Thoracic aortic aneurysm - symptoms and treatment

It branches like a tree, first into large branches (trunks), then into smaller branches and twigs, and is conventionally divided into several parts or sections:

1. The ascending aorta is the area from the aortic valve to the brachiocephalic trunk.
2. The aortic arch is a short section from which all the vessels supplying the arms and head (brachiocephalic arteries) depart. They anatomically form an arch connecting the ascending and descending aorta.
3. The descending (thoracic) aorta begins from the mouth of the left subclavian artery and continues to the diaphragm.
4. Below the diaphragm and before the bifurcation of the aorta (bifurcation) is the abdominal aorta.

Dividing the aorta into sections is very important for assessing risk and choosing optimal treatment tactics in patients with aortic aneurysms.

An aortic aneurysm is an area of local expansion.

What is an aneurysm

A thoracic aortic aneurysm is an abnormal bulge on the walls of the artery, formed due to intense blood pressure on a weak area of the vessel. An aneurysm can be:

fusiform - has a convex shape, protrudes from both sides of the aorta;
saccular - a rounded formation that protrudes from one side of the vessel.

A small aneurysm does not pose a health threat. However, if it is present, you must be observed by a doctor so as not to miss the moment of disease progression.

Abdominal aortic aneurysm

Abdominal aortic aneurysm is a chronic degenerative disease with life-threatening complications. An abdominal aortic aneurysm is defined as an increase in its diameter by more than 50% compared to the norm or a local bulging of its wall. Under the pressure of blood flowing through this vessel, the dilatation or bulging of the aorta may progress. The diameter of a normal aorta in the abdominal region is approximately 2 cm. However, at the site of an aneurysm, the aorta can be dilated to 7 cm or more.

Why is an aortic aneurysm dangerous?

An aortic aneurysm poses a major health risk as it can rupture. A ruptured aneurysm can cause massive internal bleeding, which in turn leads to shock or death.

An abdominal aortic aneurysm can cause other serious health problems. Blood clots (thrombi) often form in the aneurysm sac or parts of the aneurysm tear off, which move with the blood flow along the branches of the aorta to the internal organs and limbs. If one of the blood vessels becomes blocked, it can cause severe pain and lead to organ death or loss of a lower limb. Fortunately, if an aortic aneurysm is diagnosed early, treatment can be timely, safe and effective.

Classification of the disease

Pathology is divided into 3 types depending on the extent and location:

In the ascending aorta with advancement along the arch. Occurs in 50% of the total number of recorded cases of the disease.
In the ascending aorta. Diagnosed in 35% of cases.
In the descending part of the aorta with progression down/up along the arch. Occurs in 15% of cases.

Stretching of the vessel occurs quickly - it does not require weeks. The process can be compared to inflating a balloon, which expands several times when filled with air.

Depending on the duration of the process, an aneurysm can be:

acute – 1-2 days have occurred since the formation of aortic dissection;
subacute – the endothelial defect appeared 2-4 weeks ago;
chronic – the aneurysm formed 4 or more weeks ago.

Some patients ignore the symptoms of the disease and do not see a doctor for years. But the fact that the thoracic aortic aneurysm does not rupture is pure chance and luck. This can happen at any time, and in 90% of cases the person will die.

Symptoms of pathology

Symptoms of a thoracic aortic aneurysm differ depending on the location of the formation. In some cases, a person does not feel any discomfort at all, which greatly complicates the timely diagnosis of the disease.

Aneurysm of the ascending aorta is accompanied by:

Acute pain in the heart area. This is due to the pressure of the damaged vessel on nearby organs and tissues;
Shortness of breath, significantly increasing over time. It is problematic for a person with an aneurysm to walk long distances or climb stairs;
Constant feeling of heartbeat. This is one of the most common complaints from patients. This phenomenon is associated with blood pressure on weakened vessel walls;
Dizziness. May be accompanied by a severe headache that is not relieved by pills;
Swelling of the face, upper half of the body. This phenomenon is due to the fact that the aneurysm compresses the superior vena cava.

