Aortic aneurysm

Aortic aneurysm's disease overview

The aorta is the largest artery of the body, coming from the heart, running an arc in the chest, through the diaphragm and down the abdomen. The aorta divides blood supply branches for organs in the body. The disease of the aorta is very diverse and complicated. In which aortic aneurysm is one of the common diseases in this pathology group.

Autoplasty aortic historical surgery consists of three layers: inner shirt, middle shirt, outer shirt. The aortic aneurysm is true when the bulge is still intact three -layer structure. This is very important to distinguish aneurysm and fake aneurysm. In general, the aorta is considered an ane when the diameter increases by 50% compared to the healthy aorta right above it. However, this definition is not usually used in clinical diagnosis. The aortic aneurysm is divided into two types: chest aortic aneurysm and abdominal aortic aneurysm .

Causes of Aortic aneurysm's disease

Most aortic aneurysms are due to degeneration, weak arteries over time causing aneurysm

connective tissue disorders such as Marfan syndrome, Leyys-dietz syndrome, Ehlers-Danlos syndrome ..

In addition, aortic aneurysm also has a family element. Có đến 1/5 số bệnh nhân phình động mạch chủ ngực có người trong gia đình mắc bệnh mà không có các bệnh về mô liên kết

Causes of infections, artery walls, chest trauma often cause aortic aneurysm.

Symptoms of Aortic aneurysm's disease

The aortic aneurysm is mostly silent, with no symptoms, often discovered by chance through a health examination or sometimes the patient feels itself in the abdomen and goes to the clinic.

Aortic aneurysms when symptoms are often complications or the risk of high events

The most common symptom of chest aortic aneurysm is chest pain. When chest pain, patients often have complications such as aortic separation or aneurysm.

Other symptoms appear when the aneurysm is large enough and depends on the position of the bulge, caused by an aneurysm compressing the structures in the chest:

aneurysm in the aortic section or the aortic strap: there may be a heart failure attached due to the aortic valve opened due to Valsalva sinus relaxation and valve ring deformity. Valsalva sinuses can break into the right ventricle to create continuous blowing in the heart. Large bulge can cause difficulty swallowing if inserted into the esophagus, hoarseness when inserted into the left -pointed larynx, shortness of breath, blood cough if inserted into bronchial gas, venous syndrome if inserted into the vein Owner (face, neck, spend) and may have a stroke if pinched into the ornamental circuit.

aneurysm in the aorta: less symptoms than aneurysm in the owner and the strap. Often only symptoms when the bulge is very large, can be pinched, causing back pain or pain due to aortic complications.

Symptoms of abdominal aortic aneurysm

like chest aortic aneurysm, abdominal aortic aneurysms are often asymptomatic for a long time. P>

The possible signs of the abdominal aorta aneurysm: abdominal pain, no typical back pain, the abdominal block in the heart beat of the heart beat, the lower limb embolism due to blood embolism The mass or plaque from the bulge shot.

Symptoms of broken aorta aneurysm: shock, hypotension, chest pain, shortness of breath, pleural effusion, pericardium (with aneurysm. chest field vessels), abdominal pain, abdominal distention, bleeding syndrome in the abdominal cavity (with abdominal aortic aneurysm). Patients with aortic aneurysm if not surgery, timely intervention certainly death.

People at risk for Aortic aneurysm's disease

In addition to the above -mentioned reasons, the risk factors for aortic aneurysm are similar to the risk factors for atherosclerosis:

Men

Old age

Smoking

Hypertension

Disorders of lipid lipid disorders

Diabetes is a risk factor for atherosclerosis, but it has no connection to the aortic aneurysm

Prevention of Aortic aneurysm's disease

Preventive by reducing the risk factors of atherosclerosis and treating cardiovascular diseases:

Lifestyle changes: weight loss, regular exercise, 30 minutes a day, at least 5 days/week

Quit smoking

Control blood pressure: Take the drug regularly, diet reduces salt, lots of green vegetables, low fat animal fat

Treatment of blood lipid disorders

The European Heart Association (ESC) recommends that ultrasound screening for the abdominal aortic aneurysm for all men over 65 years old (the level of strong evidence IA), or women on 65 years old with a history of smoking (the level of evidence is weaker than IIB)

In 2018, the study has shown that Quinolone (Levofloxacin, Moxifloxacin, etc.) increases the risk of aortic separation and the astronaut rupture. In 2019, the FDA (US Pharmaceutical Department) officially warned that the Quinolone group should not be used for aortic aneurysms or the risk of aortic aneurysm

Diagnostic measures for Aortic aneurysm's disease

Chest X-ray: You can see wide mediastinum, abnormal mass on the movie

Ultrasound: is a useful measure to assess the size of aneurysm in the section near the aorta (the aorta), Valsalva aneurysm, the aortic valve is open. /p>

Abdominal ultrasound: Especially vascular doppler ultrasound, non -invasive exploration, easy to implement, cheap cost but requires a specialist of blood vessels. This is a good method to diagnose as well as screening for abdominal aortic aneurysm.

Multi -sequential computerized tomography: is the most accurate method in diagnosis as well as proposing treatment strategies. Based on the film angiography, it can locate the bulge, the relationship with other structures, measure the size of the bulge, prepare the intervention device or decide on surgery

Genetic genetic tests are not yet popular in Vietnam

Aortic aneurysm's disease treatments

Including medical treatment, intravascular intervention, surgery.

Medical treatment should be done with both chest and abdominal aortic aneurysms. Intravascular intervention or surgery depends on the position of the bulge, the risk of surgery and procedures. Overall, the bulge in the aorta is often surgery. The aneurysm in the aortic section, the abdominal aorta can intervene in the intravascular intervention, in the strap section, it is possible to bridge the carotid artery or the artery displacement surgery and then the intravascular intervention (Hybrid). Surgery will replace the pathological artery section with artificial vessels. Interior interventions will place Stent Graft (bracket) covering the bulge, preventing the risk of progress and aneurysm. Interior intervention has been growing strongly recently, which has been implemented in many large centers, can avoid the risk of the surgery, but the cost is quite large.

Medical treatment (common for both chest and abdomen aneurysm):

Control blood pressure: The target of systolic blood pressure should be less than 120mmHg if the patient can tolerate. The priority drugs are beta blockers and receptor inhibitors/transferred inhibitors. A few studies show that Losartan (receptor inhibitors) may slow down the progression of the aorta dilatation in Marfan syndrome.

Statin therapy: Despite the lack of data in statin can reduce the progression of the aortic aneurysm, the statin treatment should still be done to control blood fat and stabilize the array. atherosclerosis, reducing cardiovascular risk in general aortic aneurysm. Common medicines: rosuvastatin, atorvastatin, ..

Treatment of chest aortic aneurysm

Aortic root: Surgery is indicated when the diameter of the aorta is ≥ 50mm with Marfan syndrome, ≥45mm when there is Marfan syndrome attached to the syndrome Risk factors, ≥50mm if there is a valve aortic valve disease, ≥ 55mm if there is no connective tissue disease

Aortic aneurysm: surgery when the diameter of the bulge ≥ 55mm

Aortic aneurysms: intravascular intervention is prioritized than surgery, indicated when the size of the block ≥ 55mm

Treatment of abdominal aortic aneurysm

Considered to be the abdominal aorta aneurysm when the size of the block ≥30mm

Interventions/surgery when the size of the bulge is ≥ 55mm or the bulge increases in size> 10mm/year

For patients with an aneurysm size from 30-55mm: re-examination every 3 years if the size of the bulge is from 30-39mm, again 2 years/time when the size is from 40 -44mm, re -examination annually when size> 45mm.

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