Aortic aneurysm

Introduction to aortic aneurys Aortic aneurysm (aorticaneurysm) refers to a local or diffuse abnormal expansion of the aortic wall, which causes symptoms by pressing the surrounding organs, and the rupture of the tumor is its main risk. Often occurs in the ascending aorta, aortic arch, thoracic descending aorta, thoracic and abdominal aorta, and abdominal aorta. Aortic aneurysms are classified into true aortic aneurysms and pseudo-aortic aneurysms. A true aneurysm is a three-layer structure in which blood vessel widening involves the vessel wall. A pseudoaneurysm is a partial rupture of the artery that is formed by a block of blood or adjacent tissue. basic knowledge Sickness ratio: 0.0001% Susceptible people: no special people Mode of infection: non-infectious Complications: radiation damage to the nervous system, renal failure, aneurysm

Cause of aortic aneurysm

The middle layer of the normal arterial wall is rich in elastic fibers, and the blood is transferred as the heart beats. The middle layer is damaged, the elastic fiber is broken, and the fibrous scar tissue is replaced. The arterial wall loses its elasticity and cannot withstand the blood flow impact. The artery is in the artery. The lesions gradually enlarge and form an aneurysm. The increase of intra-arterial pressure helps to form an aneurysm. The main causes of main aortic aneurysm are as follows:

(1) Atherosclerosis is the most common cause. Atherosclerotic plaque erodes the aortic wall, destroys the middle layer, and the elastic fibers undergo degeneration. The wall is thickened by atherosclerosis, which causes the nourishing blood vessels to be compressed. Nutritional disorders, or nourish the rupture of blood vessels and blood in the middle layer, more common in older men, male to female ratio of about 10:1, mainly in the abdominal aorta, especially between the origin of the renal artery and the part of the fork.

(B) infection with syphilis is significant, often eroding the thoracic aorta, sepsis, endocervitis bacteremia causes the bacteria to reach the aorta through the bloodstream, the abscess adjacent to the aorta spread directly, or in atherosclerotic ulcer On the basis of secondary infection, bacterial aneurysms can be formed, and the pathogenic bacteria are mainly streptococcus, staphylococcus and salmonella, which are rare.

(C) cystic middle necrosis is a relatively rare pathological unexplained lesion, aortic middle elastic fiber rupture, replaced by metachromatic acid mucopolysaccharide, mainly seen in ascending aortic aneurysm, more common in men, hereditary diseases Such as Marfan syndrome, Turner syndrome, Ehlers-Danlos syndrome, etc. can have cystic necrosis, easy to cause dissection aneurysms.

(4) Traumatic penetrating injury directly affects the aorta caused by the aorta in the damaged area, which can occur in any part. Indirect injury often acts on the non-movable part, such as the distal end of the left subclavian artery or the ascending aorta. The root, rather than the easily movable part, is more likely to form an aneurysm when subjected to more stress.

(5) Congenital aortic sinus tumors.

(6) Others include giant cell aortitis, Behcet's disease, and more common arteritis.

Aortic aneurysm prevention

1. Regular follow-up of at least 6 months to 1 year is a must, and CT changes are used to determine changes in the aorta.

2. Patients with hypertension should control their blood pressure. Some activities that can cause a sudden increase in blood pressure (such as: intense activity, mental stress, going to the bathroom, in the cold) should be avoided.

3. It is impossible to completely prevent the rupture of large aneurysms. When the tumor is large enough, surgery should be selected as soon as possible.

4, advanced age, high blood pressure, diabetes, or other circulatory diseases, patients with a family history of aneurysms, are at high risk.

5, we should also pay attention to develop good living habits to prevent the formation of atherosclerosis.

Aortic aneurysm complications Complications of the nervous system, radiation damage, renal failure, aneurysm

Aortic aneurysm causes an increase in intravascular pressure, so it is progressively enlarged. If it develops for a long time, it will eventually rupture. The larger the tumor, the greater the possibility of rupture. Embolization is another complication. According to statistics, if surgery is not performed, 90% of thoracic aortic aneurysms die within 5 years, and 3/4 abdominal aortic aneurysms die within 5 years.

