Aorta enlargement causes: Enlarged Aorta Risks, Symptoms and Treatment: What to Know
Enlarged Aorta Risks, Symptoms and Treatment: What to Know
Each year in the United States, aortic aneurysms contribute to nearly 20,000 deaths. But with awareness, monitoring and proper care, aortic aneurysm treatment can be relatively simple — often with a minimally invasive procedure if surgery becomes necessary.
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To raise awareness of aortic aneurysms, also known as an enlarged aorta, Michigan Medicine vascular surgeon Jonathan Eliason, M.D., outlines the symptoms and risk factors.
What are enlarged aorta symptoms, and how is it diagnosed?
Eliason: An individual with an enlarged aorta typically experiences no symptoms until the aneurysm ruptures. In most cases, this means an aortic aneurysm wouldn’t be discovered unless some type of screening was performed that allowed aortic measurements. Aortic aneurysm screenings are recommended for certain individuals, depending on their age, gender, family history and other risk factors.
Screening is typically done via an ultrasound scan, a painless test that uses sound waves to create images of organs and structures inside the body. If an aneurysm is detected, its size can also be measured by ultrasound.
What are enlarged aorta risk factors?
Eliason: Because the condition can be hereditary, screening is recommended for men or women over age 65 who have a person in their immediate family with an abdominal aortic aneurysm (AAA). Men over 65 who have smoked more than 100 cigarettes in their lifetime should also be screened. According to the U.S. Preventive Services Task Force, this group stands to benefit the most from early detection and surgical treatment due to a higher prevalence of larger AAAs compared to other patient groups. Routine screening is not recommended for women, who are at lower risk for AAAs.
Individuals with connective tissue disorders, such as Marfan or Loeys-Dietz syndromes, are more likely to experience an aortic aneurysm at a younger age and should be closely monitored.
The vast majority of patients with an AAA do not have a family history and instead have other risk factors. Smoking is by far the strongest risk factor for aortic aneurysm, even a remote history of smoking cigarettes or breathing secondhand smoke. Uncontrolled high blood pressure is also a risk factor, though far less than cigarette smoking. Hardening of the carotid or coronary arteries contributes as well. We often order testing in these areas if a patient has an AAA.
How much can an aorta stretch before it could burst?
Eliason: The average aorta is approximately 2 cm, or slightly smaller than one inch. An aneurysm means that the diameter is 1.5 times larger than normal, or 3 cm, in the abdominal aorta.
SEE ALSO: Observe or Operate? When an Enlarged Aorta Requires Action
The rupture rate really increases at 5.5 cm in men and 5 cm in women. That doesn’t mean an aneurysm can’t rupture at a smaller diameter or at a larger diameter, but these tend to be the sizes where surgery is actively considered. If a person has a connective tissue disorder, aneurysm repair may be considered at a smaller size.
What happens if an aneurysm ruptures? Is there any warning?
Eliason: During an abdominal aortic aneurysm rupture, an individual typically experiences severe abdominal or back pain. Sudden death can also occur. In some cases, patients might experience symptoms without a rupture. These patients may get a warning of abdominal pain or escalating back pain. If the aneurysm is in the chest only, the individual may experience chest or upper back pain.
Is an individual with an aortic aneurysm more likely to experience another aneurysm?
Eliason: Yes. One study reported that just over a quarter of individuals with an abdominal aortic aneurysm had a simultaneous thoracic aortic aneurysm. This suggests that thoracic aortic aneurysm screening is appropriate for patients with abdominal aortic aneurysms.
Is there anything else individuals should know about risks associated with an enlarged aorta?
Eliason: Yes, anyone diagnosed with an abdominal aortic aneurysm is more likely to have atherosclerosis (hardening or blockages) in other arteries. This may put them at an increased risk for other cardiovascular conditions such as heart attack or stroke. Screening for these conditions may be indicated.
Observe or Operate? When Aneurysms Require Action
If you’ve been diagnosed with an enlarged aorta, a condition affecting the main artery that carries blood from the heart to the rest of the body, you likely have many questions.
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How big is too big? When should I be worried? What does “watchful waiting” mean? Are there any early warning signs before it bursts?
After learning that he had a total of five aortic enlargements, Bob Stephens, pictured above, had all of those concerns and more.
“It’s awfully scary,” says 72-year-old Stephens of Dexter, who in 2009 was diagnosed at the University of Michigan Frankel Cardiovascular Center, where his condition was closely monitored until surgery was required.
Otherwise known as an aortic aneurysm, the exact causes remain unknown.
Clues, however, often lie in a person’s age, gender and medical history. Also at play are the size and position of the enlargement (which can occur in the chest or abdomen). Other enlarged aorta risks include a history of blood or chest pressure and lifestyle factors such as smoking habits.
Regardless of circumstances, the discussion can be a delicate exchange.
Stephens’ cardiologist, Michael Shea, M.D., says he hesitates to use the word “aneurysm” when consulting with patients about an enlarged aorta. He might instead use terms such as “aortic dilation,” or a call it a blood-vessel issue.
Until measurements are taken, at least.
Shea will start to consider surgery when a patient’s aortic diameter is greater than 50 percent of what is considered normal. The typical size of an abdominal aorta is 2.0 to 3.0 centimeters. An enlarged abdominal aorta is typically greater than 3. 0 centimeters, but each patient is different.
For patients requiring open surgical repair of their aorta, a large incision is made in the abdomen to expose the aorta. Once the abdomen is opened, the aneurysm is repaired with a graft. Open repair remains the standard procedure for an abdominal aortic aneurysm repair.
Enlarged Aorta | Frankel Cardiovascular Center
Answers to Questions About an Enlarged Aorta Depend on Individual Factors
If you’ve been diagnosed with an enlarged aorta, you likely have many questions about your condition: How big is too big? When should I be worried? What does “watchful waiting” mean? Are there any early warning signs before it bursts?
Most of the answers to these questions depend on a variety of factors, including your age and body size, medical history and the position and size of your aorta, among others.
Is an Enlarged Aorta the Same Thing as an Aortic Aneurysm?
Dr. Michael Shea, a cardiologist at the University of Michigan Frankel Cardiovascular Center, says he hesitates to use the word “aneurysm” when consulting with patients about an enlarged aorta, instead referencing an aortic dilation or a blood vessel issue. “It’s a scary term,” he says, “especially if a patient has a relative who has died from it.”
When an Enlarged Aorta Requires Surgery
Regardless of the terminology, surgery to repair an aortic aneurysm depends on the size of an individual’s aorta, which can vary according to age, gender and the area of the aorta involved. The typical size of an abdominal aorta, for example, is 2.0 to 3.0 centimeters. An enlarged abdominal aorta is typically greater than 3.0 centimeters.
Overall, when an aneurysm grows to 5.5 cm in men and 5 cm in women, these tend to be the sizes where surgery is actively considered. Until then, regular monitoring, also known as “watchful waiting,” is the typical protocol. This may include testing by CT scan or ultrasound imaging. “Every case is different, which causes a lot of angst among patients,” says Dr. Shea.
Conditions Where Rupture of an Enlarged Aorta May Be More Likely
For example, a patient with connective tissue disorders such as Marfan or Loeys-Dietz syndromes typically experiences ruptures at a much lower diameter than a patient without one of these conditions. A patient with a bicuspid valve may also experience rupture at a lower diameter. For example, a person with a 5 cm dilation and a bicuspid aortic valve is more at risk than a person with a 5 cm dilation with no underlying conditions. Overall, patients with these conditions, as well as those with a family history of aneurysm, would be considered for surgical intervention at 4 to 5 cm.
Other Risk Factors
Other risk factors that come into play include:
- Where the aortic dilation is located: chest (thoracic aortic aneurysm), abdomen (abdominal aortic aneurysm) or a combination of the chest and abdomen (thoracoabdominal aortic aneurysm)
- Whether the patient is feeling chest pressure
- Whether the patient’s blood pressure is under control
- Whether the patient is smoking
- The patient’s overall lifestyle
Cardiologists also consider whether the dilation is stable or growing. According to Dr. Shea, growth can range from 0.1 to 1 cm a year, with measurements done on a regular basis, beginning with a baseline evaluation via echocardiogram, CT scan or MRI.
