Diagnosis and Treatment of Aortic Aneurysm
A dangerous condition in which the wall of the body's main blood vessel dilates is called an aortic aneurysm. This large vessel originates directly from the heart and carries blood to all organs of the body. If the aortic wall weakens, one section of it becomes wider than usual. This change is called an aneurysm.
The dilation can occur in different sections of the aorta: closer to the heart or further from it. The larger the diameter of the dilation, the greater the risk of rupture. Rupture can lead to severe internal bleeding and is life-threatening.
An aortic aneurysm is a localized, pathological increase in the diameter of the aorta. Aortic dissection is an incomplete tear or rupture of the inner lining (endothelium), which causes blood to leak under high pressure between the layers of the aortic wall, causing it to separate. These two conditions are often closely related, in which case the condition is referred to as a dissecting aneurysm.
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Structure and pathogenesis of the aorta
Thanks to its complex structure, the aorta, which carries blood from the heart to all organs and tissues, can withstand high pressure. Pathology begins when some part of the wall loses its strength. For example, as a result of aging, high blood pressure, or diseases such as atherosclerosis.
The vessel wall weakens, thins, and begins to bulge outward, forming an aneurysm. Problems most often occur in the abdominal or thoracic aorta, although pathology can develop anywhere.
What is the aorta
The main vessel in our body, originating directly from the heart, is called the aorta. It has a complex three-layer structure. The inner lining is smooth, the middle layer consists of elastic fibers, and the outer layer protects the entire structure.
Changes in a Thoracic Aortic Aneurysm
A thoracic aortic aneurysm is a significant dilation of a section of the main artery in the chest. This occurs because the vessel wall has lost its elasticity. This anomaly increases the risk of rupture. The larger the rupture, the higher the risk of dangerous consequences. The main causes are age-related changes, injuries, infections, etc.
Changes in an Abdominal Aortic Aneurysm
An abdominal aortic aneurysm occurs when a noticeable dilation appears in the lower part of the main artery. This usually occurs due to a loss of strength in the vessel wall. The vessels here experience significant pressure, so any disruption can be serious.
Classification of aortic aneurysm
To facilitate diagnosis and select the appropriate treatment strategy, a special classification of aortic aneurysms exists. These pathologies are divided into various types based on several key characteristics: location, cause, structure, shape, and clinical presentation. This classification is necessary for specialists to facilitate diagnosis, accurately determine the degree of risk, and select the optimal treatment.
By location
There are two main types: thoracic – the aneurysm is located close to the heart; abdominal – the lesion is located below the diaphragm.
By causes
The causes of aneurysms can be congenital (vascular malformations) or acquired (atherosclerosis, trauma, inflammation).
By structure
The damaged aortic wall can have different structures. A true aneurysm affects the entire thickness of the wall, while a false aneurysm affects only the outer layer.
By shape
The appearance of an aneurysm depends on its shape, which can be saccular (a bubble-like protrusion) or fusiform (a uniformly dilated vessel).
By clinical course
The clinical development of an aneurysm reflects its nature: the acute form of the pathology manifests itself with severe, sudden symptoms, while the chronic form progresses slowly, often unnoticed.
Symptoms of aortic aneurysm and dissection
Aortic aneurysms that develop as a result of congenital, hereditary, or past pathology and are not associated with vascular wall dissection, in most cases have no obvious clinical signs and are an incidental finding.
Larger aneurysms may be accompanied by a feeling of fullness, dull pain in the back, and symptoms of compression of adjacent organs.
A dissecting aortic aneurysm has a more pronounced and characteristic clinical picture. When the internal aortic wall ruptures, sharp pain occurs in the chest, back, or lower back (depending on the location of the lesion). This pain is short-lived but can cause a reflex drop in blood pressure and fainting.
After some time, the patient begins to experience a burning chest pain radiating to the arms, neck, and shoulder blades. This pain is not relieved by nitroglycerin. A dry cough develops, a feeling of oxygen deprivation develops, blood pressure drops, and collapse occurs.
If the dissection occurs in the lower aorta, pain is felt in the lower back, radiating to the pelvis and legs. If the dissection affects the orifices of the branches extending from the aorta, symptoms of impaired blood circulation in the corresponding organs are observed.
Usually at this stage, patients are hospitalized and undergo emergency surgery.
