteries;
• sepsis and fungal infections affecting the aorta.

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Risk factors

Risk factors are all factors that predispose to the development of a disease. They can be divided into those that can be eliminated and those that cannot be eliminated.

• Irremovable factors:

1. old age;
2. male gender (aneurysm develops more often in men);
3. unfavorable heredity (if there have already been cases of abdominal aortic aneurysm among relatives).

• Factors that can be eliminated:

1. bad habits (in particular, smoking);
2. high blood pressure;
3. high blood cholesterol level;
4. high blood sugar limit;
5. significant nutritional errors;
6. significant excess weight;
7. hypodynamia.

To properly prevent the development of abdominal aortic aneurysm, it is necessary to completely eliminate or minimize the influence of removable risk factors. To do this, you need to, first of all, adjust your lifestyle and diet.

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Pathogenesis

In addition to the defect in the development of the aortic wall, other physical and physiological factors are involved in the appearance of an aneurysm. The expansion of the vessel most often occurs in areas of excessive functional stress, in the zone of increased blood flow, non-standard pulse amplitude, etc. Constant damage to the artery against the background of increased enzymatic activity leads to the destruction of the elastic framework and the development of non-specific signs of degeneration in the vascular wall.

An already formed aneurysm gradually progresses, as the tension in the wall increases as the vessel expands diametrically. Inside the aneurysm, blood circulation slows down, and a kind of turbulence is observed. Less than half of the blood volume inside the aneurysm enters the distal section. This is explained by the fact that when entering the damaged area of the aorta, the blood diverges along the walls, while the central flow is restrained by the turbulent process and blood clots that are in the cavity. Clots inside the aneurysm serve as a factor in the further development of thromboembolism of the distal aortic branches.

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Symptoms abdominal aortic aneurysms

In the vast majority of cases, abdominal aortic aneurysm does not manifest itself with any symptoms. The patient does not complain about anything, and the doctor will not be able to suspect anything wrong during a routine examination. This is the main danger of the disease.

Unfortunately, often the first sign of an aneurysm is its rupture, which leads to the death of the patient in almost 90% of cases. The rupture is accompanied by sudden paleness of the skin, loss of consciousness. If immediate surgical intervention is not performed, the patient dies.

Since most patients have no symptoms, an aneurysm can only be detected during diagnostic tests, such as ultrasound, X-rays, etc. Less often, aneurysms are noticed during abdominal surgery.

In rare cases, when the aneurysm reaches a significant size, the first signs may be observed:

1. pressing pain in the upper part of the abdominal wall - intense, paroxysmal, radiating to the lumbar or sacral region;
2. a feeling of pulsation in the abdomen - especially during exercise, with increased intra-abdominal pressure.

If the aneurysm is large, the functioning of nearby organs may be disrupted.

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Forms

There are several different classifications of this disease.

• By location:

1. infrarenal aneurysm, in which the dilation is located below the site of divergence of the renal arteries;
2. suprarenal aneurysm, in which the dilation is located above the site of divergence of the renal arteries.

• By etiology:

1. hereditary aneurysm;
2. acquired aneurysm.

• By character:

1. true aneurysm with layer-by-layer expansion of the entire section of the artery and the formation of a “sac”;
2. false aneurysm, which is accompanied by the accumulation of blood between the layers.

• By form:

1. fusiform aneurysm with expansion along the entire circumference;
2. saccular aneurysm with a local protrusion not exceeding ½ the diameter of the vessel.

• By size:

1. small aneurysm – from three to five centimeters;
2. average aneurysm – from five to seven centimeters;
3. large aneurysm – size exceeds seven centimeters.

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Complications and consequences

An abdominal aortic aneurysm is very dangerous – and, first of all, because it does not reveal itself with any symptoms for a long time. However, contrary to the opinion of many, the absence of symptoms does not mean that there is no danger. The most dangerous complication – rupture of the vessel, can occur even without preliminary signs of the disease.

An aneurysm can rupture for the following reasons:

• in the absence of adequate treatment (if the doctor insists on surgery, then it must be done, otherwise the patient’s life will be at risk);
• during physical activity, which is strictly contraindicated for all patients with aneurysm;
• with high blood pressure;
• when consuming foods that increase gas formation in the intestines;
• in case of worsening atherosclerotic changes in blood vessels, in case of progressive tuberculosis or syphilis.