The main treatment for aortic aneurysm is surgery, and the main complications of the operation are as follows:

1. Major bleeding is the most dangerous complication of surgery, and it is also the main cause of death. Therefore, imported artificial blood vessels or domestic artificial blood vessels can be pre-coagulated by albumin, which can effectively prevent oozing blood of artificial blood vessels. Artificial blood vessels should be as close as possible to aortic caliber. Matching to avoid anastomotic leakage, vascular anastomosis using continuous suture method.

2, neurological complications is another serious complication of aneurysm surgery, intraoperative cryoprotection of the nervous system, aortic root or the involvement of the bow of the surgical application of hypothermic cardiopulmonary bypass, can be applied to the right subclavian when the need to stop the circulation Arterial intubation, selective cerebral perfusion; descending aortic surgery can use left heart bypass to protect the spinal cord and kidney. When the lesion has a long range and need to remove the longer aorta, the intercostal vessels should be anastomosed to the artificial blood vessel. Adrenal cortex protects nerve cells, strengthens perioperative management, controls blood pressure before surgery to correct heart failure, and pay attention to blood pressure control during surgery, especially before blocking opening, pay attention to blood pressure and circulation capacity, and correct acidosis and electrolyte imbalance. To prevent sudden cardiac arrest after opening blood pressure.

3, most of the abdominal aortic aneurysm is located below the level of the renal artery, the abdominal aorta block below the renal artery is less likely to occur or renal failure, but there may be a lower extremity blood supply disorder, so the abdominal aorta blocking time Need to be as short as possible, 2% to 7% of abdominal aortic aneurysm surgery should be above the level of the renal artery, and even above the level of the celiac artery.

4, aneurysm surgery exposure range, long time, surgical trauma, low temperature and extracorporeal circulation have an impact on the body's immunity, so postoperative infection is easy, prevention may lead to all aspects of infection, and pay attention to the rational use of antibiotics, avoid antibiotics A double infection caused by improperness.

Symptoms of aortic aneurysm Common symptoms thrombus loss weight loss hardening vascular murmur pulsatile mass on the clavicle lower limb blood pressure low aortic sclerosis

The symptoms of aortic aneurysm are caused by compression, traction, and erosion of surrounding tissues, depending on the size and location of the aortic aneurysm. Thoracic aortic aneurysm swells in the facial, neck and shoulder veins when the superior vena cava is compressed, and may have edema; coughing and shortness of breath caused by compression of the trachea and bronchus; compression of the esophagus causes difficulty in swallowing; compression of the recurrent laryngeal nerve causes hoarseness. Thoracic aortic aneurysm in the ascending aorta may deform the aortic annulus, the valve leaf is separated and the aortic valve is incompletely closed, and corresponding murmurs occur. Most of the processes are slow and the symptoms are few. If sudden, the acute pulmonary edema may occur. Thoracic aortic aneurysms often cause pain, and a sudden increase in pain indicates a possible rupture. The aortic arch aneurysm oppresses the left innominate vein, which can make the left upper extremity higher than the right upper extremity. Ascending aortic aneurysm can erode the sternum and costal cartilage and protrude from the anterior chest, showing a pulsatile mass; descending aortic aneurysm can erode the thoracic transverse process and ribs, even on the back of the body to the surface; Produces pain. Thoracic aortic aneurysm rupture into the bronchus, trachea, chest or pericardium can be fatal.

Abdominal aortic aneurysm is common and can be asymptomatic. Because the cause is atherosclerosis, there are often symptoms of kidney, brain and coronary atherosclerosis. The first thing that caught the attention was the pulsatile mass in the abdomen. The more common symptoms are abdominal pain, mostly in the umbilical or mid-abdominal, and may also involve the back. The occurrence and development of pain indicates an enlarged aneurysm or a small amount of bleeding. The pain persists violently and spreads to the back, pelvis, perineum, and lower extremities, or significant tenderness on the mass, all of which are signs of rupture. Abdominal aortic aneurysm often rupture into the left retroperitoneal space, followed by the abdominal cavity, occasionally can be broken into the duodenum or vena cava, often occurs after rupture. Unless excessively obese, pulsatile masses are generally difficult to reach, usually between the umbilicus and the pubic bone, sometimes systolic murmurs can be heard at the mass, and a few are accompanied by tremors. Percussion of aortic aneurysms, especially tenderness, must be taken care to prevent rupture. Abdominal aortic aneurysm compression of the iliac vein can cause lower extremity edema, local varicose veins can be seen in the optic vein, and compression of one side of the ureter can cause hydronephrosis, pyelonephritis, and renal dysfunction.

