July 10, 2011

Aneurysms of the thoracic aorta   - It is irreversible pathological enlargement of one of its regions, exceeding the normal diameter of the vessel. The aorta - the largest vessel, starting from the left ventricle, and then goes up and goes down arc. Extending into the thoracic cavity of the vessel is called the thoracic aorta, and moving into the peritoneal cavity - abdominal aortic .

The abdominal aorta divides into two branches - the so-called iliac artery, are responsible for blood supply to the lower body extremities, and internal genitalia. Special saccular expansion of the walls of the abdominal aorta that occurs as a result of the thinning of blood vessels, called abdominal aortic aneurysm. Considered normal aortic diameter equal 2 cm . However, in the event of an aortic aneurysm, its diameter, it can be stretched up to alarming proportions. Complications occur aneurysms of the thoracic aorta - the aorta wall separation or gap.

There are aneurysm, usually at the site of the aorta where the weakened vessel wall, and high blood pressure contributes to further its expansion. If the aneurysm is not detected in a timely manner and are not treated, it can cause them to rupture and fatal bleeding. In this case, the survival rate is not more than 30%, because great importance is early diagnosis and prompt treatment of aneurysms of the thoracic aorta.

Aortic aneurysms can occur and develop at any site. One quarter of them developed in the thoracic aorta, the rest - in the abdomen. The shape of the aneurysm is divided into fusiform   and saccular .

In medicine, thoracic aorta aneurysms are classified by location, etiology and type.

According to the localization are the following categories:

• aneurysm of the ascending aorta;
• aneurysm of the ascending aorta and its arch;
• Aneurysms of sinuses;
• aneurysm of sinus of Valsalva and ascending aorta;
• aortic aneurysms arcs;
• arcs and aneurysm of the descending aorta;
• aneurysm of the ascending portion of the arc and the descending aorta;
• aneurysm of the descending aorta;
• torrakoabdominalnye aneurysm.

Etiology of aneurysm subdivided into several forms: inflammatory . noninflammatory   and Congenital .

Inflammatory form   The disease occurs in non-specific aortoarteriit, syphilitic, rheumatic, mycotic and others. Do not inflammatory form is atherosclerotic, traumatic, post-operative complications. Congenital aneurysms occur in Marfan syndrome, pathologic cystic medial necrosis, in congenital tortuosity of the aortic arch, coarctation. All of these forms are distinguished also by the form and it can be true, false, or dissecting aortic aneurysm.

At present, the exact causes of aneurysms of the thoracic aorta is not yet known, but it is assumed that damage the walls of blood vessels and the development of aneurysms are many factors. Arterial hypertension   - Steady increase in blood pressure of 140/90 mm Hg or higher, is one of the main causes of the disease. Atherosclerosis   - In this case in the patient's body is formed of different distinctive lipid deposits differently, plaques concerning vascular wall and sealed therein changes occur, at which they become brittle. For this reason, there is a narrowing of the lumen, there is a high probability of separation of the vessel wall and rupture of aortic aneurysm. Inflammatory diseases of the walls of the aorta - aortitis - inflammation of the aorta, developed in connection with any acute infectious diseases or traumatic injuries. They lead to a weakening of the tone and appearance of aortic aneurysmal sac.

Marfan syndrome   - Congenital disorder of the connective tissue from the group of hereditary kollagenopaty. It is a special case of differentiated connective tissue dysplasia of the human body. In 20% of cases of aneurysm, the pathology occurs due to hereditary factors. Also affects the aorta and infectious diseases, leading to damage to the wall of the aorta ( tuberculosis . syphilis ).

Often the causes of aneurysms are the pathology of valvular aortic pathology or transferred. The trauma of the aorta as a result of damage to the rib cage. Most often caused by automobile accidents. In some cases, an aneurysm can cause obesity and banal.

Risk factors for aneurysms of the thoracic aorta is traditionally considered to be the following:

• Age - Most aneurysms occur in people over sixty years.
• Smoking - one of the main risk factors for aortic aneurysm.
• Paul, the most likely to suffer an aneurysm of the thoracic aorta men. Women suffer less, but they have higher probability of aortic rupture of blood vessels than in males.
• Race - it noted that an aneurysm of the thoracic aorta is most often seen in persons of white race.

Complications of aneurysms of the thoracic aorta

The most dangerous complications of aneurysms of the thoracic aorta include gaps in the walls of the aorta and aortic rupture - conditions that threaten the patient's life. The larger an aneurysm is, the higher the risk of rupture.

