Aneurysms
• Introduction • • abdominal aortic aneurysms Aneurysms of thoracic aorta
Introduction
An aneurysm is a localized enlargement of an artery wall, usually the aorta.
Extension usually results in a weakened part of the wall. Although aneurysms can occur anywhere along the aorta, in three-quarters of all cases it occurs in the part that passes through the stomach. Aneurysms can be either rounded (saccular) or elongated (fusiform) were often fusiform.
Aortic aneurysms are primarily a result of atherosclerosis, which weakens the aortic wall to the extent that the pressure in the aorta, which is great, pressing the weakened portion of the wall and creates a bulge outward, like a balloon. The aneurysms often create a clot that can be spread along the inner wall. High blood pressure and cigarette smoking increase the risk of aneurysm. Other mitigating factors for the occurrence anurizme may include trauma, inflammatory disease of the aorta, hereditary disorders of connective tissue, for example.Marfan syndrome and syphilis. In Marfan syndrome, aneurysm affecting most of the ascending aorta (the part that fills with blood directly from the heart).
Aneurysm, except aorta, may occur in other arteries. Many of them are the result of congenital (congenital) or arteriosclerosis disorders. Some aneurysms are the result of trauma caused by stab or gunshot wound, or the artery wall due to infection by bacteria or fungi. The infection can start anywhere in the body, but usually starts at the heart valve flaps. Infected aneurysm of the arteries in the brain are especially dangerous and require immediate treatment. The most commonly treated surgically, which is very risky.
Abdominal aortic aneurysm
• Introduction • Symptoms • Diagnosis • Treatment
Introduction
Aneurysms that occur in the part of the aorta that passes through the stomach occur frequently in some families.In many cases, these aneurysms can occur in people with high blood pressure. Such aneurysms often become several times wider than the aorta, and may burst.
Symptoms
Patients with abdominal aortic aneurysm often have the feeling that something is pulsating in his belly.
An aneurysm can cause pain, usually deep, which is mainly spread in the back. The pain can be extremely strong and is usually permanent, but may be terminated by changing the body position.
The first sign of rupture (break or rupture) is usually very severe pain in the lower abdomen and back with painful sensitivity of the abdomen above the aneurysm. If there is internal bleeding, the patient quickly gets into shock. Rupture of abdominal aortic aneurysm is often fatal.
Diagnosis
Pain is a useful symptom for the diagnosis, but often occurs too late. However, many patients with aneurysms have no symptoms, a diagnosis is made incidentally during routine examination or radiograph performed for other reasons. The doctor can feel the pulse formation in the central abdominal line. Aneurysms that grow rapidly may quickly burst. They are often painful and sensitive to touch on clinical examination of the abdomen.In obese patients are difficult to detect even large aneurysms.
On diagnosis of aneurysm helps more laboratory tests. X-ray of the abdomen may show calcium deposits in the aortic wall. Ultrasound examination is usually clearly show the size of the aneurysm. CT of the abdomen, especially if performed after intravenous administration of contrast, is a safe method for determining the size and the edges of the aneurysm, but this method is expensive. MR is also a reliable method, but is more expensive than ultrasound and is rarely necessary.
Treatment
If no burst aneurysm, treatment depends on its size. Aneurysms of a width of less than 5 cm rarely burst, but if they are wider than 6.4 inches breast more often. This is why doctors usually recommend surgery to address an aneurysm wider than 5 cm, if the risk is too great for other accompanying medical conditions. During the surgery, put a synthetic implant (graft) in place of the aneurysm. The risk of death of such an operation is about 2%.
Rupture (burst) or threatening rupture of abdominal aneurysm requires emergency surgery. The risk of death from surgery in this state is about 50%. When the thoracic aortic aneurysm abdominal kidneys are in great danger because of the sudden interruption of blood supply or the shock that was created for the loss of blood. If kidney failure develops after surgery, patients chances of survival are very poor.
Aneurismal
• Introduction • Symptoms • Diagnosis • Treatment
Introduction
Aortic aneurysm in the fragment that passes through the thorax (chest, thorax) belong to one quarter of all aortic aneurysms. Thoracic aorta aneurysms occur most frequently in one form: the expansion of the aorta occurs at the point where the aorta leaves the heart, immediately after the aortic valve. This enlargement of the aorta may be the cause of malfunctioning aortic valve (valve located at the point where the aorta leaves the left ventricle), because the existence of such an aneurysm can lead to leakage (regurgitation) of blood back to the heart at the time the aortic valve is closed. About 50% of patients with this problem suffer from Marfan syndrome, this syndrome or similar variations. The other 50% of cases the cause is unknown, but many people in this group have high blood pressure.
Symptoms
Thoracic aneurysm (thoracic) aorta can become very large, and that do not cause symptoms. The symptoms are a result of the enlarged aortic pressure on other structures in the chest. Typical symptoms are pain (usually high in the back), coughing and wheezing in the lungs (wheezing) as well as in asthma. The patient may cough blood pressure due to an aneurysm of the windpipe (trachea) or the adjacent airways and mucosal damage. Pressure on the esophagus (the channel that connects the mouth to the stomach) can cause difficulty swallowing. Hoarseness may result from pressure on the throat (larynx). The patient may have multiple disorders simultaneously (Homer's syndrome), which consist of narrow pupil (miosis), sunken eyeballs, and sweating on one side of the face. X-ray shows a shift of the trachea (trachea). Abnormal pulsations of the chest wall can also be a sign of thoracic aortic aneurysms.