Aortic aneurysm examination

There are several main methods for examining aortic aneurysms:

(1) The discovery of thoracic aortic aneurysm In addition to the symptoms and signs, X-ray examination is helpful. Aortic shadow enlargement can be found in the posterior anterior and lateral radiographs. The size, position and shape of the lesion can be estimated from the shadow. The expansive pulsation of the aneurysm can be seen under fluoroscopy, but the pulsation may not be obvious when there is thrombosis in the aneurysm. The aortic aneurysm must be distinguished from the substantial mass attached to the aorta, which causes conduction pulsation, the main Arteriography can be identified.

(2) X-ray computed tomography (CT) is also useful for diagnosis. The posterior anterior X-ray of the thoracic aortic aneurysm shows that the ascending aorta is more bulging, the aorta is widened, and the esophageal aortic pressure is widened. The contours of the arteries are significantly irregular and there are multiple aneurysms.

The left anterior oblique X-ray of the thoracic aortic aneurysm shows a wavy contour on the upper edge of the aortic arch, the esophagus is distorted with the aorta, and the undulating edge represents irregular expansion of the adjacent aorta and aneurysm.

(3) Ultrasonography is extremely important for definitive diagnosis. Many cases are currently found in routine ultrasound examinations. Therefore, the diagnostic detection rate of this disease is much higher than in the past. Echocardiography can detect aortic aneurysms of ascending aorta. The aorta of the lesion is enlarged. The width of the aorta is widened. The width of the liquid level between the anterior and posterior walls of the artery is increased. If the thrombus is formed, the widened section is not obvious, but the anterior and posterior walls of the aneurysm are synchronized with the heartbeat. All exist, the outer diameter of the artery still increases, the ultrasound can confirm the size of the lesion, the accuracy of 2 ~ 3mm, its range and morphology and intracavitary thrombosis, X-ray computed tomography is also useful, especially for intracavitary thrombosis and wall Calcification is easier to detect and can show the relationship between aneurysms and adjacent structures such as the renal artery, retroperitoneal cavity, and spine.

(4) MRI examination is equivalent to CT and abdominal ultrasound in determining the size of the tumor and its relationship with the renal artery and the radial artery. The main disadvantage of MRI is that the image analysis takes a lot of time.

(5) Aortic angiography is also helpful for localization diagnosis, but intracavitary thrombosis may affect the assessment of the extent of the lesion, but for patients with unclear diagnosis, the extent of aneurysm in patients with hypertension with renal artery disease is unclear, suspected obstruction Patients with or with tumor-like lesions and those who are scheduled for surgery still advocate aortic angiography.

(6) Aortic angiography is also helpful for localization diagnosis, but intracavitary thrombosis may affect the assessment of the extent of the lesion, but for patients with unclear diagnosis, the extent of aneurysm in patients with hypertension with renal artery disease is unclear, suspected obstruction Patients with or with tumor-like lesions and those who are scheduled for surgery still advocate aortic angiography.

Diagnosis of aortic aneurysm

Differential diagnosis

1. Thoracic aorta and lung cancer:

Symptom similarity of two diseases: cough, hemoptysis and lung mass are important symptoms and signs of lung cancer, and some aortic aneurysms can cause pulmonary venous pressure to rise, causing varicose veins and rupture of the bronchial mucosa, leading to cough. Symptoms such as hemoptysis, and some patients have a history of cough, the aortic aneurysm on the chest X-ray will be mistaken for a lung mass. Due to the incidence of lung cancer in recent years, the mortality rate has been the highest in malignant tumors. There is a trend of rejuvenation. Patients with repeated cough, hemoptysis and long-term smoking history are easy to consider lung cancer, which leads to misdiagnosis. Patients with aortic sinus aneurysms have a history of congenital heart disease. When the aortic aneurysm is located in the ascending aorta, The aortic annulus can be deformed, the valve leaflets are separated and the aortic valve is incompletely closed, and corresponding murmurs occur; when there is thrombosis in the aneurysm, blood flow noise can be heard in the corresponding auscultation area; the expanded aortic aneurysm can cause local Pulsation; aortic arch aneurysm compression of the left innominate vein can make the left upper extremity higher than the right upper extremity; the aortic dilation causes increased pulse pressure, the performance of the above cardiovascular diseases can guide the physician Related examination, aortic aneurysm can also compress the superior vena cava, esophageal and recurrent laryngeal nerve caused the corresponding symptoms, which is no different from the compression symptoms and signs caused by lung cancer, but should pay attention to whether the patient showed significant weight loss or significant increase in lesions, The nature of blood stasis and the law of hemoptysis, with or without metastatic lesions, these may prompt the physician to check for cancer cells, lung cancer markers and enhanced CT or MR examination, which may help to rule out the diagnosis of lung cancer, such as the clinician neglecting the diagnosis and Differential diagnosis of the meaning of the meaning, it is easy to cause misdiagnosis.