Aneurysm of the aortic arch is characterized by the following symptoms:

Swallowing problems. The swollen section of the vessel presses on the esophagus;
Hoarse voice, periodic coughing. The main cause of the malaise is the pressure of the aneurysm on the recurrent nerve;
Increased salivation. Occurs due to pressure from the damaged aorta on the vagus nerve;
Breathing problems, shortness of breath. It manifests itself in the case of aneurysm pressure on the trachea and bronchi;
Unilateral pneumonia. An aneurysm can put pressure on the root of the lung, preventing its normal ventilation. When an infection enters the body, in 94% of cases this condition develops into unilateral pneumonia.

An aneurysm of the descending aorta is accompanied by:

Pain of unknown nature in the left arm, acute pain syndrome in the scapula area;
Paresis, paralysis. It occurs due to the pressure of the aneurysm on the intercostal arteries, which disrupts the supply of oxygen to the spinal cord;
Displacement of the vertebrae if the patient’s aneurysm is in a chronic condition;
Painful sensations in the side, sternum, similar in nature to pain due to radiculitis/neuralgia.

Symptoms of aortic aneurysm

Unfortunately, the diagnosis of aortic aneurysm cannot always be established during the “cold period” (before complications develop), since this disease is usually asymptomatic. Most often, it is discovered accidentally during fluorography, ultrasound or tomography studies performed in connection with other diseases. Treatment of an aneurysm of the ascending aorta before complications develop is much safer for the patient, therefore, in the early diagnosis of an aortic aneurysm, routine medical examination is important.

It is worth noting that every hundredth patient who died suddenly dies from aortic dissection.

Complaints usually appear when the aneurysm begins to stratify or, enlarging, compresses surrounding organs and tissues. Pain or dysfunction of those organs located in the area of the aneurysm appears. At first, this is not of a bright nature and, therefore, does not alarm either the patient or the doctor.

However, the pain intensifies as these deadly complications of an aortic aneurysm develop—it is some of the most severe pain a person can experience. It is localized in the chest if the aneurysm is located in the ascending, descending sections or in its arch, or in the abdomen if it formed in the abdominal section. Characterized by severe weakness, pallor, and often the person loses consciousness.

Impaired blood supply to organs located in the area of aneurysm rupture or aortic dissection (brain or spinal cord, kidneys, intestines, upper or lower extremities) leads to loss of function of these organs, and a large volume of blood loss during aortic rupture represents the most serious danger. To save a life, minutes count. If early surgical treatment is not available, the first-day mortality rate for aortic dissection is 1% per hour (one person in a hundred dies every hour). Within the first 24 hours, 33% of patients die from aortic dissection, 50% of patients within 48 hours and 75% within two weeks. Only early surgical intervention makes it possible to save a significant proportion of patients.

Reasons for development

A disease such as thoracic aortic aneurysm develops as a result of:

Atherosclerosis. It is this pathology that in 90% of cases is the cause of aneurysm formation;

Traumatic damage to a vessel. Occurs most often as a result of an accident, a fall from a great height, or a strong blow to the chest.
Congenital pathologies. When a patient has a systemic connective tissue disease, the walls of blood vessels are in a chronically inflamed state.
Complications after medical procedures. These include reconstructive operations on the aorta, cardiac catheterization and other interventions in the cardiovascular system.
Infectious diseases. An aneurysm can develop in patients with tuberculosis, sepsis, syphilis, osteomyelitis, and pericarditis.

Previously, the pathology was diagnosed mainly in patients over 50 years of age. However, every year the disease becomes younger. Already today, young people aged 25-30 years often turn to doctors when an examination reveals a thoracic aneurysm.

