Symptoms, treatment of aneurysm of the thoracic aorta is an exclusively relevant topic of modern medicine, since a pathological condition is associated with a danger to the patient's life. Aorta is called one of the largest blood vessels. It starts from the heart and serves by moving blood to smaller ducts. The aorta conducts oxygen-filled blood to organs. It starts from the ventricle on the left and passes through the impressive part of the human body.
Pathology: what is it about
Before considering the symptoms and causes of the thoracic aortic aneurysm, attention should be paid to the terminology and present the disease in general. Aneurysm is usually called such a local violation of the integrity and normal state of the vascular wall, which provokes the formation of protrusion. The reason is blood pressure combined with weakening of the wall and aggressive factors. The protrusions are different - from very small to truly gigantic, the diameter of which exceeds 10 cm. The main danger is the possibility of a gap. Blood can seep between the aortic membranes, the organ may stratify.
Timely detection of symptoms, diagnosis of thoracic aortic aneurysm are aimed at preventing rupture. If it was not possible to notice the aneurysm in time, there may be severe bleeding, an instant fatal outcome. The formation may form in the unpredictable part of the aorta. Abdominal varieties are more common than pectoral ones. The form of the aneurysm is a bag or spindle.
Where did the trouble come from?
The causes of the appearance of the thoracic aortic aneurysm have not yet been identified accurately. Several factors are known that can provoke pathology, but even with a combination of several such predisposing states, aneurysm may not form. If a neoplasm is detected in a patient, a thorough examination may show the absence of predisposing aspects, however, the pathology progresses.
It is generally accepted that the thoracic aortic aneurysm of the ascending arc is more threatening to men than women. Age category - 50 years and older. For men in old age, in principle, vascular diseases associated with the weakening of the walls of the circulatory system are characteristic, aneurysm is one of them.
Nuances and relationships
Among the factors that increase the likelihood of thoracic aortic aneurysm occurrence include atherosclerosis of the blood vessel. The presence of specific plaques can provoke numerous pathological conditions of the cardiac system. On average, aneurysm is more often more characteristic of people who have suffered a stroke, heart attack, and ischemia sufferers.
Sometimes aneurysm of the descending thoracic aorta appears due to genetic nuances. We are talking about the specific structure of the circulatory system. A classic example is Marfan’s disease, in which connective tissue is weaker than normal. Certain types of these tissues exist in various organs and systems, including the vascular walls. Pathology is accompanied by improper generation of protein structures, as a result of which the vessel walls become thinner, the risk of aneurysm formation increases.
Causes, consequences: what is possible?
Sometimes, amid symptoms, treatment of a thoracic aortic aneurysm is vital for people who have had a sternal injury before. The formation on the vessel appears a year or a couple of years after the influence of the traumatic factor, in some the development period reaches two decades or even more.
Occasionally, symptoms of a thoracic aortic aneurysm are observed with tuberculosis and syphilis. These diseases provoke a violation of integrity, a decrease in the strength of the vascular aortic walls in different departments. Aortitis is associated with similar risks, an inflammatory process in the aortic wall that occurs due to a variety of infectious agents.
Aneurysm appears with a combination of a predisposing phenomenon and internal influence, that is, increased pressure. Hypertensive heart disease is a danger group in aspects of the formation of aneurysm.
How to notice?
Symptoms of a thoracic aortic aneurysm with small dimensions of the neoplasm may not bother for a long time. As a rule, primary manifestations are observed if the aneurysm has caused complications. The latent course of the disease significantly worsens the prognosis. For many years and decades, a person may not even suspect a pathological condition until one day a break or stratification occurs, which can cause instant death.
Symptoms of the thoracic aortic aneurysm are expressed if the neoplasm presses on adjacent tissues and organs. If the formation is quite large, the person suffers from a dry nasal cough, due to pressure on the trachea. As a rule, during exertion, sometimes - even at rest, suffocation suffers. Aneurysm develops dysphagia if pressure affects the esophagus.
Case Nuances
Symptoms of a thoracic aortic aneurysm may include hoarseness and even complete loss of voice. This is observed if vascular protrusion affects the recurrent nerve, which is responsible for conducting impulses to the larynx, ligaments. In some, due to an aneurysm, it hurts near the heart, sensations are given between the ribs.
Sometimes symptoms of a thoracic aortic aneurysm indicate pressure on the vena cava. In this case, the neck, face are prone to swelling, the veins on the neck are often swollen, the skin is bluish. It is possible to observe such signs on only one side. If pressure is exerted on bundles of nerves, drooping of the eyelid is possible from one half of the body, the pupil is narrow, and the eye is dry. All this in medicine as a whole is called Horner's syndrome.
In the presence of complications, a turbulent picture is observed, the patient's condition is severe, the probability of instant death is high.
Diagnosis
If there is a suspicion of aneurysm of the thoracic aorta, diagnosis begins with a survey of the patient and the collection of all complaints, a study of the general condition. Having collected an anamnesis, the doctor palpates the jugular wreath, estimates the strength and frequency of the pulsation. Perhaps pulsation visible in the eye in certain parts of the sternum. Aneurysm can be suspected by a frequent pulse, cutaneous cyanosis, blanching of the integument.
To confirm the diagnosis, the patient is sent for instrumental examinations. Basic - an x-ray in three projections. According to the results, vasodilatations and shadows can be identified, due to calcium accumulations on the vascular wall. A more accurate examination is echocardioscopy, during which the size of the bag is assessed, the presence of a blood clot, the nuances of a violation of blood flow are determined.
