Aortic aneurysm
Summary/Definition
Aortic aneurysm is a condition in which the wall of the aortic vessel is deformed into either a multi-chambered (thickened) or spindle (spherical) shape, with the diameter of the aorta in the affected area being more than 1.5 times larger than normal. The aneurysm lesion occurs in approximately 75% of patients in the abdominal aorta and 25% in the thoracic aorta (descending aorta). Also, in the majority (approximately 90%) of patients with abdominal aortic aneurysm, the lesion is concentrated in the inferior aorta rather than in the renal artery. If an aortic aneurysm is present, damage to the vessel wall at normal blood pressure is possible, as the blood vessel wall loses its elasticity over time. The most significant cause of an aortic aneurysm is atherosclerosis. In addition, causes may include rupture of the aortic aneurysm, external injuries, hereditary diseases, arteritis (inflammation of the arterial walls), congenital anomalies, sexually transmitted infections, mycoses (fungal infections), and other factors. Based on the location of the aneurysm, it can be classified as ascending aortic aneurysm, aortic arch aneurysm, and descending aortic aneurysm. However, aneurysms can also be classified by shape as spindle and saccular (pouch-like) aneurysms.
Symptoms
When an arterial aneurysm enlarges, pain is caused by irritation of the nerve fibers in the arterial wall. An abdominal aortic aneurysm causes pain in the abdomen and lower back, while a thoracic aortic aneurysm causes pain in the chest and back. Most people with an abdominal aortic aneurysm have no symptoms, and the condition is usually detected during medical examinations in 70-80% of patients. The most common symptoms include pain radiating to the side, back, lower back, etc. and a throbbing lump that can be felt on palpation. An abdominal aortic aneurysm is often detected by percussion (tapping) of nearby organs, symptoms include rapid congestion, or the occurrence of nausea, vomiting, etc. In the case of ascending aortic aneurysm, pressure on the ribs or sternum can lead to tissue necrosis or compression of organs under the sternum, causing superior vena cava syndrome with compression. Aneurysms of the descending aorta can damage the recurrent laryngeal nerve and the left vagus nerve, which can lead to a hoarse voice and diaphragm elevation. Aortic arch aneurysms can compress organs and can also cause hemocele (haemorrhage) in the brain when the carotid artery is compressed.
Diagnostics
The diagnosis of aortic aneurysm is not limited to routine physical examination, especially if there is concurrent heart valve disease, which can cause a difference between systolic and diastolic blood pressure and manifest itself in audible heart murmurs. Chest and abdominal radiography, CT, MRI, computed tomographic angiography, magnetic resonance angiography and other procedures are used to diagnose this condition more accurately.
Treatment and course of the disease
Surgery is necessary for ascending aortic aneurysm, aortic arch aneurysm, descending aortic aneurysm and thoracic aortic aneurysm. This surgery usually involves removing the aortic aneurysm and replacing the blood vessels. In addition, treatment may involve percutaneous stent implantation surgery.
