Abdominal aortic spasm symptoms. Abdominal aortic aneurysm - a large overview of the disease. Aneurysms of other locations

If any of the primary signs aneurysms abdominal aorta, you need to urgently contact a specialist.

For older people age category(from 60 years old) it is necessary to regularly visit a doctor and undergo preventive examinations. Men who smoke between the ages of 65 and 75 should undergo an ultrasound examination of their organs. abdominal cavity Every year. This examination is also performed for men with a family history of abdominal aneurysm.

To get checked, you need to contact a therapist, who will refer you for examinations and, if necessary, to a specialist.

Diagnosis of abdominal aortic aneurysms

How to diagnose an abdominal aortic aneurysm and is it possible to determine its possibility based on complaints? The examination algorithm looks like this:

Complaints. Paroxysmal or constant pain in the umbilical region, lower back. Episodes of hypertension, visible pulsation of the anterior abdominal wall. General state not broken. Most abdominal aortic aneurysms are asymptomatic and detected incidentally.
Inspection. Forced position with bent knees. Pallor, swelling of the legs.
Physical data. Painful palpation in the projection of the formation. Frequent soft pulse, arterial hypertension. Auscultation - vascular murmur in the projection of the aneurysm.
Laboratory examination. When involved renal arteries– increased creatinine levels, low density urine.
. Tachycardia and concomitant cardiac diseases are detected.
X-ray in oblique projection helps to identify limited protrusion associated with the aorta, as well as calcifications, but does not allow differential diagnosis.
Ultrasound of the abdominal aorta— “gold standard” for diagnosing aneurysms. Liquid round formation or diffuse expansion of the aortic lumen of more than 3 cm, thinning vascular wall, parietal thrombus.
Computed tomoangiography (CTA), MRI. Expansion of the lumen and thinning of the wall of the abdominal aorta, double channel of blood flow, deformation of the contour of the renal arteries, parietal hematoma, blood clots, local edema, compression nerve trunks. The methods are recommended for emergency diagnosis.
Transcatheter aortography. The method allows you to determine the expansion of the aortic lumen in the absence of thrombus formation. If blood clots are present, the results become false negative.

Differential diagnosis

The disease is differentiated from:

Pancreatitis;
Pancreatic cyst;
Perforation of stomach ulcers and duodenum;
Diverticulitis;
Renal colic;
Intestinal bleeding;
Colon cancer.

Comprehensive differential diagnosis performed using imaging methods - ultrasound, CT, aortography. Methods of objective and laboratory research not effective.

Treatment: choice of tactics

Therapy begins from the moment of diagnosis; tactics depend on the size of the formation. Mainly carried out surgery, however, if the aneurysm small sizes(up to 50 mm), asymptomatic (or symptoms do not interfere full life), then the patient can be offered the method of “active waiting”, which consists of regular ultrasound examinations and monitoring the patient’s condition.

Indications for treatment without surgery:

Diameter less than 50mm;
Lack of a clinic;
Presence of contraindications to surgery;
Exacerbation period chronic diseases (bronchial asthma, COPD).

Drug therapy:

Beta blockers;
Statitis;
Fibrates;
Nitrates;
Aspirin;
According to indications - diuretics, ACE inhibitors.

Indications for surgery and surgical tactics

Indications for surgery:

Diameter more than 55 mm;
Presence of symptoms;
Progressive growth of more than 10 mm per year or more than 6 mm in six months;
Gap;
The appearance of daughter aneurysms;
Thrombosis;
Bag-shaped;
Intestinal ischemia;
Involvement of the renal arteries.

Relative contraindications for surgery:

Cerebral circulation disorders.

The threat of rupture is absolute indication To open surgery in all patients. In other patients, if there are contraindications, medication and symptomatic therapy, aimed at controlling the dynamics of the process, blood pressure levels, and cholesterol.

The operation is most often performed using one of two methods:

Traditional operation. During this operation, the patient is under general anesthesia. The surgeon makes an incision from the urinary process of the sternum to the navel. The damaged area of the vessel is excised, and an artificial prosthesis is implanted in its place. The procedure lasts 3-5 hours. The period of postoperative hospital stay is about a week.
Endovascular method. The procedure is usually performed using epidural anesthesia. The surgeon makes a small puncture in the groin area, through which a stent graft is inserted into the aneurysm using a special catheter. Having brought the device to the designated location, the surgeon opens it and places it in the aneurysmal area. After the stent graft opens, a channel is formed through which normal blood flow occurs. The duration of the procedure is 3-5 hours, and postoperative hospitalization does not exceed 5 days.

Possible complications

Surgical mortality in planned patients reaches 12%, emergency – 78%.

Possible complications after surgery in case of resection of an abdominal aortic aneurysm:

Injury to the renal arteries;
Ureteral rupture;
Secondary infection;
Heart attack;

Complications during endovascular intervention occur in 1.2-5% of patients:

Stent thrombosis;
Anastomotic rupture;
Displacement of parts of the stent inside the vessel;
Secondary infection.