Dr. Shea points out that many patients with a slow-growing aortic dilation never undergo surgery, but are monitored on a regular basis as a precaution to measure any growth.
For more information about aortic disease, visit the Aortic Disease and Frequently Asked Questions about Aortic Disease pages.
Make an Appointment
To schedule an appointment to discuss an enlarged aorta or any other cardiovascular condition, call us at 888-287-1082 or visit our Make a Cardiovascular Appointment page, where you may fill out a Patient Appointment Request Form and view other details about making an appointment.
Abdominal aortic aneurysm (AAA) – Illnesses & conditions
Treatment for an abdominal aortic aneurysm (AAA) depends on several factors, including the aneurysm’s size, your age and general health.
In general, if you have a large aneurysm (5.5cm or larger) you will be advised to have surgery, either to strengthen the swollen section of the aorta or to replace it with a piece of synthetic tubing.
This is because the risk of the aneurysm rupturing is usually greater than the risk of having it repaired.
If you have a small (3.0-4.4cm) or medium (4.5-5.4cm) aneurysm, you will be offered regular scans to check its size.
You will also be given advice on how to slow its growth and reduce the risk of it rupturing – for example, stopping smoking – and perhaps medications to reduce your blood pressure and cholesterol level.
If you have a large AAA
If you are diagnosed with an AAA that is 5.5cm or larger, you will be referred to a vascular surgeon (a surgeon who specialises in diseases of the blood vessels), who may recommend an operation.
The surgeon will discuss treatment options with you, taking into account your general health and fitness, as well as the size of your aneurysm.
If it’s decided that surgery isn’t suitable for you, it’s still possible to reduce the risk of the aneurysm bursting, and you will have regular scans to check its size – in the same way people with small or medium aneurysms are treated.
See below for more information on treating small and medium aneurysms.
There are two surgical techniques used to treat a large aneurysm:
- endovascular surgery
- open surgery
Although both techniques are equally effective at reducing the risk of the aneurysm bursting, each has its own advantages and disadvantages.
The surgeon will discuss with you which is most suitable.
Endovascular surgery is a type of “keyhole” surgery where the surgeon makes small cuts in your groin.
A small piece of tubing called a graft– made of metal mesh lined with fabric – is then guided up through the leg artery, into the swollen section of aorta, and sealed to the wall of the aorta at both ends.
This reinforces the aorta, reducing the risk of it bursting.
This is the safest of the two types of surgery available. Around 98-99% of patients make a full recovery, and recovery time from the operation is shorter than if you have open surgery.
There are also fewer major complications, such as wound infection or deep vein thrombosis (DVT).
However, the way the graft is attached is not as secure as open surgery. You’ll need regular scans to make sure the graft hasn’t slipped, and in some patients, the seal at each end of the graft starts to leak and will need to be resealed. You will need to have surgery again if either of these occurs.
In open surgery, the surgeon cuts into your stomach (abdomen) to reach the abdominal aorta and replaces the enlarged section with a graft.
This type of graft is a tube made of a synthetic material.
Because the graft is stitched (sutured) into place by the surgeon, it’s more likely to stay in place, and will usually work well for the rest of your life.
The risk of complications linked to the graft after surgery is lower than in people who have endovascular surgery.
Open surgery isn’t usually recommended for people who are in poor health as it is a major operation. It is slightly more risky than endovascular surgery, with 93-97% of patients making a full recovery.
The main risk of open surgery is death or heart attack, and recovery time is longer than with endovascular surgery.
There is also a greater risk of complications, such as wound infection, chest infection and DVT.
If you have a small or medium AAA
If you are diagnosed with a small (3.0-4.4cm) or medium (4.5-5.4cm) aneurysm, you won’t be referred to see a vascular surgeon, as it’s unlikely you’d benefit from surgery.
You’ll be invited back for regular scans to check the size of the aneurysm, in case it gets bigger – every year if you have a small aneurysm and every three months if you have a medium aneurysm.
You will also be given advice on how to prevent the aneurysm from getting bigger, including:
- stopping smoking
- eating a balanced diet
- ensuring you maintain a healthy weight
- taking regular exercise
If you smoke, the most important change you can make is to quit. Aneurysms have been shown to grow faster in smokers than in non-smokers.
Read more about stopping smoking and nicotine replacement therapies (NRTs) that can make it easier to stop smoking.
Your GP will be sent your test result and may decide to change your current medication or start you on a new one, especially if you have:
- high blood pressure – which you will probably be treated for with a medication called an angiotensin-converting enzyme (ACE) inhibitor
- high cholesterol – which you will probably be treated for with a medication called a statin
Treating a ruptured AAA
Emergency treatment for a ruptured AAA is based on the same principle as preventative treatment. Grafts are used to repair the ruptured aneurysm.
The decision on whether to perform open or endovascular surgery is made on a case-by-case basis by the surgeon carrying out the operation.
Aortic Aneurysm | Columbia University Department of Surgery
Causes | Symptoms | Diagnosis | Treatment | Next Steps
What is an aortic aneurysm?
An aortic aneurysm occurs when the walls of the aorta, which are typically strong and elastic in order to withstand the stress of blood flow from the heart, begin to weaken. Over time, the aortic walls lose their elasticity and expand outwards. As the weakened wall deteriorates and the damaged tissue grows in size, the risk of a more serious tear, known as an aortic dissection, or an aortic rupture, increases.
An aortic aneurysm can occur anywhere in the aorta, including at the aortic root, which may involve damage to the aortic valve, the aortic arch, the descending thoracic aorta, or the abdominal aorta.
How common is an aortic aneurysm?
Aortic aneurysms have an incidence of 5-10 cases per 100,000 in the United States, and are more common in men over the age of 60. Though aortic aneurysms do not directly cause death, complications arising from an aneurysm – such as dissection or rupture – cause approximately 15,000 deaths annually. Recently, the decline in smoking and use of cholesterol-regulating medications has decreased the incidence of aortic aneurysms.
Aortic Aneurysm Causes
What are the causes of aortic aneurysm?
There are numerous causes to aortic aneurysms, from genetic predispositions to lifestyle factors. One of the major factors is age; over time, the aorta naturally loses its elasticity, which can lead to aneurysm. Some other causes that increase the likelihood of an aneurysm developing include:
- Hypertension, or high blood pressure
- Atherosclerosis, or hardening of the aortic walls
- Hypercholesterolemia, or high cholesterol
- Infections, such as endocarditis
- Injury to the chest or stomach
- Genes associated with aortic aneurysms include ACTA2, FBN1, MYh21, and TFFBR1/2.
There appears to be a familial component to the development of aortic aneurysms, as well. Having a relative with an aortic aneurysm significantly increases the risk of developing one. Certain inherited connective tissue disorders such as Marfan’s syndrome can also weaken aortic walls, increasing the risk of aneurysm.
Aortic Aneurysm Symptoms
What are the symptoms of aortic aneurysm?
Aortic aneurysms are typically asymptomatic, and are often discovered during routine exams for other diseases. Symptoms may appear if the aneurysm expands and compresses adjoining organs, causing pain or discomfort.
Aortic aneurysms are separated into two categories, thoracic, which involves the ascending aorta, the aortic arch, and the first part of the descending aorta, and abdominal, which involves the descending aorta. Symptoms for thoracic and abdominal aortic aneurysms are different.
The symptoms of a thoracic aortic aneurysm include:
- Chest or back pain
- Dysphasia, or difficulty swallowing
The symptoms of an abdominal aneurysm include:
- Abdominal pain
- A pulsing sensation in the stomach
If an aortic aneurysm tears and causes an aortic dissection, the symptoms will appear suddenly and are much more serious. Pain will be sudden and intense, and there will be a drop in blood pressure. Dizziness and nausea may also occur. A dissection is a medical emergency, and experiencing any of these symptoms is a sign to visit the emergency room.
