Abdominal aortic aneurysm - a pathological process characterized by persistent expansion of ventral saccular (located in the retroperitoneal space) - the largest artery in the human body - the aorta as a result of thinning its walls.Aneurysm of the abdominal aorta is the most common pathology of this vessel.An aneurysm can be diagnosed at any aorta, but in 90% of all cases, it is found in its abdominal part, preferably below the discharge from her renal arteries.
aneurysm is a rather serious threat, since it can occur separation or rupture, resulting in a massive haemorrhage.In addition, an aneurysm is a predisposing factor for thromboembolism.
With regard to the clinical picture of abdominal aortic aneurysm, maybe 2 scenarios: in the first case, the disease process can occur entirely asymptomatic (have no specific clinical signs), and the disease is diagnosed by chance on ultrasound for another reason;in the second case, an aneurysm is very pronounced clinical picture and delivers a large
So, the most frequently occurring clinical signs of an aneurysm of the abdominal aorta include:
- constant pain in the abdomen: a primary place of localization of pain is the umbilical region and the left half of the abdomen.The nature of pain can range from aching, Expander, obtuse to acute and paroxysmal.Often there is irradiation of pain in the lumbar spine or groin;
- feeling intensified pulsation in the abdomen.This is similar to the feeling of pulsation phenomenon heartbeat;
- feeling of heaviness, bloating, fullness, discomfort in the stomach;
- bursting sensation in the near- and nadpupochnoy areas;
- characterized by the appearance of pallor of the lower extremities;
- pain in the lower extremities.There may be paresthesia - a violation of the sensitivity, manifested by tingling and "pins and needles";
- violation of motor function in the lower extremities;
- in case of rupture of the dilated vessel there is a strong pain, dizziness, weakness, loss of consciousness is possible;
- in some cases there is abdominal syndrome characterized by symptoms such as belching, vomiting, loss and lack of appetite, diarrhea or constipation (perhaps their striping), weight loss;
- is an indirect sign of urological syndrome and lower limb ischemia syndrome.If urological syndrome marked pain in the lumbar region, violation of urination, hematuria (blood in urine).The syndrome of chronic leg ischemia patient complains of intense pain in the legs, worse walking;
- palpation predicated pathological pulsation of the abdominal aorta must be distinguished from the physiological surge in asthenic body type, at a curvature of the spine - in these cases, the ripple will be determined on both sides of the aorta;
- auscultatory picture shows the specific noise of turbulent blood flow into the aneurysm formed.
treatment of abdominal aortic aneurysm
main method of treatment of abdominal aortic aneurysm is a surgical intervention in the pathological process.If the diameter of the aneurysm reaches or exceeds 5 cm, the surgery is not indicated.In this case, you must start an intensive conservative therapy, which is essentially a preventive measure aimed at preventing possible complications of the disease.Conservative treatment implies a following activities:
- maintaining a healthy lifestyle: smoking cessation, renunciation of the use of alcoholic beverages;
- existing treatment of hypertension (use of beta-blockers - propranolol, metoprolol, carvedilol, calcium channel antagonists - verapamil, diltiazem, Nifidipin; ACE inhibitors - Hart, enalapril and other drugs);
- decrease in cholesterol (cholesterol) in the blood serum;
- regular screening and monitoring of the status of the aneurysm, which is produced 2 times within a year (CT or ultrasound).
main method of treatment of abdominal aortic aneurysms remains a surgical procedure, which can be done in two ways:
- open surgery.Surgical access is for the middle front line of the abdomen, and maybe across the chest (side section).After penetration into the abdominal cavity and expose the aneurysm begin to clamping and suturing the previously prepared specific synthetic material to the aorta (above and below the localization of the aneurysm) in the place of the cut of its front wall.Prostheses not tend to contribute to the conservation and rejection aortic function throughout the life of the patient.The success of the treatment of abdominal aortic aneurysms using this method is 90%;
- endovascular surgery.The main advantage of this surgical technique is the fact that with this method does not require the abdominal cavity opening.The essence of the endovascular technique is to place a synthetic prosthesis in the aneurysm cavity through an incision in the groin.The stent is delivered to the aneurysm through the femoral artery under fluoroscopic guidance required.A great advantage of this operation is a low degree of invasiveness.postoperative rehabilitation period is rarely more than 2-3 days, but it is worth remembering that in the immediate postoperative period is necessary to have regular x-ray on the functioning of the stent.This operation is contraindicated for people with renal failure.