The prognosis is unfavorable. For small aneurysms of the abdominal aorta, the survival rate in the first year is 75%, within 5 years - 50%. If the aneurysm is larger than 6 cm, then the rates are reduced to 50% and 6%, respectively.

Primary and secondary prevention

Primary prevention is aimed at preventing the development of pathology. It includes:

Blood pressure control.
To give up smoking.
Treatment of concomitant diseases.
Elimination of stress and injury.
Maintaining a body mass index within 18.5-24.9.

Secondary prevention is aimed at slowing progression and preventing complications. It includes:

Observation by a surgeon, ultrasound - 2 times a year.
Duplex scanning - at least once a year.
Dispensary registration.
Monitoring lipid and glucose levels in the blood - 4 times a year.
Taking statins, aspirin, beta blockers and ACE inhibitors.
For patients who have undergone endovascular intervention, aortography is recommended once a year to monitor the condition of the stent.

Abdominal aortic aneurysm is an insidious and unpredictable disease. Growth cannot be predicted, so it is important to consult a specialist at the first symptoms and undergo regular medical examinations if diagnosed.

Useful video

For more details about the disease, watch the video:

The aorta is the largest unpaired artery. She belongs big circle blood circulation and nourishes all organs of our body with blood. The aorta is divided into 3 sections and 2 parts - abdominal and thoracic. Most often (in 95% of cases) an aneurysm of the abdominal aorta occurs, which we will talk about today.

An aneurysm is an enlargement or bulging of the aorta. This disease is still the basis of many discussions, because doctors cannot come to a unanimous opinion on what degree of expansion of the vascular wall can be diagnosed as an aneurysm. Previously, the diagnosis was confirmed when the aorta doubled in size or when its diameter expanded by more than 3 cm. But given that the aorta has a diameter from 15 to 32 cm, the concept of “more than 3 cm” is clearly quite vague. Therefore, in 1991, thanks to a study by American scientists, an aneurysm began to be considered a pathological expansion of the lumen of the aorta 50% larger than its normal diameter. But this definition remains rather conditional.

This question becomes especially important when choosing surgical tactics, however, alas, it still remains open. Meanwhile, about 15,000 Americans die each year from aneurysms. In most cases, it simply does not have time to be diagnosed.

Which doctor treats an aneurysm?

This disease is treated by a vascular surgeon, since the main treatment for the problem is surgical. If surgery is not indicated, the patient should be observed by a therapist, cardiologist or internist (specialist in internal diseases), carefully monitor your condition. An aneurysm is quite insidious; it can begin to grow suddenly, increasing the risk of its most serious complication - rupture.

Who is at risk?

Aneurysm is diagnosed in both men and women (in the latter, however, much less often). However, it has been noted that it occurs more often in men over 65 years of age. This is largely due to the passion of many for smoking, which is especially harmful in old age.

So, the risk group includes:

people suffering arterial hypertension;
smokers;
persons whose family has already been diagnosed with an abdominal aortic aneurysm or other cardiovascular diseases and/or pathologies of peripheral circulation;
owners overweight and people leading sedentary lifestyle life.

Attention! Research shows that many aneurysms are inherited from ancestors.

Types of abdominal aortic aneurysms: classification

Abdominal aortic aneurysm is divided into several types depending on its shape, location and pathological features:

Saccular (resembles a sac, which is connected through the neck to the lumen of the aorta).
Fusiform. The shape resembles a spindle, which through an opening is connected to the lumen of the aorta. The most common form of aneurysm.

By pathological features The following types of aneurysms are distinguished:

True. The wall of the vessel is expanded, as it is formed from many layers of the aorta.
Pseudoaneurysm. Appears after injury due to the development of a pulsating hematoma.
Delaminating. That is, its walls are stratified, and the cavities are filled with an intramural hematoma, which through the wall of the damaged vascular tissue is connected to the lumen of the aorta.

It is also distinguished by localization:

An aneurysm of the infrarenal abdominal aorta is located above/below the branch of the renal arteries.
Suprarenal is located above the branching of the arteries
A total aneurysm spreads along the entire length of the vessel.

What are the causes of an aneurysm?