Aortic Aneurysm Diagnosis
How is an aortic aneurysm diagnosed?
Because aortic aneurysms are typically asymptomatic, it can be difficult to identify them before there are complications, such as blood clots or a more serious rupture. Many aortic aneurysms are diagnosed during routine testing for other medical conditions, including x-rays of the chest. Because smoking and age are risk factors for aortic aneurysms, preventative screening is recommended for male smokers above the age of 65. Men with a family history of aortic aneurysms are also recommended for preventative screening, starting at age 60.
If an aortic aneurysm is suspected, the diagnosis can be confirmed using specialized procedures such as an echocardiogram, a CT scan, or an MRI.
Aortic Aneurysm Treatment
What is the treatment for aortic aneurysm?
There are two major treatments for aortic aneurysm. Aneurysms smaller than 5 centimeters generally do not need surgical treatment. Certain medications, such as beta blockers or calcium channel blockers, may be prescribed to reduce the risk of dissection or rupture.
Any aneurysm larger than 5 centimeters, however, may require surgery; in the case of aortic root aneurysms, which may place pressure on and disrupt the functioning of the aortic valve, repairing or replacing the valve may also be necessary.
There are numerous surgical options, including open and endovascular, depending on the type of aneurysm and whether a more simple repair or more extensive replacement required. During surgery, the damaged section of the aorta is replaced with a graft or repaired with a stent, which provides structural support for the aneurysm and reduces the risk of further complications.
If you are in need of help for an aortic condition, we’re here for you. Call us now at (844) 792-6782 or fill out our online form to get started today.
Familial thoracic aortic aneurysm and dissection: MedlinePlus Genetics
Familial thoracic aortic aneurysm and dissection (familial TAAD) involves problems with the aorta, which is the large blood vessel that distributes blood from the heart to the rest of the body. Familial TAAD affects the upper part of the aorta, near the heart. This part of the aorta is called the thoracic aorta because it is located in the chest (thorax). Other vessels that carry blood from the heart to the rest of the body (arteries) can also be affected.
In familial TAAD, the aorta can become weakened and stretched (aortic dilatation), which can lead to a bulge in the blood vessel wall (an aneurysm). Aortic dilatation may also lead to a sudden tearing of the layers in the aorta wall (aortic dissection), allowing blood to flow abnormally between the layers. These aortic abnormalities are potentially life-threatening because they can decrease blood flow to other parts of the body such as the brain or other vital organs, or cause the aorta to break open (rupture).
The occurrence and timing of these aortic abnormalities vary, even within the same affected family. They can begin in childhood or not occur until late in life. Aortic dilatation is generally the first feature of familial TAAD to develop, although in some affected individuals dissection occurs with little or no aortic dilatation.
Aortic aneurysms usually have no symptoms. However, depending on the size, growth rate, and location of these abnormalities, they can cause pain in the jaw, neck, chest, or back; swelling in the arms, neck, or head; difficult or painful swallowing; hoarseness; shortness of breath; wheezing; a chronic cough; or coughing up blood. Aortic dissections usually cause severe, sudden chest or back pain, and may also result in unusually pale skin (pallor), a very faint pulse, numbness or tingling (paresthesias) in one or more limbs, or paralysis.
Familial TAAD may not be associated with other signs and symptoms. However, some individuals in affected families show mild features of related conditions called Marfan syndrome or Loeys-Dietz syndrome. These features include tall stature, stretch marks on the skin, an unusually large range of joint movement (joint hypermobility), and either a sunken or protruding chest. Occasionally, people with familial TAAD develop aneurysms in the brain or in the section of the aorta located in the abdomen (abdominal aorta). Some people with familial TAAD have heart abnormalities that are present from birth (congenital). Affected individuals may also have a soft out-pouching in the lower abdomen (inguinal hernia), an abnormal curvature of the spine (scoliosis), or a purplish skin discoloration (livedo reticularis) caused by abnormalities in the tiny blood vessels of the skin (dermal capillaries). However, these conditions are also common in the general population. Depending on the genetic cause of familial TAAD in particular families, they may have an increased risk of developing blockages in smaller arteries, which can lead to heart attack and stroke.
Five Things You Should Know About Aortic Aneurysms
Aortic aneurysms are known as a “silent killer” with good reason. Unless found by accident – usually during a routine, unrelated medical test – aortic aneurysms may go undetected until they rupture, at which point a person only has minutes to live.
We sat down with M Health Fairview Vascular Surgeon Amy Reed, MD, who also serves as a professor and chief of vascular surgery at University of Minnesota Medical School and is co-director of the AM Health Fairview Aortic Center. Reed gave us answers to some common questions that patients may have about aortic aneurysms, including risk factors, prevention, and treatment options.
What is an aortic aneurysm? How are they found?
Aortic aneurysms are a swelling and weakening in the wall of the aorta, the largest artery in the human body. This is the artery that exits the heart and supplies blood to the brain and entire body. If the aneurysm is not found and identified, it may burst, causing significant and often fatal bleeding.
A normal aorta is about 3 centimeters—or a little over 1 inch across. An aneurysm occurs when a portion of the aorta has enlarged to at least 1.5 times its normal size. Aortic aneurysms less than 4 centimeters in size have a low chance of bursting, but an aneurysm more than 5.5 centimeters in diameter has an increasing chance of rupturing in the next year.
One of the things that makes aortic aneurysms so dangerous is that many times, they go undetected until they burst. Most aneurysms found before a rupture are discovered by accident during an unrelated medical test.
What health factors increase your risk of an aortic aneurysm?
Men are at much higher risk of developing an aneurysm than women, though aneurysms do occur in women and often first present in women as a rupture. 58 percent of aortic aneurysms diagnosed in 2018 were in men, according to the Centers for Disease Control and Prevention (CDC). A family history of aneurysms can also increase your risk. Smoking, obesity, age and high blood pressure can all put a person at higher risk for aneurysms.
About 75 percent of abdominal aortic aneurysms happen in people with a history of smoking, according to the CDC. Nevertheless, it’s important to note that anyone—even people in excellent physical condition—can suffer an aortic aneurysm. Patients who have a history of aortic dissection – a condition from high blood pressure where the wall of the aorta “unzips” or splits – are also at risk of developing an aortic aneurysm. This condition impacts men and women.
Are there any activities you can do to prevent an aortic aneurysm or reduce your risk?
People at higher risk for an aortic aneurysm can adopt heart-healthy lifestyle changes, including a healthy diet, more physical activity, and smoking cessation. Your doctor may also recommend medicines including statins, beta blockers, or other prescriptions that are generally helpful for the cardiovascular system.
Learn more about M Health Fairview’s vascular surgery care services.
How is an aortic aneurysm treated?
If the aneurysm is more than 4 centimeters in size, your doctor may recommend monitoring and some heart- and cardiovascular-healthy lifestyle changes. Smaller aneurysms rarely rupture and grow at an average rate of one-third of a centimeter each year.
If the aneurysm is more than 5.5 centimeters in size, or if it’s rapidly getting larger, your doctor may recommend surgery to repair the aneurysm. In many cases, doctors will run a catheter through the patient’s femoral artery in the groin to the site of the aneurysm in the aorta, then implant a stent graft. The stent graft reinforces the weakened aorta and eventually the aneurysm will shrink around the graft. Under experienced care, this procedure is often possible using a minimally invasive approach with essentially no incisions. There are patients whose anatomy is not suitable for a stent repair in which open surgery will be necessary.
Though most treatment centers in the nation require patients to be under general anesthesia for a stent graft, our highly specialized M Health Fairview care team performs many of these procedures with only local anesthesia and mild sedation. This approach allows for treatment of about 80 percent of abdominal aortic aneurysms. The remaining 20 percent of aneurysms are often better treated with open surgery to provide a definite cure in a place where a stent graft may be less durable.
