May 11, 2011

Aorta   It is the largest vessel in the human body. In aorta and its branches oxygenated blood from the left ventricle of the heart goes to all organs. It is the main thoroughfare in the human bloodstream, it conditionally divided into several sections: the ascending aorta . aortic arch   and descending aorta . Last Division is divided into chest   and abdominal   part. The most frequent disease of the vessel - aneurysm . In three of four cases of vascular disease occur abdominal aortic aneurysm, and only one localization occurs in the thoracic region.

Aneurysm   - Abnormal enlargement of the vessel in a weakening of its walls. Under the influence of high blood pressure is an expansion of the vessel wall, and as a consequence its protrusion. The shape of the aneurysm is divided into saccular   and fusiform   education. In both cases, the blood flow is disturbed, which contributes to a thrombosis . In some cases, the aneurysmal sac there is an accumulation of calcium and calcific vessel wall, making it fragile and predisposes to fracture.

Abdominal aortic aneurysm is localized mainly below the point of origin of the renal arteries. Therefore, it is dangerous to complications of pelvic and lower limbs. As a complication more likely to occur embolism . When it extends from a blood clot within the aneurysmal sac along the course of the vessel. There is a fragmentation of the thrombus and its pieces spread to the bloodstream and pelvic limbs. Pieces of clot may occlude the artery that leads to necrosis of the lower extremities. But the most dangerous for the patient's life is a ruptured aneurysm, which occurs as a result of bleeding into the abdominal cavity.

Although clear symptoms of abdominal aortic aneurysm, and no, there are some complications indirect signs, which will be discussed below, but first focus on the causes of the disease.

The causes of abdominal aortic aneurysms

The development of the aneurysm due to several factors. Most often, the disease is caused by atherosclerosis In which the narrowed vessel lumen and its walls become fragile. This leads to delamination of the aortic wall, and the more fragile inner walls are broken and the outer wall bulges forming dissecting aortic aneurysm . The causes of abdominal aortic aneurysms is also hypertension, inflammatory diseases of the aortic wall, congenital connective tissue diseases, infectious diseases, in particular syphilis Accompanied by damage to the aorta.

Predisposition to the development of an aneurysm in men older than 60 years, mostly in smokers or have uncontrolled high blood pressure. Women are less susceptible to this disease. Also plays the role of a hereditary factor, the presence of the disease in other family members. It is proved that Marfan syndrome   parents greatly increases the chances of developing an aneurysm.

Diagnosis and symptoms of abdominal aortic aneurysm

In some cases, the disease is virtually asymptomatic, because of which it detected in the diagnosis of other diseases, but most abdominal aortic aneurysm can be manifested by the presence of pulsatile. In the abdominal cavity there is a surge in heart rate.

In some cases, a periodic pain caused by the pressure of the aneurysmal sac to the spinal roots - it gradually increases with the development of an aneurysm. Pain may also occur after ingestion, there intermittent claudication Due to embolism. The emergence of a strong sharp pain in the abdomen and lower back is a symptom of aneurysm rupture. When complications are pain in the legs, their pallor or cyanosis, which is caused by a blockage of the arteries pieces of blood clots.

Such scant signs of abdominal aortic aneurysm is difficult to diagnose the disease in its early stages. In 40% of cases the problems detected in the instrumental study for suspected other diseases. X-rays or ultrasound of the aorta gives a more accurate result, it is at these studies and find it often.

On examination, the doctor may suspect an aneurysm with a stethoscope. You will hear a ripple and noise that occurs when blood flow in the aneurysmal formation. But such a diagnosis can only be the case if the patient is not suffering from overweight . If you suspect that an aneurysm is performed computed tomography, which makes it possible to more accurately determine the size and shape of the damage to the vessel, after which the doctor prescribes the treatment of abdominal aortic aneurysms. X-rays less informative than the other, it makes it possible only to discover the aneurysm by calcium deposits, but to know exactly its size or shape in this survey possible.

The treatment of abdominal aortic aneurysms

The normal diameter of the aorta in the abdominal cavity is about two centimeters in diameter , Aneurysmal expansion may significantly exceed the permissible limits, reaching critical size. Extensions of less than 5 cm rarely fraught with rupture, so the operation is not required. But it should be noted that the disease does not pass by itself, in most cases eventually require surgery.

To any disease progressed, and aneurysmal enlargement did not increase in the size of the patient should be under a doctor's supervision is the prevention of the development of abdominal aortic aneurysms. Every six months, carried out US   and CT   to control the condition and size of the aneurysm. Be sure the correction of blood pressure, appointed for this antihypertensive drugs. Only the implementation of all doctor's instructions and timely research can enable to control the condition of the patient and spend time surgery.

Treatment of abdominal aortic aneurysm 5 cm in size only to spend quickly. Such expansion frequently complicated by rupture that requires immediate surgical intervention otherwise break ends lethal . But even with immediate intervention mortality rate is 50%. Therefore, as soon as detected symptoms of abdominal aortic aneurysm and put appropriate diagnosis, so it is important to be monitored, and in case of further enlargement of the vessel to carry out the operation on time.

Today, there are two types of surgical treatment, but only a doctor can decide which one is more appropriate to the patient, given his condition, lifestyle and other factors. In both types of surgery it is based on implantation of an artificial vessel to restore normal blood flow through the damaged section of the aorta.

Traditional surgical treatment of abdominal aortic aneurysm involves the implantation of an artificial vessel of plastic material, inside the aortic enlargement. The aorta as it envelops your implant tissues. All surgery is performed through an incision in the abdominal cavity, and lasts for about 6 hours. When the radical method of treatment in 90% of operated patients have a favorable prognosis.

The second type of treatment is introduction of endovascular stent-graph , A special device, through which the aneurysmal sac is isolated from the general circulation. Thus, the gap prevents thinning walls and creates a new path for blood flow. In this surgery the implant is introduced through a puncture in the groin area. At the point of connection of femoral vessels introduced special catheter By which the device and is introduced directly into the aneurysm where the stent-graph is opened and forms a channel for normal blood flow. This operation takes about 2 to 5 hours and is a good alternative to the traditional method, especially for patients with high risk of complications during surgery. But such treatment is contraindicated in patients with disorders of the arteries of the kidneys and other organs. Endoprosthesis   no contraindications for age, and much easier tolerated by elderly patients than open surgery.

Prevention of abdominal aortic aneurysm, and in the treatment of postoperative period

In traditional surgery hospital stay is from 5 to 8 days, after which does not require constant monitoring, complications occur in very rare cases. When endovaskulyatornom intervention hospitalization takes 2 to 5 days, but it requires observation and repeated passage of CT. It is necessary for the continuous monitoring of the state of the stent graph. In some cases, it may narrow the lumen, and the operation must be carried out again.

Prevention of abdominal aortic aneurysm is the same as in coronary heart disease . The first is control of blood pressure, correction of lifestyle, avoiding harmful habits, such as smoking. There must be a number of studies carried out every 3-6 months. Indications ultrasound will allow the doctor to accurately determine the need for surgery and his method.

We should not forget that aneurysm rupture , Dangerous heavy bleeding, in which damaged organs and tissues, and even with a successful urgent surgical intervention may develop kidney failure during and after the operation, which is exacerbating the patient's condition. Without surgical help to break the patient does not survive, and this complication occurs in 90% of patients who refused to operate in the early stages of the disease.