Atherosclerosis, in which the vascular wall becomes thick and loses elasticity, and fat forms on its walls in the form of atherosclerotic plaques. The composition of the plaques includes bad cholesterol and other fats. So far, doctors have not fully determined how exactly atherosclerosis affects the development of an aneurysm, but it is assumed that as a result of this disease, circulatory disorders appear in the vessel and the supply stops nutrients. As a result, the vascular tissue is damaged, followed by its splitting. As a result, a diagnosis of “abdominal aortic aneurysm” is made.
Diabetes mellitus, which “loves” to affect the blood arteries. It is often accompanied by retinopathy, nephropathy, and aneurysm.
Genetics. For some congenital syndromes(Ehlers-Danlos, Marfan, Erdheim's cystic medianecrosis, etc.) arteries are affected, including the abdominal aorta. It is often possible to trace the relationship between abdominal aortic aneurysm and genetic diseases.
Infectious diseases. These include diseases that affect inner layer heart (endocardium), - syphilis, ecdocarditis, salmonellosis, etc.
Injuries received in the abdomen. For example, when strong impact the aorta may be affected in the chest or abdomen.
Inflammatory processes. for example, causes weakening of the aortic wall. True, no specific information on this issue Not yet. But non-inflammatory diseases of the vascular wall often arise due to atherosclerotic plaques.

In general, the most common causes of aneurysm development are smoking, physical inactivity and age. It is extremely important to diagnose it in time. Aneurysms of the thoracic and abdominal aorta have different symptoms, which we will now consider.

What are the symptoms of an abdominal aortic aneurysm?

Most often, an aneurysm does not make itself felt at all and is diagnosed completely accidentally during an examination. Since it displaces organs, disrupting their vital functions, the diagnosis may be made incorrectly, therefore it is extremely important to conduct an ultrasound of the abdominal cavity. Doctors note that aneurysm is especially “secretive” thoracic. It may not appear at all or cause chest pain, coughing and shortness of breath. If it increases, an aneurysm of the abdominal aorta becomes relevant.

Of the few symptoms of an aneurysm, there are several that occur together or separately:

Heaviness in the abdominal area, unpleasant feeling distension and pulse, which resembles an increased heart rate.
Abdominal pain, not acute, rather aching, stupid character. It is localized directly in the navel area or to the left of it.

AND indirect signs An aneurysm of the abdominal aorta makes itself felt. Its symptoms are so different that it is very difficult to suspect a true problem in them. This is because a growing aneurysm can interfere with the functioning of different organs and systems. As a result, it can be confused with renal colic, pancreatitis or radiculitis.

Ischioradicular syndrome causes pain in the area lower section back (particularly the lower back) and impaired sensation in the legs along with movement disorders.

Abdominal syndrome is manifested by vomiting, belching, diarrhea or constipation, as well as lack of appetite, which entails weight loss.

Chronic ischemia of the legs is expressed in poor circulation (cold legs), muscle pain while walking and at rest, periodic lameness.

Urological syndrome manifests itself through urination disorders, pain, a feeling of heaviness in the lower back, and even the appearance of red blood cells in the urine.

Rupture of an abdominal aortic aneurysm begins with increased pain in the abdomen, general weakness and dizziness. Sometimes the pain radiates to the lower back, groin or perineum. In this case, the patient needs immediate medical care, since the condition is fraught with death. Often the aneurysm ruptures in middle section small intestine, stomach or duodenum, less often - into the large stomach. When an abdominal aortic aneurysm ruptures, symptoms may include nausea and vomiting. A mass is palpated in the left, slowly enlarging and with strong pulsation. Its boundaries cannot be felt.

When an aneurysm ruptures, the symptoms are very vivid, but they are easily confused with other health-threatening conditions, so for any acute pain in the stomach or chest, be sure to call ambulance.

Diagnosis of the disease

The first diagnostic stage is an examination by a doctor who, upon palpation, feels a strong pulsation in the abdomen; this is an aneurysm of the abdominal aorta. Its diagnosis includes studies that allow you to visualize what is happening in the aorta. First of all, this is ultrasound, as well as multislice computed tomography of the aorta (MSCT).

If an abdominal aortic aneurysm is suspected, ultrasound makes it possible to confirm its presence with almost one hundred percent certainty. It shows the exact location of the aneurysm, the condition of the vascular wall, and the location of the rupture, if any.

A CT or MSCT is performed to identify calcification, dissection, intrasaccular thrombosis, threatened rupture or an existing rupture.

In case the above diagnostic studies do not allow an accurate diagnosis to be made (although this happens quite rarely), aortography is prescribed. The method allows you to examine the aorta and its branches in real time by introducing a special liquid into the vessel. It is indicated if there is a suspicion of damage to the visceral and renal arteries, and the condition of the distal bloodstream is unknown.

Complications of abdominal aortic aneurysm

This condition is dangerous not only for health, but also for life. First of all, the aorta can cause embolism (blockage) of the arteries, infectious complications, develop heart failure.

Dissecting aneurysm of the abdominal aorta - dangerous complication, which consists in its rupture and blood entering the layers vascular body. If all 3 layers are dissected and the aorta ruptures completely, intense blood loss occurs.