In addition to rupture, other complications may occur that are much less dangerous:

• frequent dyspeptic disorders;
• urinary disorders, pain in the kidney projection area;
• sensory disturbances, paresis;
• increased degree of thrombus formation, ischemia.

Ruptured abdominal aortic aneurysm

An aneurysm can be complicated by a rupture, which is accompanied by severe bleeding, collapse and shock, and acute cardiac failure.

A damaged vascular wall – an aneurysm – can break through into the pericardial or pleural cavity, into the esophageal cavity, into the superior vena cava system, into the abdominal cavity. The patient’s condition in all cases of rupture is extremely critical: it can be combined with superior vena cava syndrome, hemopericardium and hemothorax, cardiac tamponade, as well as any internal bleeding.

If there were thrombi inside the aneurysm, their detachment leads to the clinical picture of acute vascular thrombosis. There is cyanosis and pain in the fingers of the extremities, hemorrhages of the livedo type, and the inability to walk. If the thrombus passes into the renal arteries, then there is an increase in blood pressure of the rhinovascular type, as well as renal failure.

When a blood clot enters the arteries of the brain, an acute stroke develops.

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Diagnostics abdominal aortic aneurysms

Many patients are diagnosed with abdominal aortic aneurysm by chance, for example, during an ultrasound examination of diseases of the digestive system or kidneys.

If the patient already has any specific complaints, then the doctor, having assumed the presence of an aneurysm, recommends conducting additional diagnostics.

First, the doctor conducts an examination, determines pulsation in the abdominal wall when the patient is in a horizontal position. When listening to the abdominal area, a systolic murmur is detected in the area of the anomaly. When palpating, a protruding pulsating neoplasm can be detected, resembling a tumor - this is an aneurysm.

The tests are included in the list of mandatory studies and include:

• general blood test;
• blood biochemistry;
• determination of cholesterol levels in the blood;
• blood glucose determination;
• rheumatic tests.

Tests are considered auxiliary types of diagnostics: it is impossible to diagnose an aneurysm solely based on test results.

Instrumental diagnostics includes the following research methods:

• Ultrasound examination in combination with duplex scanning helps to examine a vascular anomaly, clarify its location and size, determine the speed and quality of blood circulation in the affected area, and detect signs of atherosclerosis and thrombosis.
• Computed tomography and magnetic resonance imaging are used to provide clearer and more detailed visualization of the aneurysm.
• Contrast angiography is used only to clarify certain unclear points.
• X-rays are used for an aneurysm only when there are calcium deposits on the walls of the affected vessel.

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Differential diagnosis

Differential diagnostics of aneurysm is often required, since many diseases are characterized by a common clinical picture. For example, pulsation can accompany tumor processes in the stomach and pancreas, and enlarged lymph nodes.

The tumor has a dense structure and an uneven surface. It is difficult to move and does not reveal systolic noise (only when the tumor compresses the celiac and superior mesenteric arteries). To clarify the diagnosis, fibrogastroscopy, laparoscopy, aortography and ultrasound are used.

A tumor process in the kidney or such an anomaly as a horseshoe kidney can also be mistaken for an aneurysm. Often, a drooping wandering kidney close to the aorta is confused with an aneurysm. Such a kidney is easily displaced during palpation, it does not have a systolic murmur, and the use of isotope scintigraphy allows for a correct diagnosis.

Aortography helps to finally confirm an aneurysm: this method allows us to differentiate the disease from mesenteric lymphosarcoma, from aortic curvature against the background of high blood pressure.

Treatment abdominal aortic aneurysms

An aneurysm can only be treated surgically, regardless of its size and the presence or absence of symptoms. Drug therapy can only be prescribed when there is no possibility of performing a full-fledged intervention.

No medication can reduce the risk of a ruptured vessel, much less eliminate an anomaly such as an aortic aneurysm. However, surgery eliminates the problem: the surgeon removes the weakened section of the vessel and restores its contours and strength.

Medicines for aneurysm are used primarily to prevent complications, as much as possible. The doctor may prescribe the following medications:

• Cardiotropic agents:

1. Prestarium is taken once a day in the morning before breakfast. The dosage is determined by the doctor. The drug can cause frequent headaches and deterioration of vision.
2. Verapamil is taken 80-120 mg three times a day. During the intake, dyspeptic symptoms, increased urination, and angina attacks may occur.
3. Recardium is prescribed at 12.5 mg daily for two weeks. Longer use may be accompanied by dry mouth, nasal congestion, and increased bleeding.
4. Noliprel is taken in the morning, one tablet daily. Treatment may be accompanied by the appearance of paresthesia, headaches, sleep disorders.