Although the majority of aneurysms are small and do not require surgery, the presence of an aneurysm may indicate the patient has related health concerns that need attention.
Learn more about M Health Fairview’s heart care services.
How is M Health Fairview uniquely positioned to treat this condition?
M Health Fairview’s multidisciplinary care teams are leaders in successfully treating aortic aneurysms. Our uniquely equipped hybrid operating rooms and the high level of expertise our care teams possess allows us to treat both low- and high-risk patients. Many of our physicians are national and international leaders in the treatment of aortic aneurysms.
Because we offer state-of-the-art technology and care team expertise, we are leaders in providing aneurysm repair options for high-risk patients. Most repairs can be done without incisions or the stress of general anesthesia, which reduces the risk for patients with heart or lung problems. These advances mean even low-risk patients can get back to their daily routine faster.
M Health Fairview’s experts have developed a pilot program to help primary care doctors determine who should receive an ultrasound screening to detect aortic aneurysms on the basis of a number of health factors.
90,000 Aortic aneurysm – symptoms and treatment. Causes, signs, diagnostics, prevention
The aorta is the largest blood vessel in the body. Its walls are dense and strong, but in some cases they can partially weaken. In this case, there is an expansion, or aneurysm of the aorta. Such a formation can rupture, and also provokes heart disease, kidney disease, and stroke. Aortic aneurysm rupture is a formidable complication, often leading to an unfavorable outcome. Therefore, it is important to diagnose the disease at an early stage, with the help of the specialists of the clinic on Barclay.
Classification of aortic aneurysm
Depending on the location of the saccular expansion of the vessel walls, the classification includes several variants of the disease:
- aneurysm of the ascending aorta: localized at the very beginning of the vessel, where it departs from the heart and goes vertically in the chest;
- aneurysm of the aortic arch: located in the upper part of the chest, where the vessel bends, and large arteries branch off from it to the head, neck, upper limbs;
- aneurysm of the thoracic part of the aorta: located in the descending part of the vessel from its arch to the point of penetration through the diaphragm;
- Abdominal aortic aneurysm: occurs below the diaphragm, where arteries branch off from the vessel to the internal organs.
The course of the disease and its treatment options differ for different types.
Symptoms and causes of aortic aneurysm
Thoracic aortic aneurysm is often associated with genetic diseases and accompanies conditions such as bicuspid aortic valve, Marfan and Lois-Dietz syndromes. Other possible causes of pathology:
- high blood pressure;
- infectious process;
- atherosclerosis and high cholesterol;
- chest trauma.
Symptoms of a thoracic aortic aneurysm appear only when the mass reaches a large size or ruptures. As the diameter increases, the following symptoms of a thoracic aortic aneurysm may occur:
- chest or back pain;
- Difficulty breathing or swallowing
- dry cough;
- hoarseness of voice.
90 011 shortness of breath;
Abdominal aortic aneurysm has no well-defined cause.In its occurrence, genetic changes, atherosclerosis, smoking, hypertension, vasculitis or abdominal trauma are important.
Aortic aneurysm of the abdominal cavity is asymptomatic for a long time. Only in some cases are its symptoms possible:
- back pain or abdominal pain;
- Sensation of pulsation in the umbilical region.
An aneurysm of the abdominal aorta may rupture (dissection occurs), and then the patient will feel sudden sharp pain in the abdomen or back, dizziness, severe weakness, sweating, palpitations and shortness of breath.
Complications of aortic aneurysm
Very often, signs of aortic aneurysm appear only with the development of complications of this disease. They can be divided into two groups: dissecting aneurysm or wall rupture with the development of bleeding and thrombosis.
Aortic dissecting aneurysm is accompanied by acute pain and rapidly emerging symptoms of internal bleeding. Blood can freely flow into the chest, abdominal cavity, pericardium, pleural cavity, esophagus.
In the enlarged section of the vessel, the normal flow of blood is disrupted, therefore conditions are created in it for the formation of its clots – blood clots. Migrating through the bloodstream, such blood clots can cause blockage of important vessels with the development of stroke, myocardial infarction or internal organs, arterial thrombosis of the lower extremities.
Diagnostics and treatment of aortic aneurysm
Given the long asymptomatic course of the pathology, the diagnosis of aortic aneurysm is difficult. Often, the disease is an accidental finding in studies performed for another reason. It could be:
- chest or abdominal radiography;
- echocardiography (ultrasound of the heart), which is especially informative in recognizing the expansion of the ascending aorta;
- computed or magnetic resonance imaging.
Methods with vascular contrast, for example, aortography, are used to clarify the size and localization of the expansion before the operation.
In case of genetic abnormalities and the presence of other possible causes of pathology that increase the risk of developing the disease, annual screening is necessary to assess the rate of aneurysm enlargement. In addition, some medications are prescribed, for example, to normalize blood pressure or lower cholesterol levels.
When symptoms of the disease appear or the aneurysm grows rapidly, surgery is prescribed.For example, treatment for an abdominal aortic aneurysm consists of removing the affected area of the vessel and replacing it with a strong synthetic tube (aortic prosthesis), or such a prosthesis is placed inside the dilatation. Similar interventions are carried out when the lesion is localized in the thoracic part of the vessel.
Traditional methods of treatment are only of auxiliary value, helping to maintain a normal level of pressure or affecting the amount of cholesterol in the blood. With such a serious disease as aortic aneurysm, treatment only with folk remedies without regular examination by a cardiologist is unacceptable.
Primary prevention of aortic aneurysm has not been developed because its causes are unknown. With an already diagnosed disease, it is necessary to exclude the influence of harmful factors, such as smoking, hypertension or high blood cholesterol levels. To prevent rupture of an aneurysm, an annual diagnostic examination is required.
Treatment of aortic aneurysm in the clinic on Barclay
Benefits of monitoring, diagnosing and treating patients with aortic aneurysm at our center:
- Experienced cardiologists, doctors of functional and ultrasound diagnostics conduct appointments here;
- uses expert-class equipment, which increases the accuracy of diagnostics;
- Possible complex treatment of concomitant diseases, recommendations for the correction of risk factors;
- offers affordable prices for medical services.
If you suspect a disease or have already diagnosed an aneurysm, we invite all patients living in Moscow for a consultation with our specialists. To make an appointment, you need to call the specified phone number.
Abdominal aortic aneurysm. Booking Health
Currently, due to the difficulties associated with the organization of treatment in Turkey, Switzerland, South Korea and India, we have suspended the processing of applications in these areas.
If you are interested in organizing treatment in Germany, please leave a request and our specialists will contact you as soon as possible.
What is an abdominal aortic aneurysm? Is this disease dangerous? Does it need to be treated urgently or is simple observation enough? Let’s talk about what an abdominal aortic aneurysm is, why it develops, how it manifests itself, is diagnosed and treated.
- Clinical signs
- Aneurysm rupture
- Is conservative treatment possible?
- Indications and contraindications for surgery
- Organization of treatment in Germany
Abdominal aortic aneurysm is a disease in which there is an increase in the diameter of an individual section of the aorta 2 or more times compared to the normal width of this vessel. Pathology is dangerous in that at any time the aneurysm can rupture. This deadly complication is fatal in many cases. Abdominal aortic aneurysms can have different causes. But one of them prevails in frequency over the others. Atherosclerosis is the cause of the disease in 96% of cases. All other causes of abdominal aortic aneurysm taken together cause pathology in only 4% of patients.
Among such reasons:
- Congenital defects of connective tissue
- Nonspecific aortitis (inflammatory processes of bacterial etiology)
- Surgical operations and diagnostic procedures
Different parts of the aorta can expand.By localization, they are divided into 4 types:
- Proximal region (closest to the diaphragm)
- Aneurysm of the infrarenal abdominal aorta without involvement of the bifurcation (this is the place where the aorta is divided into 2 iliac arteries)
- The same localization with bifurcation lesion
- Dilation of the entire abdominal aorta
90% of patients are diagnosed with type 2 or 3 of the disease. This is a lesion of the infrarenal region, when the pathology is localized below the branch of the renal artery.