But, of course, the most terrible complication an aneurysm is its rupture. Many patients with untreated aneurysm die within 5 years. Before a breakup a person feels severe pain in the lower abdomen and lumbar region. If an abdominal aortic aneurysm is ruptured, the course of the disease is characterized by profuse bleeding, which leads to shock and death. Therefore, if you have acute pain in the abdomen and chest, be sure to call an ambulance, as it is dangerous to hesitate. Statistics show that only 3% of patients die immediately after aortic rupture, while others live from 6 hours to 3 months. In most cases, they die within 24 hours. How is an aneurysm treated? Let's look at it below.

Treatment of abdominal aortic aneurysm

Many people mistakenly believe that when diagnosed with “abdominal aortic aneurysm,” treatment can only be surgical. In fact, everything is individual here.

If the aneurysm does not reach 4.5 cm in diameter, then surgery is not indicated, because it itself may carry a greater risk to life than the enlarged vessel itself. Typically, this tendency is observed in older men who suffer from concomitant diseases and, in addition, do not stop smoking (and with such a diagnosis, it is simply necessary to stop smoking!). For them, a wait-and-see approach is preferable, because the risk of aortic rupture with this diameter is only about 3% per year. In this case, once every six months the patient is forced to undergo an ultrasound to find out the size of the aorta. If the vascular wall gradually expands, then this is the main indication for surgery, because the likelihood of its rupture increases by 50%.

For elderly people who have been diagnosed with an abdominal aortic aneurysm, it is advisable to carry out treatment using an endovascular, minimally invasive method. During the operation, a catheter is inserted into the patient's artery, through which a stent is inserted. Once in the aorta, it opens and clasps the artery, thereby replacing the affected area of its body. The advantages of the operation include easier tolerability and small recovery period- just a few days. But this method also has its own nuances, so it is not suitable for everyone. The main disadvantage of this operation is that in 10% of cases distal migration of the installed stand is observed.

If a diagnosis of abdominal aortic aneurysm is made, the operation is often open. During this procedure, the affected area of the aorta is removed and replaced with a prosthesis made of Dacron (polyester-based synthetic fabric). To provide access to the aorta, a midline laparatomy is used. The duration of the operation is usually about 2-3 hours. After surgery, a noticeable scar remains.

The patient recovers for about two weeks. Resumption labor activity in some cases it is possible only after 4-10 weeks. The patient is strictly prohibited from physical activity and is advised to rest and walk.

Contraindications to open surgery

Surgery is prohibited for the following conditions:

Recent heart attack (at least a month).
Heart and pulmonary failure.
Kidney failure.
Affected iliac and

Rehabilitation period after surgery

Of course, the presence of complications after surgery is influenced by age and accompanying illnesses patient. Also, the patient’s condition may worsen if his body is already weakened (HIV, cancer, diabetes), obesity and heart disease occur. Moreover, surgery planned in advance gives the patient a better chance of survival and recovery than emergency intervention for a ruptured aortic aneurysm.

Complications may occur as a reaction to general anesthesia, which not everyone can tolerate, the development of infection, damage internal organs and bleeding. At all small quantity In some cases, the operation ends in death.

If an operation is planned, doctors recommend stopping taking blood thinners and anti-inflammatory drugs (aspirin, etc.) a week before the operation. Be sure to inform your doctor about the medications you are taking for this moment, before surgery.

The risk of relapse is extremely small, but if a person suddenly begins to experience pain in the back or abdomen, nausea, vomiting, numbness in the legs or general bad feeling, you should consult a doctor immediately.

Prevention of aneurysm

You are less likely to develop an abdominal aortic aneurysm if you give up (and ideally do not acquire this habit at all) smoking, control your blood pressure and your weight. It is also important to lead an active and healthy lifestyle. Be healthy!

Pulsation in the abdominal aorta can only mean one thing - an abdominal aortic aneurysm. The process is pathological, characterized by persistent saccular expansion of the major artery body - the aorta due to the thinning of its walls. Abdominal aortic aneurysm is the most common pathology of this vessel. It can be diagnosed in any part of the aorta, but in 90% of all cases it is found in the abdominal part.

The aneurysm itself is serious danger. It may rupture or separate, resulting in massive bleeding. An aneurysm is also a predisposing factor for the development of thromboembolism.

Clinic

With pulsation of the abdominal aorta, two scenarios are possible. The pathological process can be completely painless, and the disease will be detected by chance during an ultrasound for another problem. Or the aneurysm will have pronounced clinical signs, delivering a large number of problems.

The most common clinical signs of abdominal aortic pulsation or aneurysm include:

constant pain in the abdomen (mainly in the umbilical region and the left half of the abdomen). Sometimes the pain radiates to groin area or lumbar spine;
feeling of “pulse beating” in the stomach. The feeling of pulsation is similar to a heartbeat;
feeling of heaviness, fullness in the stomach;
appearance of pallor lower limbs, sometimes their sensitivity is impaired, tingling sensations and “crawling goosebumps” appear;
in some cases, abdominal syndrome manifests itself (belching, vomiting, lack of appetite). Possible constipation or diarrhea, sudden weight loss.