2, pseudo aortic aneurysm:

Pseudo-aortic aneurysm is an rupture of the arterial wall, an extrahepatic hematoma is formed, and the tumor wall has no full-thickness structure of the aortic wall. Only the endometrial surface covers the fibrous connective tissue, which is mostly caused by trauma, and occurs in the descending part of the aortic arch. Catheter ligament and left subclavian artery opening, local aortic wall infection or postoperative incision leakage can also form a hematoma, CT is a soft tissue mass close to the aortic wall, can be connected with the aorta when the breach is not closed, enhance After the center is strengthened, a large number of thrombus formation can be seen around it, and the fracture can be seen. A small number of patients with pseudoaneurysm have a normal arterial blood vessel due to the tumor, and the blood flow in the tumor cavity is slow to form a wall thrombus, which causes blood clots to accumulate and become mechanized. In the early stages of tremors or murmurs, sometimes they are misdiagnosed.

3. The diseases that need to be identified for abdominal aortic aneurysm are as follows:

Abdominal pain, shock, low back pain are the most common manifestations of abdominal aortic aneurysm rupture. Naturally, most of the false diagnoses are associated with it. The most common misdiagnosis is renal colic, which accounts for more than 20% of total misdiagnosis. When the symptoms of shock are absent, severe low back pain, obvious pain in the kidney area, microscopic hematuria and other symptoms often lead the doctor's thinking to the urinary calculi, renal colic, but I do not know that these appearances are because they are soaked in a large amount of blood. The kidneys, the ureter is stimulated, or the renal artery opening is ruptured, and the symptoms such as abdominal pain are often incorrectly attributed to celiac disease, such as gastrointestinal bleeding and rupture, sigmoid diverticulitis, intestinal obstruction, cholecystitis. , cholelithiasis, pancreatitis, etc., abdominal aortic aneurysm rupture produces symptoms similar to these diseases, may be related to abdominal aorta 2 gastrointestinal fistula, tumor wall thrombus detachment, acute ischemia of the inferior mesenteric artery, etc., abdominal aorta Tumor rupture is easily missed by incarcerated inguinal hernia, abdominal aortic aneurysm with inguinal hernia and/or emphysema, systemic connective tissue dysplasia and Degeneration may be the common pathological basis of the two. When the abdominal aortic aneurysm ruptures, the giant retroperitoneal hematoma causes a sudden increase in the pressure on the weak groin, which leads to the incarceration of the sputum. It is easy for the doctor to be blinded by the surface phenomenon and miss the diagnosis. Aneurysm.

Other rare diseases that require differential diagnosis include acute myocardial infarction (MI), abdominal blunt trauma, etc. Aortic aneurysm patients often have severe atherosclerosis and affect coronary blood supply, myocardial ischemia and Electrocardiogram changes caused by hypotension are the main cause of misdiagnosis as acute myocardial infarction. However, acute myocardial infarction has a history of recurrent angina pectoris. The painful part is mostly behind the sternum or to the neck, and the left arm is radiated. Nitrate can be used. Morphine mitigation; and abdominal aortic aneurysm rupture pain has a wide range, morphine and other analgesics are ineffective, and acute myocardial infarction ECG can be seen in a series of myocardial infarction pattern evolution, serum myocardial zymogram rises a specific curve, These are the distinguishing points from the rupture of the abdominal aortic aneurysm.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.