When it comes to burst (rupture) of thoracic aorta, there is very strong pain that usually begins high in the back and may spread down the back and abdomen, depending on where the rupture spreads. Pain can also be felt in the chest (chest) and hands and mimic a heart attack (myocardial infarction). The patient can quickly fall into a state of shock and die because of blood loss.
Diagnosis
The doctor can diagnose an aneurysm of thoracic aorta on the basis of symptoms or aneurysm can be detected during physical examination. Chest radiograph done for some other reason can detect an aneurysm. CT, MRI or transesophageal ultrasound is used to accurately determine the size of the aneurysm. Aortography (X-ray imaging of the aorta after injection of contrast into the aorta) is applied to accurately determine which surgical technique will be applied.
Treatment
If the thoracic aorta aneurysms larger than 7.6 cm, surgeons implanted a synthetic implant (graft). Knowing that the probability of rupture in Marfan syndrome, a large, doctors recommend surgery and when it comes to smaller aneurysms. The risk of death during surgery of aneurysm of thoracic aorta is about 10% -15%. Because patients with thoracic aortic aneurysm should be given beta blockers to slow down the speed of heart rate (heart rate) and lowered blood pressure and thus reduce the risk of rupture (rupture) of aneurysms.
DISECTIO AORTEAE
(Aortic dissection)
• Introduction • Symptoms • Diagnosis • Treatment • Forecast
Introduction
Aortic dissection (dissecting aneurysm, dissecting hematoma) is a very serious condition, often fatally, in which there is a cleft envelope inside the aortic wall (aortic endothelial cells), while the outer sheath remains intact.The blood enters the aortic wall through the gap, further splitting the middle envelope and creates a new channel in the wall of the aorta.
Damage to the aortic wall in most cases responsible for the formation of aortic dissection. The most common cause of such damage is high blood pressure, and was detected in more than two thirds of patients with aortic dissection occurs. Other causes are hereditary (hereditary) disorders of connective tissue, especially Marfan and EHLER-Dunlosov syndrome. Further causes are congenital defects of the heart and blood vessels, such as coarctation of the aorta, the ductus open arteriozus, aortic valve defects, arteriosclerosis and injury (trauma). In rare cases, dissection occurs accidentally, during catheterization when a doctor asks a catheter into an artery (aortography, angiography) or during surgery of the heart and blood vessels.
Symptoms
In principle, any person who experienced aortic dissection felt the pain that is typically sudden and lancinating.People often describe the pain as tearing or ripping chest. The pain occurs regularly in the back between the shoulder blades, and often spreads in the direction in which it spreads along the aortic dissection.
If the dissection progresses to close one or more arteries that leave the aorta. Depending upon which arteries are blocked effects may include: stroke, heart attack (myocardial infarction), sudden abdominal pain, and nerve damage can cause numbness or prevent movement of the arms or legs.
Diagnosis
The doctor diagnoses aortic dissection on the basis of characteristic symptoms. In two thirds of patients with aortic dissection can be found in the arteries pulse weakened arms and legs. Dissection that extends to the back, behind the heart, can cause noise that a doctor can hear using a stethoscope. Blood can accumulate in the chest.Also, due to dissection of the blood can flow from the heart and can accumulate in the pericardial sac (pericardium) around the heart and prevent the normal heart. It is a condition called cardiac tamponade, and endangers the life.
X-ray of the chest showed enlargement of the aorta in 90% of patients with aortic dissection. Ultrasound examination usually confirms the diagnosis even in cases where the aorta is enlarged.
The application of CT contrast is authoritative for the diagnosis, but it should be done quickly because it is very important in this emergency situation.
Treatment
Patients with aortic dissection should be admitted to the intensive care unit, where they closely monitor and measure vital signs (pulse, blood pressure and respiration rate). Lethality can occur several hours after the commencement of aortic dissection. That's why doctors as soon as possible give medicines to slow heart rate and lowering blood pressure to the lower value, and yet provide enough blood flow to the brain, heart and kidneys. Shortly after the initial therapeutic measures doctor should decide whether to take urgent surgery or treatment will continue only with medication.
Doctors almost always recommend surgery for dissections that affect the first few inches of the aorta immediately after its exit from the heart, dissection if complications are not so large that surgery is too great a risk. If the dissection farther from the heart usually continues to treat with drugs, except in the case of dissection leading to impending rupture (burst) aorta, or in case of dissection in the Marfan syndrome. In these cases require surgery.
During the surgery, the surgeon removes as much as possible of rascijepljenog (stratified or diseciranog) aortic wall, thus eliminating the possibility of entering the blood in the aortic false channel, and cut off part of the aorta is replaced by a synthetic graft (graft).
If there was leakage (regurgitation) aortic valve surgeon repaired or replaced.
Forecast
About 75% of patients with aortic dissection die within the first two weeks if left untreated. In contrast to this, 60% of patients who were treated and lived for the first two weeks can experience at least 5 years after aortic dissection, and 40% of them live at least 10 years. Out of people who die within the first two weeks approximately one-third die from complications of dissection, while the other two thirds to die of other diseases.
The risk of death from aortic dissection surgery in specialized centers is high today about 15% of dissections, which are close to the heart, a little more for those that are further away from the heart. All patients who survived aortic dissection, including those who underwent surgery, doctors make a long-term therapy to maintain low blood pressure, reducing the impact of blood flow to the aorta.
Doctors should also monitor patients for the possible development of late complications, such as the three most important: the emergence of a new dissection, the development of aneurysms in the aorta, and diminished gradually increasing leakage (regurgitation) aortic valve.
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