Treatment

The main treatment method for aortic aneurysm is surgery. If the diameter of the aneurysm does not exceed 5 cm, then surgical treatment may not be indicated. IN in this case doctors recommend starting intensive conservative therapy, which is inherently preventive measure. They are aimed at preventing complications of the disease.

Conservative treatment in this case involves maintaining healthy image life, quitting smoking and drinking alcoholic drinks, treatment of arterial hypertension, lowering blood cholesterol levels. Regular examination is also required constant control for the condition of the aneurysm

Surgical intervention

Most often, open surgery is performed. In this case surgical approach exposed along the midline of the abdomen or through the chest (making a lateral incision). After penetrating the abdominal cavity and exposing the aneurysm, surgeons begin to clamp and sew the prepared special synthetic material to the aorta at the site of the incision in its wall. Prostheses made from this material do not tend to be rejected; they help preserve the basic functions of the aorta throughout the patient’s life. The prognosis for treating abdominal aortic pulsation using this technique is favorable in 90% of cases.

Endovascular surgical treatment is carried out less frequently. Main advantage this method- it does not require opening the abdominal cavity. The essence of the endovascular technique is the placement of a special synthetic prosthesis in the area of the aneurysm through a small incision in the groin. The stent is delivered through the femoral artery to the aneurysm under mandatory constant radiological control. The big advantage of this operation is its low degree of invasiveness. The postoperative rehabilitation period rarely exceeds three days, but it is worth remembering that in the near future postoperative period You will need to undergo regular x-ray examinations regarding the functioning of the implanted stent. This operation is contraindicated for persons with kidney pathologies.

An abdominal aortic aneurysm is a local expansion of the lumen of the abdominal aorta, developing as a result of pathological change its walls or anomalies of their development. Among all aneurysmal lesions of blood vessels, abdominal aortic aneurysm accounts for 95%. The disease is diagnosed in every twentieth man over the age of 60; women suffer less frequently.

Expansion of the lumen of the abdominal aorta with an aneurysm

In most cases, an abdominal aortic aneurysm is asymptomatic, but it gradually increases in volume (by about 10-12% per year). Over time, the walls of the vessel stretch so much that they are ready to burst at any moment. Aneurysm rupture is accompanied by massive internal bleeding and the death of the patient.

Abdominal aortic aneurysm ranks 15th on the list of diseases leading to fatal outcome.

Forms of the disease

The classification of abdominal aortic aneurysms most often used by clinicians is based on the characteristics anatomical location pathological extensions:

infrarenal aneurysms, i.e. localized below the branches of the renal arteries (observed in 95% of cases);
suprarenal aneurysms, i.e. located above the origin of the renal arteries.

Based on the structure of the sac wall, abdominal aortic aneurysms are divided into false and true.

According to the shape of the protrusion:

exfoliating;
fusiform;
diffuse;
saccular.

Depending on the cause, abdominal aortic aneurysms can be congenital (associated with abnormalities in the structure of the vascular wall) or acquired. The latter, in turn, are divided into two groups:

Inflammatory (infectious, infectious-allergic, syphilitic).
Non-inflammatory (traumatic, atherosclerotic).

According to the presence of complications:

uncomplicated;
complicated (thrombosed, ruptured, dissecting).

Depending on the diameter of the area of expansion, abdominal aortic aneurysms are small, medium, large and giant.

In the absence of timely surgical treatment of abdominal aortic aneurysm about 90% of patients die within the first year from the moment of diagnosis.

A. A. Pokrovsky proposed a classification of abdominal aortic aneurysms, based on the prevalence of the pathological process:

Infrarenal aneurysm with long proximal and distal isthmuses.
Infrarenal aneurysm, located above the level of bifurcation (bifurcation) of the abdominal aorta, having a long proximal isthmus.
Infrarenal aneurysm extending to the area of the bifurcation of the abdominal aorta, as well as iliac arteries.
Total (infrarenal and suprarenal) aneurysm of the abdominal aorta.

Causes and risk factors

The results of numerous studies have shown that the main etiological factor aneurysms of the abdominal aorta, as well as other localizations of this pathological process ( thoracic aorta, aortic arch), is atherosclerosis. In 80-90% of cases, the development of the disease is caused by it. Much less frequently, the development of acquired abdominal aortic aneurysms is associated with inflammatory processes(rheumatism, mycoplasmosis, salmonellosis, tuberculosis, syphilis, nonspecific aortoarteritis).

Often, an abdominal aortic aneurysm forms in patients with congenital defects in the structure of the vascular wall (fibromuscular dysplasia).

Causes of traumatic aneurysm of the abdominal aorta:

spinal and abdominal injuries;
technical errors when performing reconstructive operations (prosthetics, thromboembolectomy, stenting or aortic dilatation) or angiography.