General symptoms of aortic aneurysm:
- A feeling of fullness and dull pain in the back
- Pressure on organs
- Sharp pain in the chest, back, or lower back
- Burning pain in the chest, radiating to the upper limbs, neck, and back
- Cough and shortness of breath
- Collapse and decreased blood pressure
- Sciatica and leg pain
- Impaired blood flow: if the damage extends to the branches of the aorta, blood circulation in the associated organs is impaired organs
Unfortunately, most aneurysms have no symptoms and are discovered by doctors by chance. It is crucial to detect this vascular pathology early, as a complete rupture of the aortic wall can lead to massive bleeding and terminal shock. Sadly, more than 90% of such patients die.
Pain Syndrome
Shortness of Breath and Cough
Pulsation and Abdominal Discomfort
Other symptoms and complications
General information
Diagnostics
Several diagnostic methods are used to accurately diagnose an aortic aneurysm. First, the doctor performs an examination and listens to the patient's heart rate. Then, instrumental procedures are prescribed to visualize the vessel's condition from the inside.
The main diagnostic methods include ultrasound (ultrasound), computed tomography (CT), and magnetic resonance imaging (MRI). Ultrasound allows one to assess the shape and size of the aneurysm, while CT and MRI provide a detailed picture of the lesion.
Dissection of the initial sections of the aorta can be determined using transthoracic or transesophageal echocardiography. One of the most reliable methods for diagnosing the entire aorta is aortography. This method allows real-time visualization of aortic wall defects, the secondary lumen formed as a result of dissection, and the aneurysm cavity. If the rupture site is sealed by a thrombus, aortography may yield a false-negative result. This can be corrected by performing a CT scan with contrast, which can be performed at K+31.
Doppler ultrasound
Doppler ultrasound is a diagnostic test that shows blood flow and the condition of the vessel walls. Using Doppler ultrasound, the doctor assesses patency and looks for narrowing or dilation.
CT scan
Computed tomography is performed when precise measurements and a detailed image of the vessel are needed. CT diagnostics allow one to examine the wall thickness, location, and depth of the lesion.
MRI
Magnetic resonance imaging is indispensable where image accuracy is essential. MRI diagnostics allow for a detailed examination of the vascular bed.
Ultrasound
A simple ultrasound examination is useful at the initial diagnostic stage. Ultrasound is accessible and safe, allowing for immediate detection of problem areas and confirmation of a suspected aneurysm.
Clinical Cases and Commentary
The clinical presentation of aortic aneurysm varies widely. Some patients present with persistent chest or back pain, while others experience a sudden loss of strength. It's important to understand that even similar situations may require different treatment approaches.
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Causes and risk factors
The main cause of aortic aneurysms and dissections is aortic wall pathology due to atherosclerotic lesions. Unfortunately, the severity of this problem is sometimes underestimated, which may be due to the prolonged absence of symptoms. Since the aortic lumen is very large, it is impossible for an atherosclerotic plaque to block it. However, deformation of the aorta, impaired elastic function (the aorta experiences significant pulsatile loads), and occlusion of the branches extending from the aorta are very serious consequences of atherosclerosis, leading to complications such as aneurysms and dissections.
Long-term, large and abrupt fluctuations in blood pressure over many years also negatively impact the condition of the aorta, contributing to damage to its inner layer, followed by dissection and aneurysm formation. Thus, atherosclerotic lesions and arterial hypertension are the most common factors destabilizing the aortic wall.
Much less frequently, aortic aneurysms and dissections occur due to destructive infectious processes both in the aorta itself and in surrounding tissues and organs (for example, purulent mediastinitis), syphilis, congenital aortic malformations, and chest and abdominal trauma.
Another possible cause of aneurysms is genetics. A hereditary predisposition increases the likelihood of developing this pathology, especially if close relatives have experienced similar diseases. Age also plays a significant role. With age, blood vessels lose their elasticity, becoming weaker and more susceptible to damage.
Smoking also negatively impacts blood vessels, increasing the risk of aneurysms. Diabetes mellitus is another risk factor. This pathology disrupts metabolism, weakening the vessel walls and increasing the likelihood of their dilation. All of these factors affect the condition of the aorta, so taking care of your health, avoiding bad habits, and paying close attention to your well-being can help reduce the risk of developing the disease.
Congenital Aneurysms
One congenital defect that can trigger the development of an aneurysm is Marfan syndrome. This condition weakens the tissue that supports the structure of large vessels, such as the aorta. Another rare condition that affects tissue strength and can manifest as an aneurysm is Ehlers-Danlos syndrome.
Acquired Aneurysms
This category of pathologies develops over the course of life. Chronic diseases, such as the aforementioned atherosclerosis, are often the cause. Infections also play a role—bacteria can penetrate the vessel and cause inflammation. Various types of trauma can also trigger the development of acquired aneurysms.