Most of the symptoms of an abdominal aortic aneurysm are caused by compression of adjacent anatomical structures. It depends on what kind of tissue is squeezed, what symptoms of an aneurysm of the aorta of the abdominal cavity the doctor detects.
Abdominal pain in abdominal aortic aneurysm is the main clinical sign of pathology. This symptom is observed in 90% of patients. Often it is the abdominal pain that becomes the reason for seeking medical attention. It is associated with the compression exerted by the enlarged section of the artery on the nerve plexuses.
Pain is usually dull, aching. It is often localized in the navel area, although it often radiates to the groin, lower back and even legs. Sometimes the intensity of pain increases significantly, signs of an acute abdomen appear. This happens when the aneurysm begins to press on the spinal roots.
The second clinical sign of an abdominal aortic aneurysm is a feeling of strong pulsation. It is observed in 40% of patients with this disease. The sensation is often accompanied by bloating, heaviness, and abdominal discomfort.When probing, a volumetric formation is determined more often in the left half of the abdominal cavity. Usually, pulsation appears only when the aneurysm reaches a large size. This indicates an increased risk of rupture.
During the examination, the third main symptom of an abdominal aortic aneurysm is determined. Diagnosis of the disease involves auscultation – listening to the abdominal wall using a phonendoscope. In 75% of patients, a systolic murmur is determined over the enlarged section of the aorta.It is caused by the trembling of its wall.
Other symptoms of abdominal aortic aneurysms are variable. They occur with low frequency in different patients.
Among the main clinical syndromes, the following should be distinguished:
- Ischioradical – pain in the lower back and deterioration of leg mobility when motor and sensory spinal nerves are compressed.
- Abdominal – belching, vomiting, stool disturbances, loss of appetite, weight loss. It occurs when the duodenum is squeezed.
- Urological – blood in the urine, pain and heaviness in the lower back, difficulty urinating. Associated with compression of the kidney and ureter.
- Chronic ischemic – occurs when the femoral and iliac arteries are squeezed, manifested by pain in the legs, aggravated by walking.
Symptoms give the doctor the opportunity to suspect an abdominal aortic aneurysm, but the final diagnosis is established using instrumental studies.
Abdominal aortic aneurysm is detected using classic and innovative imaging techniques.Mostly used are ultrasound, X-ray methods or MRI.
- Ultrasound . It is the simplest, safest and most inexpensive research method. It can be prescribed prophylactically to men after 50-60 years old, even if they have no complaints. During this procedure, an aneurysm of the abdominal aorta may be detected. In addition, ultrasound makes it possible to assess the condition of its wall, detect thrombosis, and clarify the size and location of the enlarged fragment of the artery.
- CT .Computed tomography is a clarifying method for diagnosing an abdominal aortic aneurysm. It allows you to detect thrombotic masses and damage to the inner lining of the artery. With the help of CT, the doctor assesses the condition of nearby organs.
- MRI . For a clarifying purpose, an MRI can also be performed. This method allows you to see the details even better. Thanks to MRI, the doctor detects calcifications, damage and dissection of the aortic walls, as well as other morphological features.
- Angiography .This research method is unsafe, because during its conduct there is a risk of rupture of the aorta. Therefore, with an aneurysm of the abdominal aorta, it is rarely prescribed. This is an X-ray diagnostic method that involves the introduction of contrast. It is used to check the condition of the branches of the aorta, or to get a more accurate picture of the disease before surgery.
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This disease is one of the most dangerous vascular pathologies.His prognosis is unfavorable. Abdominal aortic aneurysm rupture occurs in 40% of patients within the first year after diagnosis. Mortality with this complication reaches 60%.
The disease is constantly progressing, the diameter of the aneurysm increases over the years. It grows by an average of 2-3 mm per year. As a result, the outer shell of the artery begins to play the role of the frame of this large vessel. Naturally, she is not able to withstand such strong pressure for a long time. Moreover, because of the turbulence of the blood flow, it increases.That is, the pressure in the dilated portion is higher than in the rest of the aorta. As a result, rupture occurs with massive internal bleeding.
An aneurysm of the abdominal cavity of the aorta ruptures more often with a large diameter of expansion. A direct relationship was established between the size of the aneurysm and the risk of its rupture. So, with an expansion diameter of less than 5 cm, the risk of rupture is about 5%. If the diameter exceeds 7 cm, then the probability that the aneurysm will rupture reaches 76%. The risk increases if the patient suffers from uncompensated arterial hypertension.
Is conservative treatment possible?
Treatment of an aneurysm of the abdominal aorta without surgery is impossible. There is no pill that can be taken to reduce the dilated section of the blood vessel to its normal diameter. Alternative medicine and alternative medicine are also ineffective. If an abdominal aortic aneurysm is found, treatment can only be performed with surgical methods.
The need for an operation is decided in each case individually. If an aneurysm is detected, the patient is referred to the vascular surgery department.Doctors then assess risk factors and decide whether surgery is needed now or if it can be postponed until a later date.
Most experts are inclined to believe that when an abdominal aortic aneurysm is detected, treatment is always required if it has a diameter of more than 4 cm. It does not matter whether the patient has complications of the disease and how old he is.
Indications and contraindications for surgery
If an aneurysm of the abdominal aorta is detected, treatment should be carried out as early as possible.First, so that it does not have time to burst. Secondly, in order to prevent the development of complications of the disease. Therefore, active surveillance tactics are meaningless. Moreover, given the fact that the aorta is constantly expanding. Sooner or later, with an abdominal aortic aneurysm, the operation will still have to be done. But it is better to do it right away, while there are no irreversible complications yet. But still, in some cases, the start of surgical treatment has to be postponed. Many patients are stopped by the cost of the operation. Aortic aneurysm of the abdominal cavity may also not be cured by surgery due to medical contraindications.
The main ones:
- Coronary or intracerebral circulation disorders
- Renal or hepatic insufficiency
- Heart muscle infarction transferred less than 3 months ago
Surgical treatment is carried out only if the patient is compensated. The operation can be emergency or planned. Emergency surgery differs in that it is carried out as soon as possible. It is indicated for a threatening rupture of an aneurysm.Regardless of the presence of symptoms, treatment for an abdominal aortic aneurysm is prescribed for the majority of patients.
The operation is carried out as planned. Its essence lies in the fact that a prosthesis made of artificial materials is installed inside the enlarged section of the aorta. It can be linear or bifurcated. The sutured ends of the artery are fixed with clamps during the operation to prevent hemorrhage. When carrying out an operation for an aneurysm of the abdominal aorta, its price to a certain extent depends on the quality of the prosthesis being installed.
Access can be open or endovascular. With open access, a laparotomy is performed. That is, the abdominal wall is opened. Endovascular access is preferred. The cost of the operation is approximately the same.
But surgical intervention with intravascular access provides:
- Shorter rehabilitation period
- Better postoperative tolerance
- Less risk of complications during vessel resection
- Better aesthetic effect
Endovascular access is performed through the femoral or iliac artery.New methods of intravascular access are used in severe patients who cannot undergo open surgery.
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Organization of treatment in Germany
Many patients with abdominal aortic aneurysm prefer the operation to be performed in one of the German clinics. This choice is due to the fact that surgical intervention for aneurysm is very dangerous, and in clinics in developing countries postoperative survival rate reaches 95%.
The cost of an abdominal aortic aneurysm operation in Germany is higher than in the post-Soviet countries, but much lower than in the USA, Switzerland or Great Britain. In the best German clinics, there is a lower intraoperative mortality rate, a lower risk of complications, and better long-term treatment results. In Germany, there is a higher tolerance for the operation, because the patient is provided with high-quality postoperative care and modern pain relief.