Factors that increase the risk of developing an abdominal aortic aneurysm are:

smoking – smokers make up 75% of all patients with this pathology; the longer the smoking history and the number of cigarettes smoked daily, the higher the risk of developing an aneurysm;
age over 60 years;
male gender;
Availability of this disease in close relatives (hereditary predisposition).

Rupture of an abdominal aortic aneurysm most often occurs in patients suffering from chronic bronchopulmonary diseases and/or arterial hypertension. In addition, the size and shape of the aneurysm influence the risk of rupture. Symmetrical aneurysmal sacs rupture less frequently than asymmetrical ones. And giant dilations, reaching 9 cm in diameter or more, rupture in 75% of cases with massive bleeding and rapid death of patients.

Symptoms of an abdominal aortic aneurysm

In most cases, abdominal aortic aneurysm proceeds without any clinical signs and is diagnosed accidentally during a plain radiography of the abdominal cavity, ultrasound examination, diagnostic laparoscopy or routine palpation of the abdomen performed in connection with other abdominal pathology.

In most cases, an abdominal aortic aneurysm is asymptomatic, but it gradually increases in volume (by about 10-12% per year).

In other cases, the clinical symptoms of an abdominal aortic aneurysm may be:

feeling of fullness or heaviness in the abdomen;
feeling of pulsation in the abdomen.

Pain is felt in the left half of the abdomen. Its intensity can range from mild to unbearable, requiring injections of painkillers. Often the pain radiates to the inguinal, sacral or lumbar region, in connection with which the diagnosis of radiculitis, acute pancreatitis or renal colic is erroneously made.

When a growing abdominal aortic aneurysm begins to exert mechanical pressure on the stomach and duodenum, this leads to the development of dyspeptic syndrome, which is characterized by:

nausea;
vomit;
belching air;
tendency to chronic constipation.

In some cases, the aneurysmal sac displaces the kidney and compresses the ureter, thereby leading to the formation of a urological syndrome, which is clinically manifested by dysuric disorders (frequent, painful, difficult urination) and hematuria (blood in the urine).

If an abdominal aortic aneurysm compresses the testicular vessels (arteries and veins), the patient experiences pain in the testicular area and also develops varicocele.

Compression of the spinal roots by the increasing protrusion of the abdominal aorta is accompanied by the formation of an ischioradicular symptom complex, which is characterized by persistent pain in the lumbar region, as well as motor and sensory disorders in the lower extremities.

Abdominal aortic aneurysm can cause chronic disorder blood supply in the lower extremities, which leads to trophic disorders and intermittent claudication.

When an abdominal aortic aneurysm ruptures, the patient experiences massive bleeding, which can lead to death in a few seconds. Clinical symptoms of this condition are:

sudden intense pain(so-called dagger pain) in the abdomen and/or lower back;
a sharp drop in blood pressure, up to the development of collapse;
feeling strong pulsation in the abdominal cavity.

Peculiarities clinical picture rupture of an abdominal aortic aneurysm is determined by the direction of bleeding ( bladder, duodenum, inferior vena cava, free abdominal cavity, retroperitoneal space). Retroperitoneal bleeding is characterized by persistent pain syndrome. If the hematoma increases towards the pelvis, then the pain radiates to the perineum, groin, genitals, and thigh. High localization of the hematoma often manifests itself under the guise of a heart attack.

Intraperitoneal rupture of an abdominal aortic aneurysm leads to the rapid development of massive hemoperitoneum, severe pain and bloating are noted. The Shchetkin-Blumberg symptom is positive in all areas. Percussion determines the presence of free fluid in the abdominal cavity.

Simultaneously with symptoms acute abdomen When an aortic aneurysm ruptures, symptoms of hemorrhagic shock occur and quickly intensify:

sharp pallor of the mucous membranes and skin;
severe weakness;
cold clammy sweat;
lethargy;
thread-like pulse (frequent, low filling);
pronounced decrease in blood pressure;
decrease in diuresis (amount of urine excreted).

With intraperitoneal rupture of an abdominal aortic aneurysm, death occurs very quickly.

If a breakthrough of the aneurysmal sac into the lumen of the inferior vena cava occurs, this is accompanied by the formation of an arteriovenous fistula, the symptoms of which are:

pain localized in the abdomen and lower back;
formation of a pulsating tumor in the abdominal cavity, over which systole-diastolic murmurs can be heard well;
swelling of the lower extremities;
increasing shortness of breath;
significant general weakness.

Heart failure gradually increases, which becomes the cause of death.

Rupture of an abdominal aortic aneurysm into the duodenum leads to sudden massive gastrointestinal bleeding. The patient falls sharply arterial pressure, bloody vomiting occurs, weakness and indifference to the environment increases. Bleeding with this type of rupture is difficult to diagnose from gastrointestinal bleeding due to other causes, for example, peptic ulcer of the stomach and duodenum.