Risk factors

The pathology has a number of risk factors, the presence of which significantly increases the likelihood of its development:

Male gender. According to statistics, thoracic aneurysm is diagnosed 14 times more often in men than in women.
Smoking. Specialists from the Moscow Regional Research Institute conducted mass screening diagnostics of patients with atherosclerosis and aneurysm. It turned out that 3/4 of the patients had a smoking history of more than 25 years.
Age over 55 years. During this period, the walls of blood vessels stop producing collagen and elastin, as a result of which they become thinner.
Hereditary predisposition. 14% of patients with thoracic aortic dissection have a similar pathology in close relatives.
Insufficient physical activity. A sedentary lifestyle provokes blood stagnation in the extremities and puts a serious strain on the cardiovascular system.
Obesity. Excess body weight negatively affects the functioning of the heart and vascular patency.
Increased blood cholesterol levels. Scientists have long proven that the human body does not need cholesterol coming from outside to function properly - the liver produces it in sufficient quantities.

Lifestyle and Home Remedies

The best way to prevent an aortic aneurysm is to keep your blood vessels as healthy as possible. To do this, you can take the following steps:

quit smoking;
keep your blood pressure under control;
get checked regularly;
reduce the amount of cholesterol and fat in your diet.

If you think you may have an abdominal aortic aneurysm, or are concerned about your risk of an aneurysm due to a family history, see your doctor. If an aneurysm is detected early, treatment may be easier and more effective.

Potential Complications

The most common complication of the disease is rupture of a thoracic aortic aneurysm. In this case, blood flows freely into the chest, abdominal cavity, pericardium, and esophagus. This condition requires emergency hospitalization and surgery. A ruptured aneurysm in the thoracic aorta without medical assistance will invariably lead to the death of the patient.

Other complications of the pathology are:

Compression, erosion of adjacent structures;
Thromboembolism;
Coronary artery occlusion.

These conditions are deadly. The aneurysm itself is a favorable environment for the formation of blood clots, which under pressure from the bloodstream can break off at any time. If a blood clot enters the lungs, heart or brain, the patient has a more than 90% chance of death. That is why it is so important to consult a doctor at the first symptoms of the disease, who will conduct a diagnosis and select the correct treatment tactics.

Complications

Dissecting aneurysm - rupture of the aortic wall (dissection) is the main complication of an abdominal aortic aneurysm.

A ruptured aortic aneurysm can lead to life-threatening internal bleeding. In general, the larger the aneurysm, the greater the risk of rupture.

Signs and symptoms indicating a ruptured aneurysm:

sudden intense and constant pain in the abdominal cavity or lower back;
pain that radiates to the back or legs;
sweating;
sticky sweat;
dizziness;
nausea;
vomit;
low pressure;
rapid pulse;
loss of consciousness;
dyspnea.

Another complication of aortic aneurysms is the risk of blood clots. Small blood clots may develop in the area of the aortic aneurysm. If a clot breaks away from the inside wall of the aneurysm and closes a blood vessel elsewhere in your body, it can cause pain or block blood flow to the legs, toes, kidneys, or abdominal organs.

Diagnostics

The first thing a patient needs to do is make an appointment with a therapist. He will conduct an examination, collect anamnesis and issue a referral to a specialist.

In 50% of cases, pathology is discovered accidentally during an X-ray examination of the lungs. In 70% of cases, the aneurysm is audible with a phonendoscope and manifests itself in the form of characteristic noise. The problem can also be identified during an ultrasound examination of the heart.

Specific methods for diagnosing an aneurysm are:

Magnetic resonance imaging;
CT scan;
angiography.

Based on the data obtained during the examination, the doctor decides on the most appropriate treatment method.