Safe and effective aortic surgery can be performed at the Helios Krefeld Clinic, a maximum care medical center, in continuous cooperation with the world’s leading universities and research centers.The Department of Adult and Pediatric Cardiac Surgery under the leadership of Professor, Doctor of Medicine Jurgen Enncker has a number of its own developments in the field of surgical interventions on the thoracic and abdominal aorta. These are coronary artery bypass grafting with the use of minimized extracorporeal circulation (a special heart-lung machine is used), coronary artery bypass grafting on a beating heart and minimally invasive direct coronary artery bypass grafting. The department also uses hybrid endoprostheses of the thoracic and abdominal aorta, performs classical reconstructive interventions with the installation of self-expanding stents.At the same time, the department’s specialists carry out both primary and more complex revision interventions in patients of all ages.
We can arrange treatment for you in one of the best clinics in Germany.
Booking Health has direct contracts with all major medical institutions in this country, which will allow you to:
- Reduce the waiting time for surgery
- Reduce treatment costs by up to 70%
- Use the services of the best doctors in Germany, not young specialists from little-known clinics
We will provide all the necessary services and fully organize your trip to Germany for treatment. We will provide you with an interpreter, help you with visa processing, translation of documents, book tickets and a hotel for you, meet you at a German airport. To use the services of Booking Health, leave a request on the website, and we will contact you as soon as possible.
Choose treatment abroad and you will undoubtedly get an excellent result!
Authors: Dr. Nadezhda Ivanisova, Dr. Vadim Zhilyuk
Why Booking Health – Questions and Answers
Aortic aneurysm – what is it, causes, classification
Thoracic aortic aneurysm
Organization of treatment in Germany
Send a request for treatment
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Aneurysm a of the abdominal aorta – is a pathological enlargement of the aorta in the abdominal cavity. The biggest danger is that the aneurysm can rupture suddenly, leading to massive internal bleeding.
Causes and symptoms
Most aneurysms are caused by hardening of the walls of the arteries (atherosclerosis). Five out of 100 men over 65 have abnormal enlargement of the abdominal aorta, which must be strictly controlled.
Surgical treatment is necessary when the aneurysm reaches a certain size. People who smoke and former smokers are at particular risk.Hypertension and lipid metabolism disorders also play an important role. If there is a patient with an aneurysm in the family, the likelihood of other family members having the aneurysm is also high. Therefore, men and women with a hereditary predisposition over the age of 50 should be examined.
Most dangerous, the abdominal aortic aneurysm is usually not visible to the patient. Only thin patients can sometimes feel an aneurysm throbbing through the abdominal wall.
Severe abdominal pain radiating to the back occurs only when a vessel ruptures. It is not uncommon for these cases to be misdiagnosed as having renal colic or spinal problems.
Massive internal bleeding results in a life-threatening situation that can be fatal in about 80 percent of cases.
Prevention by screening
During screening, palpation and ultrasound of the abdomen are performed. Ultrasound examination is painless and safe and can be performed in many clinics and private praxis.
The size of the aneurysm is of great importance. When the size (diameter of the aneurysm) is more than 5 centimeters, the risk of rupture of the vessel wall significantly increases.
With timely screening, this can be avoided!
Further examinations such as computed tomography provide all the necessary information about the anatomy of the aneurysm and plan further treatment.
Small aneurysms, less than 5 cm in men and less than 4.5 cm in women, should be monitored regularly with ultrasound.In addition, risk factors such as smoking and high blood pressure must be adjusted to prevent further vasodilatation.
In cases where the aneurysm reaches the critical size (more than 5 cm in men and more than 4.5 cm in women) or when there are complaints associated with the presence of an aneurysm, there are indications for computed tomography and for treatment of an aortic aneurysm. There are two different methods:
In the case of open surgery , the abdominal cavity is opened and the enlarged abdominal aorta is replaced with a synthetic prosthesis.
This type of treatment has been used for many years and is a safe surgical method in the hands of experienced surgeons.
However, in cardiac patients in particular, such operations are associated with a high risk.
Another treatment is endovascular surgery .
In this case, the aneurysm will be turned off with a stent inserted into the aorta through 2 small incisions in the groin.
Compared to open surgery, this procedure is much easier for patients, since in this case the abdominal cavity will not be opened and the aorta will not be compressed.
A disadvantage of endovascular treatment is the need for regular, lifelong monitoring, usually with computed tomography.
Endovascular surgery may not be performed in all cases. For example, this is not always possible with complex anatomy (tortuosity) of the vessels.
Which method of treatment will be used in each case is decided individually after evaluating all the patient’s examination data.
90,000 “Abdominal aortic aneurysm. Information for patients “- Yandex.Kew
What is an abdominal aortic aneurysm
An abdominal aortic aneurysm is an enlarged area in the lower aorta, the main blood vessel that supplies blood to our body. The aorta, which is similar in thickness to a garden hose, extends directly from the heart and passes through the chest and abdomen, giving branches to all internal organs and limbs. Since the aorta is the main blood vessel, rupture of its aneurysm can lead to life-threatening bleeding.
Normal aorta and its branches
Depending on how dilated the aorta is and the rate at which this dilation progresses, some patients only need observation, while others may need emergency surgery. If surgery is necessary, close monitoring of the aneurysm growth and the patient’s condition helps doctors choose the optimal time for planned intervention, since emergency surgery is associated with certain risks.
Abdominal aortic aneurysms often grow slowly and usually do not cause any symptoms, making them difficult to identify. Some aneurysms never rupture, some practically do not increase over the years, although the opposite situation often happens when the aneurysm grows and grows rapidly. At this stage in the development of medicine, it is still difficult to predict how the aneurysm will behave in each individual patient.
As the abdominal aortic aneurysm grows, some patients may experience certain sensations, for example:
- Feeling of pulsation near the navel
- Deep, persistent pain in the abdomen or in one part of the abdomen
- Back pain
When to see a doctor? You should definitely consult your doctor if you have any of the above symptoms.
In addition, all people 60 years of age or older should be screened for the condition if they have risk factors such as smoking or a close family history of aortic aneurysm. Because smoking and male sex significantly increase the risk of developing an abdominal aortic aneurysm, all men aged 65-75 who have ever smoked cigarettes should undergo a single screening ultrasound scan (the aneurysm can be detected using abdominal ultrasound).The same applies to close relatives of patients with an abdominal aortic aneurysm.
For women, there are no clear universal recommendations on screening, so the doctor decides whether such screening is necessary for a particular woman, based on her risk factors, on an individual basis.
Causes of aneurysm of the abdominal aorta
Most aneurysms develop in the part of the aorta that is located in the patient’s abdomen.Although the exact causes of this condition are not known, there are a number of factors that may contribute to the development of an abdominal aortic aneurysm:
- Smoking. Smoking cigarettes and using other types of tobacco increase the risk of aortic aneurysm. In addition to directly damaging the artery wall, smoking also contributes to the deposition of fatty plaques in the arteries (atherosclerosis) and high blood pressure. Continued smoking can also accelerate the growth of an already formed aneurysm by continuing to damage the aorta.
- Atherosclerosis. Atherosclerosis is a process by which fats and certain other substances accumulate inside the wall of a blood vessel. Vessels affected by atherosclerosis have an increased risk of aneurysmal dilatation (atherosclerotic aortic aneurysm).
- Inflammation of the aorta (vasculitis). In rare cases, an abdominal aortic aneurysm can develop from infection or inflammation that weakens an area of the aortic wall.
In principle, aneurysms can form anywhere in the aorta (for example, if they form in the chest, they are called thoracic aortic aneurysms ), but they are more common in the abdominal region.
Risk factors for developing abdominal aortic aneurysms
Risk factors, that is, individual characteristics that increase the risk of aortic aneurysm formation, include:
- Age. Abdominal aortic aneurysms most commonly develop in people 65 years of age or older.
- Tobacco consumption. Tobacco use is an important risk factor for the development of abdominal aortic aneurysms.The longer you smoke (or use other types of tobacco), the higher your risk.