• Antithrombotic agents:

1. Cardiomagnyl is taken 75-150 mg daily. The drug can cause an allergic reaction, heartburn and exacerbation of inflammatory processes in the digestive tract.
2. Thrombo ASS is taken before meals, 50-100 mg once a day, periodically monitoring blood clotting parameters.
3. Clopidogrel is taken at 75 mg once a day. The duration of treatment is at least one month.

• Means for normalizing cholesterol levels in the blood:

1. Atorvastatin is prescribed at 10 mg per day, with possible further dosage adjustment. Jaundice, muscle pain, and insomnia occasionally occur during treatment.
2. Rosuvastatin is prescribed at 5-10 mg per day, but the dose is subsequently revised on an individual basis. Adverse effects of the drug include polyneuropathy, joint pain, jaundice, and diarrhea.

• Medicines that normalize blood glucose levels in patients with diabetes.

Vitamins

To further strengthen the vascular wall in aortic aneurysm, vitamin preparations should be included in the treatment regimen. Which of them are the most effective and popular?

• Ascorutin is a combination of rutin and ascorbic acid. The drug reduces vascular fragility, accelerates tissue regeneration and normalizes carbohydrate metabolism.
• Asparkam is a potassium and magnesium preparation. Asparkam improves cardiac activity, normalizes electrolyte balance, and has antiarrhythmic properties.
• Vitrum Cardio is a multivitamin-mineral complex preparation that is recommended as a prophylactic agent to prevent the development of myocardial ischemia, atherosclerosis, and complications after a stroke.
• Doppelherz Cardiovital is a drug whose action is based on the cardiotonic and sedative properties of hawthorn.

There are quite a few multivitamins that strengthen blood vessels. However, a doctor will help you choose the best drug, taking into account all the indications and contraindications for the use of a particular drug.

Physiotherapy treatment

Physiotherapy is contraindicated in most cases for abdominal aortic aneurysm, as it can provoke increased blood circulation in the affected area of the artery and worsen the patient's condition.

Folk remedies

Folk recipes can be an excellent addition to traditional therapy for aortic aneurysm. However, using such recipes does not mean that surgery can be avoided, as this is the only way to completely eliminate the problem.

• To improve the prognosis for aneurysm, take a medicine based on dried elderberry. One tablespoon of elderberry is infused in a glass of boiling water for half an hour. The infusion is taken 1 tablespoon three times a day.
• Brew 2-3 tablespoons of celandine in 200 ml of boiling water. Take 1 tablespoon of the infusion 4 times a day, with honey.
• An infusion of common dill strengthens blood vessels well. To prepare the medicine, 1 tbsp of dill is infused in one liter of boiling water and drunk throughout the day.
• Grind dry hawthorn berries in a coffee grinder. Brew 2 tbsp. of powder in 0.5 l of boiling water, leave until cool and take three times a day between meals.

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Herbal treatment

The plant mistletoe white lowers blood pressure, improves the condition of blood vessels in atherosclerosis. An infusion of the plant in the amount of 200 ml is drunk in small sips throughout the day. The duration of such treatment is one month.

An infusion based on hawthorn flowers is drunk 100 ml in the morning and evening. Hawthorn tincture can be taken 30 drops 3 times a day before meals.

Motherwort preparations demonstrate a preventive hypotensive effect in aortic aneurysm. Motherwort infusion is recommended to be taken one tablespoon up to 4 times a day. The tincture is taken 40 drops with water up to 4 times a day.

The initial duration of treatment with such drugs is one month. Later, if necessary, you can take the drugs for 10 days during each month.

In addition, it is recommended to drink teas with the addition of chokeberry berries, horsetail and yarrow herbs, coltsfoot and birch leaves.

Homeopathy

Most often, homeopathic doctors recommend treating aneurysms with a homeopathic remedy such as Calcarea Fluorica in dilutions of 3, 6, 12. Other drugs can also be used, depending on the existing symptoms.

• Platinum – dilution 3, 6, 12, 30;
• Aconite – dilution 3x, 3, 6, 12, 30;
• Bryonia - dilution 3x, 3, 6;
• Belladonna - dilution 3x, 3, 6;
• Gelsemium – dilution 3x, 3, 6;
• Drosera Rotundifolia – dilution 3x, 3, 6, 12.