Diagnosis of aortic aneurysm

In the diagnosis of aortic aneurysms, the so-called imaging techniques (ultrasound, MRI, CT, AG) are of greatest importance. In the ascending aorta, its arch and in the abdominal section, an aneurysm can be detected using ultrasound methods (ultrasound). To diagnose an aneurysm of the descending (thoracic) aorta, X-ray methods (x-ray, computed tomography) are required. To establish a final diagnosis and select a treatment method, contrast research methods are performed. Currently, the optimal diagnostic method, which provides the most complete information about the location, extent, diameter of the aneurysm and its relationship to nearby organs, is multislice computed tomography - aortography.

Surgery

It involves removing the damaged area of the aneurysm and replacing it with an artificial blood vessel - an aortic prosthesis. It is installed forever. The rehabilitation period after surgery ranges from 7 days to 1 month, depending on the patient’s age and the presence of concomitant diseases.

It is important to understand that aortic replacement does not guarantee the recurrence of an aneurysm in another part of the vessel. Therefore, it is necessary to strictly follow the doctor’s recommendations regarding nutrition and lifestyle.

The main indications for surgical treatment of an aneurysm are:

Large size. The average is more than 5.5 cm in diameter. However, here everything depends on the initial diameter of the aorta. If the patient’s normal size is 3-3.5 cm, then surgery is indicated in case of aneurysm formation larger than 6.5-7 cm;
Rapid growth - the damaged area of the vessel expands by more than 0.5 cm annually;
An aneurysm provokes compression of the bronchi, the formation of an aortoesophageal/aortobronchial fistula;
The vessel was stretched due to traumatic injury.

Treatment methods for aortic aneurysm

The main method of treating an aneurysm of any part of the aorta is surgical. The point of the method is to replace the dilated section of the aorta in order to prevent its further stretching and rupture. To replace the aorta, two methods are used - the endovascular (intravascular) method using a special intravascular prosthesis (stent graft), and open surgery - aortic replacement.

Each method has its own indications, and each of them has its own advantages and disadvantages.

The advantages of the surgical method lie in its versatility, that is, the ability to correct all disorders associated with an aortic aneurysm, regardless of the department and nature of the lesion. For example, in case of an aneurysm of the ascending aorta and damage to the aortic valve, aortic and aortic valve replacement is performed in combination with coronary bypass surgery.

To perform surgery on the ascending aorta and its arch, it is necessary to use artificial circulation, systemic hypothermia, and often complete circulatory arrest.

Indications for surgical treatment

transverse size of the aneurysm,
aneurysm growth rate;
the formation of complications of this disease.

For each section of the aorta, there is a cutoff limit for the transverse size of the aorta, after which the risk of aortic rupture statistically significantly increases. Thus, for the ascending and abdominal aorta, the transverse diameter of the aneurysm is 5 cm dangerous in terms of rupture, for the thoracic aorta - 6 cm. If the diameter of the aneurysm increases by more than 6 mm in 6 months, then this is also an indication for surgery. Also threatening in terms of rupture and dissection of the aorta are the saccular form of the aneurysm and expansion of the aorta, which is smaller than the diameter that is the indication for surgery, but accompanied by pain at the site of expansion and dysfunction of the presenting organs. Dissections and completed ruptures of aneurysms are absolute indications for emergency surgery.

Endovascular intervention

If the shape and location of the aneurysm are not critical, the endoprosthesis replacement technique is used. The operation proceeds as follows:

a puncture is made on the patient’s thigh, through which a conductor (narrow silicone tube) is inserted into the aorta;
A vascular prosthesis is inserted through a conductor into the damaged aorta, which is fixed to the normal parts of the vessel above and below the location of the aneurysm.

The intervention is classified as minimally invasive. It does not require abdominal access, making the operation much easier for the patient to tolerate. The rehabilitation period is 2-3 days. During the day after the operation, the patient is under the supervision of a doctor.

Forecast

If an aneurysm is detected, the patient needs constant monitoring by doctors. Even after surgery, it is necessary to undergo regular examinations to monitor the condition of the blood vessels. Today, no intervention provides a 100% guarantee that the aneurysm will not reappear in another part of the aorta. Therefore, you should take responsibility for your own health and not neglect regular visits to a specialist.