Diagnostics

In 40% of cases, abdominal aortic aneurysms are an incidental diagnostic finding during clinical or x-ray examination on another occasion.

The presence of the disease can be assumed based on data obtained from collecting anamnesis (indication of family cases of the disease), general examination of the patient, auscultation and palpation of the abdomen. In thin patients, it is sometimes possible to palpate a pulsating, painless formation in the abdominal cavity that has a densely elastic consistency. During auscultation over the area of this formation, a systolic murmur can be heard.

The most accessible and cheapest method for diagnosing an abdominal aortic aneurysm is plain radiography abdominal cavity. The X-ray image shows the shadow of the aneurysm, and in 60% of cases, calcification of its walls is noted.

Ultrasonography and computed tomography make it possible to accurately determine the size and localization of pathological expansion. In addition, according to computed tomography the doctor can evaluate mutual arrangement aneurysms of the abdominal aorta and other visceral blood vessels, to identify possible anomalies of the vascular bed.

Angiography is indicated for patients with arterial hypertension with severe or unstable angina, significant renal artery stenosis, patients with suspected mesenteric ischemia, as well as patients with symptoms of occlusion (blockage) of the distal arteries.

If indicated, other methods may be used instrumental diagnostics, for example, laparoscopy, intravenous urography.

Treatment of abdominal aortic aneurysm

The presence of an abdominal aortic aneurysm in a patient is an indication for surgical treatment, especially if the size of the protrusion increases by more than 0.4 cm per year.

The main operation for an abdominal aortic aneurysm is aneurysmectomy (excision of the aneurysmal sac) followed by plastic surgery of the removed area. blood vessel a prosthesis made of Dacron or other synthetic material. Surgical intervention is performed through a laparotomy approach (an incision in the abdominal wall). If in pathological process If the iliac arteries are also retracted, then bifurcation aorto-iliac prosthetics are performed. Before, during and on the first day after the operation, monitor the pressure in the heart cavities and the value cardiac output using a Swan–Gantz catheter.

If an abdominal aortic aneurysm ruptures, the operation is performed for life-saving reasons on an emergency basis.

Abdominal aortic aneurysm ranks 15th on the list of diseases leading to death.

Currently, vascular surgeons prefer minimally invasive methods treatment of abdominal aortic aneurysm. One of them is endovascular prosthetics of the area of pathological expansion using an implantable stent graft (a special metal structure). The stent is installed so that it completely covers the entire length of the aneurysmal sac. This leads to the fact that the blood stops putting pressure on the walls of the aneurysm, thereby preventing the risk of its further enlargement, as well as rupture. This operation with an aneurysm of the abdominal aorta it is characterized by minimal trauma, low risk development of complications in the postoperative period, short rehabilitation period.

Possible consequences and complications

The main complications of an abdominal aortic aneurysm are:

rupture of the aneurysmal sac;
trophic disorders in the lower extremities;
intermittent claudication.

Forecast

In the absence of timely surgical treatment of abdominal aortic aneurysm, about 90% of patients die within the first year from the moment of diagnosis. Operational mortality during execution elective surgery is 6–10%. Emergency surgical interventions, performed against the background of a rupture of the aneurysm wall, end in death in 50-60% of cases.

Prevention

For timely detection of abdominal aortic aneurysm, patients suffering from atherosclerosis or having a burdened history of this vascular pathology are recommended to systematically medical supervision with periodic instrumental examination(radiography of the abdominal cavity, ultrasound).

Quitting smoking is of no small importance in preventing the formation of aneurysms. active treatment infectious and systemic inflammatory diseases.

Video from YouTube on the topic of the article:

An abdominal aortic aneurysm is a pathological expansion of the walls of this arterial vessel, which can lead to its rupture as a result of thinning. Danger vascular disease is the likelihood of asymptomatic progression and death as a result of abdominal aortic dissection and subsequent bleeding.

Causes

An aneurysm is a protrusion of the walls of a vessel and its acquisition of the shape of a sac. The formation of an abdominal aortic aneurysm and the reasons that caused it are due to exposure to various factors. The main ones are:

atherosclerosis;
defect on local area vascular wall;
blood pressure surges;
inflammatory processes in the aorta.

When the wall of the vessel is thinned and weakened, rupture of the abdominal aorta is possible, the causes of which are also due to the above factors.

Symptoms

Approximately ¼ of all patients diagnosed with an abdominal aortic aneurysm do not experience any symptoms of the disease. Not only are there no complaints, but examination does not always reveal signs of pathology. This course is the most dangerous, since it is not possible to control the likelihood of aneurysm rupture.

There are often cases when rupture of the aortic artery is the first manifestation of the disease. This situation is fraught with rapid death. But in most cases, the pathology can be recognized before such a complication occurs. The asymptomatic type of disease is more often detected on ultrasound or during abdominal surgery on the abdominal cavity for other pathologies.

