Aortic aneurysm – causes, types, symptoms, treatment. How is an aortic aneurysm diagnosed?

Proven content

Tętniak aorty jest jej nadmiernym poszerzeniem. Może być skutkiem miażdżycy, urazów, nadmiernego wysiłku — często chory nie wie, że go ma, bowiem tętniaki aorty mogą nie dawać żadnych objawów. Największym zagrożeniem związanym z tętniakiem aorty jest jego pęknięcie.

Characteristics of aortic aneurysm

What is an aorta?

The aorta is the largest artery in the human body. Its beginning is located in the left ventricle of the heart, and then it runs down the rib cage to the abdominal cavity. This is where it divides into two common iliac arteries (a typical division of the aorta separates the thoracic and abdominal parts). Thanks to the aorta, our organs are supplied with blood. The farther the aorta is from the heart, the smaller its diameter.

Czym zatem jest tętniak aorty?

Aortic aneurysm is a widening of the aorta by more than 50% of the width considered normal in a given segment. To put it simply, it is an excessive dilation of the aorta. These types of abnormalities can occur in any section of the aorta, but most often the lesions are located in the abdominal section. The risk of ailments increases with age, and men are the most vulnerable group.

Curiosity: the frequency of occurrence of aortic arteries in the thoracic segment is the same in both men and women (quite the opposite of an abdominal aortic aneurysm).

Aortic aneurysm – causes

The causes of aortic wall dilatation, i.e. aneurysm, include a strain on the aortic wall as a result of:

1. deposition of atherosclerotic plaques,
2. arterial hypertension,
3. sudden effort,
4. injuries,
5. chronic inflammation,
6. wrodzonych defektów w budowie naczynia.

Other factors that increase the risk of an aortic aneurysm include:

1. smoking tobacco,
2. aortic valve regurgitation,
3. age (the risk increases with age),
4. atherosclerosis (may be the possible cause of an abdominal aortic aneurysm),
5. genetic predisposition – abdominal aortic aneurysm is much more common in people with family history of sick people; in addition, people suffering from genetic ailments, such as Marfan’s syndrome, are more likely to have an abdominal aortic aneurysm,
6. Chronic obstructive pulmonary disease,
7. zapalenie aorty występujące między innymi w RZS czy kile i zesztywniającym zapaleniu stawów.

Wymienione czynniki mogą wpływać pobudzająco na progresję obecnego już tętniaka.

Types of aortic aneurysms

Zmiany w budowie aorty mogą przyjmować postać tętniaka prawdziwego lub rozwarstwiającego.

1. True Aneurysm jest rozszerzeniem światła naczynia o charakterze workowatym z zachowaną fizjologiczną strukturą jego ściany.

2. Dissecting aneurysm it consists in rupture and detachment of the inner membrane of the vessel and the inflow of blood to the inside of the vessel wall. The dissection then deepens in the direction of blood flow. The bloodstream may return to the vessel lumen (intimal rupture) or break through to the outside (aneurysm rupture and hemorrhage).

Aneurysms can affect any segment of the aorta, i.e. the aortic arch, thoracic aorta, abdominal aorta and the border of the last two. Most often, however, they are formed within the abdominal aorta. The risk of developing the disease increases with age and is highest in people over 65 years of age. Aortic aneurysms are more common in men.

Aortic aneurysm – symptoms

Aortic aneurysms can be asymptomatic and are often discovered accidentally, e.g. during routine preventive examinations or during the diagnosis of other diseases. Symptomatic aneurysms, on the other hand, are manifested by pain, sometimes accompanied by a throbbing sensation in the chest or abdomen. Pain more often accompanies dissection aneurysms and increases with increasing blood pressure and during exercise.

U pacjentów z tętniakiem objawowym występujące symptomy zależą od jego lokalizacji oraz od tego czy doszło do jego pęknięcia, natomiast mały tętniak może nie dawać żadnych objawów. Wśród objawów niepękniętego tętniaka aorty wymienia się:

1. shortness of breath
2. pain in the chest,
3. back pain,
4. cough,
5. hoarseness
6. predisposition to frequent pneumonia.

The greatest risk with an aneurysm is when it ruptures. Depending on the location of the aneurysm, massive hemorrhage into the mediastinum or the peritoneal cavity occurs. This is accompanied by:

1. rozległy ból w klatce piersiowej,
2. a sharp drop in blood pressure,
3. weakness,
4. increased heart rate
5. not rarely loss of consciousness.

W większości przypadków konsekwencją pęknięcia tętniaka aorty jest zgon. Ryzyko śmierci jest bardzo wysokie, ponieważ wynosi ponad 80%. Oprócz tego tętniak aorty naciska sąsiadujące narządy i powoduje zaburzenia ich funkcji.

Occasionally, patients develop aortic valve insufficiency, which may lead to heart failure.

Aortic aneurysm – diagnosis

As mentioned above, most aortic aneurysms are diagnosed completely accidentally during tests for other indications. The diagnosis of thoracic aortic aneurysm is complicated and requires a specialized approach. The most frequently used test is the echo of the heart, which makes it possible to detect aneurysms of the ascending aorta and the aortic arch. Visualization of the descending aorta is not possible with traditional echocardiography, therefore it is necessary to perform an examination with a special organ placed in the esophagus. Computed tomography is most helpful in diagnosing a thoracic aortic aneurysm.

When it comes to an aneurysm of the abdominal aorta, diagnosis is slightly easier here. If the disease has become large, the aneurysm can be detected by palpation of the abdominal cavity. On the other hand, an ultrasound scan (USG) is used to assess the aorta. As in the case of thoracic aortic aneurysm, the best examination to assess the aneurysm will be a method in the form of computed tomography.

Aortic aneurysm – treatment

Treatment management depends primarily on the size of the aneurysm and its growth rate. In the case of aneurysms larger than 5 cm in diameter and rapidly growing, there are indications for surgical treatment. In other cases, conservative management is usually applied (blood pressure normalization, aneurysm size control in imaging studies). The indications for treatment are: pęknięcie tętniaka, tętniaki aorty wstępującej i brzusznej mające więcej niż 55 mm średnicy, tętniaki aorty zstępującej o średnicy większej niż 65 mm (nawet bezobjawowe). Przy podjęciu leczenia dużą rolę odgrywa również tempo w jakim rośnie tętniak.

Surgical methods of aortic aneurysm.

1. Classic method – consists in opening the chest or abdominal cavity, excision of the aneurysm and implanting a properly selected prosthesis in its place. The classical method is most often used for aneurysms of the ascending aorta and aortic arch. It is also a procedure for elective surgery of abdominal aortic aneurysms. Treatment is most effective if it is carried out electively (before the aneurysm ruptures).

2. Stent graft – a prosthesis that is inserted into the body through the patient’s femoral artery. There is no universal prosthesis, it must be custom-made and fitted to the patient’s vessels. The prosthesis is used in patients for whom the risk of classic surgery is associated with high risk. It is definitely better because its duration is shorter, but it is also less invasive than the classic method. It carries no risk of large postoperative scars, and postoperative hospitalization is much shorter. Unfortunately, there is one drawback – such treatments carry a risk of complications.

Prevention for aneurysms is primarily the maintenance of normal blood pressure and cholesterol levels.

Text: SzB