Another dangerous complication can be called the risk of a blood clot, due to low blood flow velocity. Formed on the vessel wall of the aorta, they may come off the blood stream and transported to other parts of the body: the limbs, kidneys, abdominal organs, the brain.

The symptoms of an aneurysm of the thoracic aorta

Depending on the location, up to a point aneurysm of the thoracic aorta can occur completely asymptomatic. It all depends on its size, as well as whether there is a stratification of the vessel wall. Often the clinical picture of the aneurysm of the thoracic aorta associated with aortic enlargement pressure on the organs of the chest cavity.

Symptoms include:

• In the case of pressure on the trachea or airway lying next appears breathlessness   and cough;
• If the increase in the amount of the aorta presses on the esophagus in patients with difficulty in swallowing;
• In connection with the compression of the nerves that innervate the larynx appear hoarseness;
• By squeezing the nerves of the autonomic nervous system extending into the thoracic cavity, symptoms, called Horner syndrome Which are expressed in the contraction of the pupil, a partial deletion of the eyelids, excessive sweating;
• A feeling of "ripple" in the chest cavity.

If ruptured, aneurysms of the thoracic aorta symptoms become pronounced. There is a sharp pain in the chest that spreads to the neck, arms, spine, and may fall into the abdominal cavity. Acute pain is a sign of insufficient blood supply to the heart and aortic valve dysfunction. Unfortunately, very often rupture of the thoracic aorta quickly lead to the development of shock and death.

Diagnosis of aneurysms of the thoracic aorta

Preliminary diagnosis of thoracic aortic aneurysm based on the collection of data by the attending physician about the history of the disease, the analysis of the patient's complaints and symptoms, as well as examination of the patient. Then appointed clinical examination:

1. Chest radiography   - Carried in the side and frontal projection, as well as in the left oblique position in which clearly visible aneurysm of the aortic arch. The main radiological sign of an aneurysm of the aorta thoracic segment is a local expansion of various size of its shadow.

2. Echocardiography   - Ultrasound of the heart, a safe and inexpensive method of diagnosis that identifies aortic aneurysms. A study carried out by transesophageal echocardiography using a probe with an ultrasound probe.

3. Magnetic resonance angiography - Very precise method to get the layering structure of all the tissues and blood vessels using an electromagnetic field.

4. Computed tomography   - One of the modern X-ray methods of research, which allows to obtain a picture of layered structure of the human body. The method associated with ionizing radiation, but is very accurate, t. To. The image processing is performed by a computer.

Persons who are at risk, it is recommended to regularly screened for an aneurysm, beginning with consultation of the doctor and the ultrasound as a rapid and inexpensive method. If necessary, more accurate examination.

The prognosis of aneurysm of the thoracic aorta is unfavorable. According to statistics, over three years after diagnosis die 37, 5%, and 5 years - 54% of patients.

Treatment of aneurysms of the thoracic aorta

The goal of treatment of aortic aneurysm - prevention of rupture . Treatment is carried out conservative   and surgery   methods. It should be understood that conservative treatment may not lead to a cure, but only slows down the development of complications aneurysm. The choice of treatment depends on the size and rate of growth of the aneurysm.

With a small amount of an aortic aneurysm, in cases where it does not cause trouble, the doctor may advise the so-called conservative expectant treatment strategy . It is a dynamic monitoring and control of disease, heart rate and blood pressure. In atherosclerosis or high blood pressure patient prescribed drugs that lower blood pressure (beta-blockers, inhibitors angiotensin   II), and to reduce blood cholesterol levels (statins). Every six months is required diagnosis of aneurysm of the thoracic aorta, or computed tomography or magnetic resonance imaging. You must not miss the moment when the aneurysm begins to reach life-threatening proportions.

By increasing the size of the aneurysm of the thoracic aorta than 5 cm, as well as the appearance of pain, tightness, and others. Of symptoms, there is a need for early surgical intervention. Before the operation required the compulsory acceptance of antihypertensive drugs to correct blood pressure and heart rate as well as increased risk of rupture of an aortic aneurysm. The question of surgical treatment is received as much as a matter of urgency.

Surgical treatment of aneurysms of the thoracic aorta - implantation of the prosthesis   section of the vessel made of synthetic fabrics - carried out either by open surgery or endovascular means. What a way to choose the operations decided by the attending physician. The risk of death during surgical intervention is reduced to 5-15%, otherwise it is unavoidable.

Thus, despite the fact that the surgical treatment of aneurysms of the thoracic aorta is rather complicated, the improvement of surgical techniques and the introduction of new techniques in operations, significantly improve the outcome of surgery and prognosis of survival of the patient. Individual results of surgical intervention testify to the high effectiveness of this method.