The characteristic symptoms of an abdominal aortic aneurysm are as follows:

Pain in the groin and abdomen varying degrees severity, in most cases dull and aching. Most often localized in the mesogastrium and epigastrium. Appears after eating or physical activity. It intensifies with movement and radiates to the lower back or sacrum.
Pulsation in the abdomen. It can be intense and resemble a contraction of the heart muscle. This feeling is constantly present or renews after physical work.
Dyspeptic phenomena. Nausea, vomiting, bloating act as secondary signs, which manifest themselves as a result of compression of the abdominal organs.

All signs of aortic aneurysm, according to the nature of the manifestations, are combined into groups: abdominal, ischioradicular, urological.

When the aneurysm reaches big size, the blood supply to the gastrointestinal tract deteriorates, the stomach and duodenum are compressed, which manifests itself in indigestion and symptoms such as nausea, heartburn and belching, stool instability and rapid weight loss.

Ischioradic symptoms are caused by compression of the nerve roots lumbar region spine. These include:

impaired sensitivity of the skin on the legs;
feeling of numbness in the lower extremities;
intermittent claudication;
lower back pain.

Manifestations of a urological nature are provoked by compression of the ureter and displacement of the kidneys from the anatomically correct position. The patient complains of heaviness in the lumbar region and difficulty urinating. There may be blood in the urine. The possibility of developing renal colic.

Diagnostics

A set of examinations aimed at identifying an aortic aneurysm includes general examination And instrumental methods diagnostics Palpation and auscultation allow one to suspect pathology abdominal area. Thus, signs of a disorder are: increased pulsation, felt through the anterior abdominal wall, and systolic murmur.

The most accessible instrumental method for diagnosing the pathology in question is plain radiography. Using it, you can visualize the shadow of an aneurysm and detect pathological expansion due to calcification of the walls of this artery.

To the number modern methods refers to ultrasound with duplex scanning main artery and branches of the aorta. Ultrasound examination makes it possible to identify a defect in the vascular wall with maximum accuracy. In particular, the following parameters are determined:

the prevalence of the aneurysm and its location;
condition of the walls of the main artery;
presence and location of rupture.

It is possible to determine a rupture of an abdominal aortic aneurysm or a threatening condition using computed multislice tomography of the abdominal aorta.

Treatment

Considering that aortic rupture can occur suddenly, when it is first detected, a decision is made to remove the damaged area. Enlargement of the abdominal aorta is treated only with surgical methods.

Medication

Drug treatment Abdominal aortic aneurysm is aimed only at strengthening the walls of the artery to prevent its rupture. If the vessel contains weakness, then the aneurysm cannot disappear on its own. It will gradually stretch under the influence high pressure in the aorta. This defect can only be corrected surgically.

No medicine can reduce this pressure because it is physiologically designed and necessary for pumping blood in the body. Drug treatment is used in for preventive purposes to eliminate diseases that can weaken the walls of the aorta. In addition, for the purpose of prevention, medications are taken:

to normalize blood pressure;
to reduce blood cholesterol;
to eliminate the severity of autoimmune processes;
to control bleeding disorders;
for therapy chronic pathologies, which are a contraindication to surgical correction aneurysms.

Surgical

Surgical treatment will allow you to completely get rid of the aneurysm by removing the defective section of the vessel. Therefore, it is impossible to do without surgery. It is performed through abdominal surgery or using endovascular surgery.

If it was possible to detect dilatation of the aorta in abdominal region, then the operation is carried out as planned and the patient is first prepared for the intervention. If a rupture occurs or a dissecting aneurysm is to be removed, then medical manipulation is carried out on an emergency basis.

During abdominal surgery, the abdominal wall is incised and direct access to the damaged area is provided. The deformed part is cut, and a special tube is inserted into the cavity, which will subsequently prevent rupture.

An aneurysm of any size and shape can be removed using this method.

The use of endovascular surgery allows the operation to be performed without dissecting the abdominal wall. Manipulations are carried out through the femoral artery. This method has a number of advantages over the cavity method: there is no risk of suture dehiscence and infection, a short rehabilitation period, and the blood flow in the aorta does not stop. But it is carried out only as planned, for emergency cases not suitable because it requires careful preparation of the patient.

Forecasts

Being a serious pathology, aortic aneurysm leads to death in the absence of timely medical care. This occurs as a result of rupture and massive bleeding. Since it is impossible to predict this vascular pathology, an unfavorable outcome occurs in 80% of cases.

The course of the disease and outcome are influenced by the following factors:

shape and size of the aneurysm;
reasons for education;
patient's age;
the presence of chronic pathologies;
compliance with doctor's recommendations.

Because aneurysm is difficult to predict, people with a predisposition to the condition and a tendency to form blood clots are advised to undergo regular screening to reduce the risk of rupture. It is important to give up bad habits.

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