Statistics on aneurysm operations say that the mortality rate of patients six months after surgery and aortic replacement is 10-15%. Within 10 years from the date of surgery, this figure increases to 40%. This is due to the fact that most patients have concomitant chronic diseases.

In case of endovascular intervention, the prognosis is more favorable. The probability of complications and re-formation of an aneurysm is only 10%, while patient death occurs in only 2% of cases.

Symptoms

Abdominal aortic aneurysms often grow slowly and are usually asymptomatic, making them difficult to identify. Some aneurysms may never rupture. Many start out small in size and remain that way, although many expand over time. Others are expanding quickly. It is difficult to predict how quickly an abdominal aortic aneurysm will grow.

As the aneurysm gets larger, some people may notice:

feeling of pulsation near the navel;
deep, constant pain in the abdomen or side of the abdomen;
lower back pain.

Prevention

There are no specific measures to prevent such pathology as thoracic aortic aneurysm. Doctors give general recommendations:

Complete cessation of smoking, including hookah and electronic cigarettes.

Complete abstinence from alcohol (the maximum allowed is 100g of medium-strength alcohol during the holidays).
Regular exercise. However, physical activity should be moderate. It is recommended to contact a rehabilitation therapist and exercise therapy specialist, who will select appropriate exercises based on the patient’s diagnosis, the presence of concomitant diseases and the current state of health.
Control of factors that can provoke a rise in blood pressure. These include stress, kidney pathologies, and prolonged exposure to the open air during the warm season.
Control of atherosclerosis. This pathology requires treatment, because it can lead to other serious complications in addition to the aneurysm.
Immediately consult a doctor in case of the slightest suspicion of malfunctions in the cardiovascular system, gastrointestinal tract or lungs. It is necessary to respond to the body's signals to prevent serious complications.

If an aortic aneurysm is already present, prevention consists of preventing the development of complications of the pathology:

Taking anticoagulants prescribed by a specialist. Such drugs are not cheap, but they are vital. They prevent the formation of blood clots in the lumen of the aneurysm.
Optimal physical activity. If the patient works in a position that involves heavy lifting or other physical labor, it is necessary to think about changing professions. Excessive force can cause rupture of the aortic wall.
Control of hypertension. It is necessary to take all medications prescribed by the doctor to avoid increasing blood flow pressure on the thinned wall of the aneurysm. The patient must be aware that it can rupture at any moment.
Control over psychological state. In medical practice, there have been cases where aortic rupture was caused by a minor stressful situation.

In order to monitor the condition of the cardiovascular system, it is necessary to visit a cardiologist annually. And do this not “for show,” but undergo a comprehensive examination. This way you can detect developing diseases in the early stages, which greatly increases the likelihood of successful treatment without incisions and pain. Take care of your health!

Causes

Most aortic aneurysms appear in the part of the aorta that belongs to the abdominal cavity. Although the exact cause of abdominal aortic aneurysms is unknown, many factors may play a role, including:

Smoking tobacco.
Cigarette smoking and other forms of tobacco use increase the risk of aortic aneurysms. In addition to the harmful effects that smoking has directly on the arteries, smoking contributes to the accumulation of lipid plaques in the arteries (atherosclerosis) and high blood pressure. Smoking can also cause rapid growth of the aneurysm and subsequent damage to the aorta.
Hardening of the arteries (atherosclerosis).
Atherosclerosis occurs when lipids and other substances deposit on the inner wall of a blood vessel, increasing the risk of an aneurysm.
Infection of the aorta (vasculitis).
In rare cases, an abdominal aortic aneurysm may be caused by an infection or inflammation that weakens part of the aortic wall.
Aneurysms can develop anywhere along the aorta, but when they form in the upper part of the aorta, they are called thoracic aortic aneurysms. Most often, aneurysms form in the lower part of the aorta and are called abdominal aortic aneurysms.