- Atherosclerosis. As discussed above, the deposition of fats and other substances damages the artery wall and increases the risk of aneurysmal dilatation.
- Male Men have a significantly higher incidence of abdominal aortic aneurysms than women.
- Family history. People with close family members who have an abdominal aneurysm are at increased risk of this condition.In people with a family history of the condition, aneurysms often develop at a younger age and are at increased risk of rupture.
Complications of the abdominal aortic aneurysm
The main and most dangerous complication of an abdominal aortic aneurysm is rupture (dissection) of its wall. A ruptured aortic aneurysm can be a source of life-threatening internal bleeding. In general, the larger the aneurysm, the higher the risk of developing it.
Signs and symptoms that a person has a ruptured aortic aneurysm may include:
- Sudden, intense and persistent abdominal or back pain
- Pain that radiates to the back or legs
- Low blood pressure
- Fast heart rate
- Loss of consciousness
- Lack of air
Another possible complication of aortic aneurysm is the risk of blood clots – thrombi.Small blood clots can form in the area of the aneurysm, and if such a clot breaks off from the place where it formed and is carried with the bloodstream, it can block the lumen of the underlying smaller blood vessels, causing disruption of the blood supply to the organs they feed, for example, the lower extremities (or fingers legs), kidneys or abdominal organs.
How to prepare for an appointment with a doctor? If you think you may have an abdominal aortic aneurysm, or are worried about an increased risk of having a close family member, see your GP or GP.If the aneurysm is detected at an earlier stage, the treatment will be simpler and more effective.
Because many abdominal aortic aneurysms are detected during routine examination or diagnostic search for some other medical condition, no special preparation is usually required. If you are scheduled to have a screening test to rule out aneurysm, your doctor may ask you if anyone in your family has had aortic aneurysm, so if you don’t have this information, it’s worth getting it ahead of time.
Since the time that a doctor has for a consultation is limited and there are a lot of issues to be discussed, it would be better if you come to the doctor already prepared. Below are some information to help you prepare for your visit and what to expect from your doctor.
So what would be useful to do before the visit?
- Find out if there are any restrictions related to the examinations planned during the examination. When making an appointment with a doctor, always ask if you need to prepare in advance somehow. For example, if an ultrasound scan is planned, you may be asked to refrain from eating for a while.
- Write down any symptoms you have, including those that do not seem to you to be associated with an abdominal aortic aneurysm.
- Record key personal information, including any family history of heart disease or aneurysms.
- Prepare a list of all drugs you are taking with doses and frequency of administration, including vitamins and dietary supplements.
- Bring a family member or friend with you, if possible. Sometimes it can be difficult to keep in mind the whole amount of new information that you may come across during an appointment with a doctor. If you have a companion with you, it is possible that he will remember something that you listened to or forgot.
- Be prepared to discuss your diet, physical activity level, and smoking. If you are not following a healthy lifestyle, talk with your doctor about the problems you may face if you decide to change your habits to healthier ones. Be sure to remember to tell your doctor if you have smoked or smoked in the past.
- Write down the questions you would like to ask your doctor. Since visit times are limited, making such a list will help you make the most of your visit. Sort the questions in descending order of importance ahead of time in case you still run out of time.
What to expect from a doctor? Your doctor is likely to ask you a number of questions. Being ready to respond quickly will save time for other issues.Your doctor may ask you:
- When did you first notice these symptoms?
- Do your sensations come and go, or do you feel them all the time?
- How severe are these symptoms?
- Have your relatives had any cases of aneurysms?
- Have you ever smoked?
- Does anything relieve your symptoms?
- If such factors exist, what aggravates your symptoms?
What else can you do? It’s never too late to change your lifestyle to a healthier one, such as quitting smoking, eating healthier foods, and increasing physical activity. All of these are primary defenses that help maintain vascular health and prevent the development and progression of their aneurysms.
If you have already been diagnosed with an aneurysm, you should definitely ask your doctor about its size, whether there are any changes compared to the previous examination, and about the timing of the next visit.
Diagnostics of the abdominal aortic aneurysm
Abdominal aortic aneurysms are often found during examination for some other reason.For example, a doctor may detect a pulsating mass in a patient’s abdomen during a routine examination, although you should not rely on hands and a stethoscope to detect any aneurysms. Also, aortic aneurysms are often seen on chest x-rays, abdominal ultrasounds, or echocardiography that were prescribed for other reasons.
If your doctor suspects that you may have an aortic aneurysm, this can be confirmed or refuted by special studies.These include:
- Ultrasound examination (ultrasound) of the abdominal cavity. This test may help diagnose an aneurysm of the abdominal aorta. During this painless diagnostic procedure, you will lie on your back and a small amount of a special gel will be applied to your abdomen. This gel helps to remove the air between your skin and the ultrasound sensor. The examining specialist moves the sensor over the abdominal skin, examining different areas.The image obtained with the help of the sensor is transferred to the computer screen, where a potential aneurysm can already be seen.
- Computed tomography (CT). This test is also painless and helps to obtain clear images of the aorta. During a CT scan, you will lie on a table inside a donut-like machine called a gantry. Sensors inside the gantry measure the X-rays that pass through your body and convert them into electrical signals.The computer processes all these signals and, depending on the intensity, assigns them a certain shade on a black and white scale. Further, a single image is built from them, which can be seen on a computer monitor.
3D reconstruction of the abdominal aortic aneurysm
- Magnetic resonance imaging (MRI). MRI is another painless imaging technique. Most magnetic resonance imaging machines contain a large donut or tunnel shaped magnet.The patient lies on a movable table that enters this tunnel. A constant magnetic field forces the protons contained in the cells of the body to occupy a certain position, after which they are affected by a certain combination of electromagnetic waves and the resulting signals are recorded. Since the electromagnetic response of different tissues is different, summarizing all these signals, the computer can also build a sufficiently clear image on which, among other things, a potential aneurysm can be seen.
Routine screening in people at increased risk of abdominal aortic aneurysm
The US Preventive Action Task Force (USPSTF) recommends that all men 65 to 75 years of age who have ever smoked should be screened for an abdominal aortic aneurysm by ultrasound once. If you are over 60 years old, have had aneurysms in your family, or have other risk factors, you should talk to your doctor about whether you need a screening ultrasound.
Abdominal aortic aneurysm treatment
The general guidelines for the management of patients with abdominal aortic aneurysms are described below.
Small aneurysms If the detected aneurysm is small, on the order of 4 cm in diameter or less, and you have no symptoms, your doctor will suggest observation rather than surgery.
In general, such small aneurysms do not require surgery because the risk of intervention will be higher than the risk of rupture.
If this approach is chosen, the doctor will monitor the aneurysm with periodic ultrasound examinations, usually every 6-12 months. You will also be asked to tell your doctor immediately if you develop pain in your abdomen or back – potential signs of dissection.
Medium aneurysms Medium aneurysms are considered when the diameter is between 4 and 5. 3 cm. In this situation, the risk ratio of surgery or expectant management is not so obvious, so the doctor and patient jointly make this decision for each individual case.If the choice is made in favor of observation, then, as with smaller aneurysms, you will need to undergo a follow-up ultrasound every 6-12 months.
Large, rapidly growing, or ruptured aneurysms If the identified aneurysm is large (larger than 5.6 cm in diameter) or growing rapidly, you will likely need surgery. In addition, operations require aneurysms with visible tears or painful sensations. For abdominal aortic aneurysms, two types of interventions are used.
- Open abdominal aortic aneurysm surgery involves the surgeon making an incision in the abdomen and removing the damaged section of the aorta and then replacing it with a synthetic tube (prosthesis) that is sutured in its place. Recovery from this type of surgery usually takes a month or more.
- Endovascular is a less invasive procedure in which a synthetic prosthesis is attached to the end of a thin tube (catheter) that is inserted through an artery in the leg into the aorta. A prosthesis called a stent graft is a tube made of woven synthetic material backed by a metal mesh. It is placed in the aneurysm and secured in place with small hooks or other attachments. A stent graft strengthens the wall of the aneurysm and prevents it from tearing.