Check it all out!
To select the best approach from all the developed options for how to treat aneurysm of the thoracic aorta, a duplex scan of the vessel, as well as its branches, should be performed. According to the results of such a study, the doctor receives a clear idea of all violations of the blood flow.
Having performed CT, it is possible to most accurately localize the pathological formation, to clarify the features of its position relative to nearby structures, tissues. When assessing the condition of the aorta in the chest, the heart system, it is recommended to do MSCT.
What to do?
Treatment of aneurysms of the thoracic aorta is practiced taking into account the irreversibility of such a formation. The only effective method of helping the patient is radical intervention. The operation can prevent the progress of the condition, minimize the risk of complications. It is known that the greatest likelihood of detachment with a localized aneurysm in the chest of more than five centimeters in diameter. If the tests showed the formation of less than 5 cm in size, the patient can be registered. You will have to regularly come for examinations to determine the development of the condition, use medications to maintain stability.
With small dimensions of the formation, which does not press on the tissue nearby, with the probability of delamination, estimated at the minimum values, dynamic monitoring of the patient's condition is shown. You will have to go to the doctor every six months, annually do MSCT. With atherosclerosis, high blood pressure you will have to regularly use statins, diuretics, antihypertensive drugs.
Status Progress and Categorical Measures
Over time, studies may show an increase in the size of the formation. MSCT can provide information suggesting the presence of stratified sections of the vascular wall. With any developmental variant, the patient should be urgently referred for surgery. An absolute indication is an increase in vascular lumen for 6 months by 0.5 cm, per year - twice as much. From medical statistics it follows: in the predominant percentage of cases per year, the aortic lumen increases by a millimeter.
The operation is practiced by one of two methods: resection or endoprosthetics. The first option is done on an open heart. The work involves mechanisms to ensure blood flow artificially. The doctor first gets access to the aorta, then dissects the pathological bag, places an artificial implant in the vessel. Anastomoses are established, and the resulting wound is sutured in layers.
Surgery: features
As prostheses, systems made of dacron have recently become widespread. Such prostheses can be placed in different parts of the aorta in the chest. In order for the implant to better take root, the surface is treated with collagen, disinfected with antimicrobial agents. This minimizes the risk of inflammation, the formation of blood clots.
Another method of operation is the introduction through the arterial system of the probe to which the endoprosthesis is fixed. The system is fixed above the hazardous area, excluding the formation from the general circulatory system, preventing any possible complications.
What to choose?
Endovascular methods of treating aneurysms are only becoming widespread, are being actively developed, and not everywhere they are practiced en masse. In practice, more often open operations are carried out, associated with considerable risks, including those associated with the use of the device to provide blood flow artificially. Endovascular technology is safer. A combination of these approaches in the treatment of one case is possible.
The choice in favor of a particular method usually remains at the discretion of the doctor who oversees the dynamics of the patient's condition. With initial complaints, confirmed aneurysm, it is important to regularly come for preventive examinations - this is the only way for a specialist to understand which approach is correct in the current situation.
Operation: is it possible or impossible?
Aneurysm localized on the aorta in the chest is a deadly pathological condition, and the operation is performed because of vital indications, which implies that an absolute contraindication simply cannot exist. There are several relative ones. So, do not practice intervention if a person suffers an acute infection, heart disease, neurological. Do not operate on those whose chronic disease has worsened.
In all these cases, the patient is prescribed a scheduled operation for the period when the condition allows the necessary procedures to be carried out if there is no risk to life due to the delay. Under favorable circumstances, the expectation will achieve a more positive outcome of the intervention. Particular care is required in case management in elderly people. High dangers for those who suffer from poor functioning of the heart in a severe form. Each such case requires an individual decision on the operation.
And if not treated?
Resection is a long-lasting event that takes several hours. If the doctor advises you to agree to an operation, it makes sense to listen to these recommendations. From statistical studies it can be seen: during the operation and soon after it, the mortality rate is 5-15%. Without treatment, the mortality rate in the assessment of the first five years after the diagnosis is clarified is 60-70%. Surgery is currently the only effective method for preventing aneurysm rupture. Without treatment, sooner or later it will surely happen or stratification will develop earlier. The moment when this happens is completely unpredictable - many rightly compare aneurysm with an internal bomb.
In addition to rupture and stratification, aneurysm can cause thromboembolism. Any of the complications leads to a serious condition of the patient. The patient suffers from severe pain in the chest, abdominal cavity, the skin turns pale, throws into a cold sweat, the condition is close to fainting. There is a shock picture. If the patient is not helped, there is a high probability of death. The risks of death are increased even if the patient was immediately taken to the intensive care unit.
Operation: negative consequences and prices
The incidence of complications in the postoperative period is estimated at approximately three percent. The most dangerous negative consequence is aortic bleeding. Intervention can cause stroke, paralysis of the legs. Complications are not always explained by improper or poorly stitched sutures, in some cases the reason is the penetration of blood clots into small arteries with subsequent clogging, which disrupts the flow of blood to the brain and heart. The likelihood of a complication is determined by both the quality of the intervention and the initial condition of the patient, the presence of blood clots in the aneurysm.
Surgery for aneurysms is practiced in many clinics in our country. You can get to the operating table for free, as part of a social program, you can pay for the event from personal funds. The price varies quite a lot, a lot depends on the case, the type of equipment, clinic. On average, you should count on 50-150 thousand rubles, although a number of hospitals set a higher price tag.