When choosing a homeopathic remedy, it is determined taking into account the patient's constitutional type. The doctor selects a remedy suitable only for this specific case.

You can take these medications in combination - then the effect on aneurysm will be better and longer lasting.

Surgical treatment

Surgical intervention can be performed both planned and urgently. A direct indication for surgery is an aneurysm without complications, the size of which exceeds 50 mm. Urgent surgery is performed in case of vessel dissection or rupture.

Surgical treatment of an aneurysm is performed using general anesthesia and an IR apparatus. The surgeon makes an incision in the anterior abdominal wall, freeing access to the abdominal aorta. The doctor then clamps the vessel from above and below, cuts off the dilated section and installs an artificial implant to the intact parts of the vessel.

An implant, or prosthesis, is a tubular element that is well accepted by the body and does not require replacement during the entire period of use. In some cases, a prosthesis with bifurcation at the end section is installed. Intervention for an aneurysm lasts from 2 to 4 hours.

After the operation, the patient is placed in intensive care, where he can stay for up to one week. After resuscitation, the patient can be placed in the cardiology, vascular surgery or cardiac surgery department.

When performing an endovascular operation, a Stent-Graft implant is inserted into the damaged area of the vessel, with the help of which the structure and blood circulation in the artery are restored. This operation is performed using epidural anesthesia. The doctor makes a puncture in the groin area, inserts a special catheter through it and brings the implant to the aneurysm with it. After installation and opening of the device, a duct is formed, providing normal blood flow in the vessel. Endovascular surgery is better tolerated by patients, but its effect may be short-lived - doctors do not guarantee the absence of the need for a repeat operation.

Diet and nutrition for abdominal aortic aneurysm

Correction of nutrition in case of aortic aneurysm should be aimed at optimizing the diet. It is necessary to reduce the amount of consumed animal fat, cholesterol, fast-digesting carbohydrates, and also to reduce daily caloric intake, which is especially important in case of excess weight.

To achieve your goals, you need to follow these rules:

1. Virtually eliminate the consumption of animal fat in any form: this could be lard, fatty meat, butter, cream.
2. Fried foods are also excluded.
3. Sharply limit your consumption of regular salt to 5 g per day, and if you have high blood pressure, to 2-3 g per day.
4. Limit your consumption of sweets.
5. Increase the proportion of fresh vegetables and fruits in your daily menu.
6. If possible, replace meat with sea fish.

With an aortic aneurysm, it is very important to monitor your weight, as extra pounds also contribute to increased intra-abdominal pressure. The recommended body mass index is from 18.5 to 24.9 kg per m2 ^, and abdominal circumference is less than 90 cm for women and less than 100 cm for men.

In case of severe obesity, you should consult specialized specialists, such as a nutritionist and endocrinologist.

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Prevention

Preventive measures consist of lifestyle correction.

• Complete cessation of smoking, even passive inhalation of cigarette smoke.
• Systematic physical activity: half an hour of daily walking, breathing exercises, gardening, cycling, etc.

Periodically - at least twice a year - you should check your blood pressure, cholesterol and blood glucose levels.

In addition, it is necessary to make changes to the nutrition system, which we have already discussed above.

If an abdominal aortic aneurysm already exists, then preventive measures are taken to prevent vessel rupture.

• The patient needs to avoid heavy physical exertion, since carrying heavy objects, jumping, and intense movements lead to an increase in intra-abdominal pressure, which increases the risk of rupture.
• The patient must strictly adhere to dietary principles of nutrition, completely refusing gas-forming foods: beer, soda, peas and beans, white cabbage, etc. It is also necessary to monitor normal bowel function.
• The patient should check his blood pressure frequently, especially if he has a tendency to hypertension. High blood pressure increases the risk of arterial rupture.

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Forecast

An abdominal aortic aneurysm often has no obvious clinical manifestations. Therefore, many patients believe: if it does not bother you, then there is nothing serious. But this is not true: an aneurysm is a really serious disease, which is often complicated by a rupture of the artery. And a rupture in 85-90% of cases leads to the death of the patient.

Moreover, it is impossible to predict in advance how an abdominal aortic aneurysm will behave. Sometimes, seemingly minor damage quickly increases and leads to a rupture of the vessel. There have also been descriptions of cases where people lived for a long time with large aneurysms, not even suspecting their existence. Therefore, it is impossible to provide an unambiguous prognosis for the disease. The best solution would be, if possible, to remove the aneurysm surgically.

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