Recovery after such an intervention proceeds much faster than after open surgery, but later on, patients need more frequent monitoring, since there are leaks in such prostheses.Control ultrasound examinations should be performed every 6 months in the first year, and then once a year.
Long-term survival rates are similar after endovascular and open procedures.
The choice of the method of intervention is influenced by such factors as the location of the aneurysm, age, the state of renal function and the presence of other concomitant diseases that may increase the risks of open or endovascular surgery.
Lifestyle & Home Remedies The best way to prevent aortic aneurysm formation is to maintain the best possible overall vascular health. This implies the following measures:
- Cessation of smoking and tobacco consumption in other forms.
- Maintaining normal blood pressure levels.
- Regular physical activity.
- Reducing dietary cholesterol and fat intake.
Talk to your doctor if you have any risk factors for aortic aneurysm. If you are at risk, your doctor may recommend additional measures, such as drugs that lower blood pressure and pressure on the arterial wall.
90,000 Table 1 – The most common causes of hypertension in different age periods / Consultant Plus
Table 1 – The most common causes of hypertension in different age periods
Up to 1 year
1 – 6 years
7 – 12 years
Thrombosis of renal arteries or veins
Renal artery stenosis
Congenital malformations of the kidneys
Coarctation of the aorta
Renal artery stenosis
Parenchymal kidney disease
Coarctation of the aorta
Tumor of the adrenal glands (corticosteroma)
Itsenko-Cushing’s disease (pituitary adenoma)
Parenchymal kidney disease
Coarctation of the aorta
Itsenko-Cushing’s disease and syndrome
Nonspecific aorto-arteritis (Takayasu’s disease)
Parenchymal kidney disease
Congenital dysfunction of the adrenal cortex, hypertensive form
Itsenko-Cushing’s disease and syndrome
Blood pressure in a person is determined by a complex of various factors that make up a functional system as defined by academician P. K. Anokhin. This system maintains a constant blood pressure in a self-regulating manner. Despite the fact that arterial hypertension (AH) remains at the moment one of the most common diseases and is an undoubted risk factor for cardiovascular mortality, the pathophysiological aspects leading to an increase in blood pressure (BP) require further study. AH is considered as a multifactorial disease, the development of which is due to the interaction of genetic disorders and acquired changes in the regulation of blood circulation and is a complex complex of neurohumoral, hemodynamic and metabolic factors, the relationship of which is transformed over time [3, 4].
At present, there is no less doubt that in hypertensive disease, an increase in blood pressure is associated with a complex interaction of genetic, psychosocial factors, as well as maladjustment of physiological mechanisms [3, 4].
Disorders of the mechanisms of autoregulation of central hemodynamics. Normally, there are autoregulatory mechanisms that maintain a balance between cardiac output and peripheral vascular resistance. So, with an increase in vascular output during exercise, the total peripheral vascular resistance decreases.On the contrary, with an increase in the total peripheral vascular resistance, a reflex decrease in cardiac output occurs. In hypertension, the mechanisms of autoregulation are impaired. There is a mismatch between cardiac output and total peripheral vascular resistance. The proposed mechanisms underlying this process are outlined by T. Kaplan, 1998 and are presented in Figure 1. In the early stages of hypertension, an increase in cardiac output is found, while the total peripheral vascular resistance may be normal or only slightly increased.With the progression of the disease, stabilization of systemic blood pressure at high levels, the total peripheral vascular resistance steadily increases .
Systemic blood pressure begins to rise with depletion of antihypertensive homeostatic mechanisms, or with excessive strengthening of vasoconstrictor and antinatriuretic neurohumoral systems (angiotensin II, norepinephrine, endotheliin-1, insulin, etc. ). 
Fig. 1 – Mechanisms for the implementation of the level of blood pressure (T. Kaplan, 1998),
where SV is cardiac output; OPSS – general peripheral
Among the antihypertensive homeostatic mechanisms are important: renal excretion of sodium ions; baroreceptors of the aorta and large arteries; activity of the kallikrein-kinin system, release of dopamine ions, natriuretic peptides A, B, C, prostaglandins E2 and I2, nitric oxide, adrenomedulin, taurine.
Endothelial dysfunction is currently considered as an important pathogenetic link in the formation of hypertension. The main indicators of systemic circulation – the minute volume of blood and blood pressure during the day are constantly changing depending on the real needs of tissues at a particular time. Between successive parts of the vascular bed, changing ratios of tone and total vascular lumen are established, which determine the volume of blood flow. From modern positions, ensuring an adequate state of the vascular bed in accordance with the needs for blood supply to the peripheral muscles and internal organs is provided by the vascular endothelium.
Endothelial dysfunction is defined as a condition in which the ability of endothelial cells to release vasodilating, angioprotective, antiproliferative factors (primarily nitric oxide) decreases, while the formation of vasoconstrictor, prothrombotic, proliferative agents persists or increases .
The reasons for the development of endothelial dysfunction are diverse and are mainly determined by long-term hemodynamic overload of the arteries, hyperactivation of the renin-angiotensin-aldosterone and sympathetic-adrenal systems, as well as a number of other mechanisms.
One of the pathophysiological mechanisms of dysfunction of the endothelium of the resistive link of the microvasculature in hypertension is the suppression of the synthesis of endothelium relaxant factor. At the same time, the stimulation of M-cholinergic receptors of the endothelium with acetylcholine does not lead to the desired endothelium-dependent vasodilation, forming an increased level of blood pressure [3, 4].
Genetic aspects. The following facts indicate the importance of heredity in the pathogenesis of arterial hypertension:
high correlation of blood pressure in monozygotic twins compared with dizygotic twins; this made it possible to establish that the differences in the levels of systemic blood pressure in humans by 30-60% are determined by genetic factors
higher values of blood pressure in children with a history of hypertension compared with children whose parents are healthy.
The gene or genes responsible for the onset of hypertension have not yet been discovered. The greatest progress in understanding the role of hereditary predisposition to arterial hypertension has been achieved in the study of the genotypes of the renin-adosterone-angiotensin system. It has been established that polymorphism of the angiotensin-converting enzyme (ACE) gene determines the activity of this enzyme. DD carriage of ACE gene polymorphism is regarded as an independent risk factor for the development of essential hypertension, is associated with an increase in ACE activity, which stimulates the adrenal medulla and cortical layer and causes an increase in vascular smooth muscle tone and general peripheral vascular resistance, VLDL cholesterol, and a high level of anxiety, which reflects pleiotropic effect of this gene.Expression of the T174M angiotensinogen gene determines the activity of angiotensinogen. Carriage of the T174M mutant allele of the angiotensinogen gene is associated with an increase in ACE activity. VNTR polymorphism of the endothelial nitric oxide synthetase (eNOS) gene determines the vasogenic effect of NO. The carriage of the mutant allele 4a of the eNOS gene determines the propensity for vasoconstrictor reactions and the formation of EAG [3, 5].
Increased activity of the renin-angiotensin-aldosterone system in the bloodstream and tissues plays an important role in the pathogenesis of hypertension.Epidemiological studies have shown that plasma renin level is an independent prognostic factor for the course of arterial hypertension. A high level of plasma renin compared to a low one increases the risk of complications from hypertension by 6 times. In the initial stages of EAH formation, an increase in the level of renin in plasma up to 60% is noted, especially during stress tests, depending on the time of day. As the elevated blood pressure level stabilizes, there is a slight decrease in the RAAS activity.For a long time, the prevailing opinion was that the most unfavorable, progressive course of EAH was observed in hyperrenin forms [3, 4]
The most important role in the regulation of blood pressure is assigned to an increase in the tone of the sympathetic nervous system, which contributes to an increase in the minute volume of blood circulation, an increase in vascular resistance, fluid retention, and remodeling of the heart and blood vessels [3, 5].