What is aortic aneurysm? What are the types of aneurysms? What is the treatment of aortic aneurysm?
What is Aortic?
What is aortic aneurysm and how is the treatment done? Before answering
the question, one of the most important and vital carriers of our body ‘Aort’u
better to get to know better.
The aorta is the largest artery that emerges from the heart and carries
oxygenated blood to the body. After exiting the heart, the coronary artery
first travels to the coronary artery, and from there to the brain and the
vessels leading to the cola. Then he draws a curve and starts to descend
down the body. The fork in the groin. There are certain parts.
1. Outpatient Aort (part after the heart)
2. Transverse Aorta (part of the cerebral vessels)
3. Descending Aort (starting from the back and downwards)
4. Thoracic Aorta (section in the chest cavity
What is Aortic Aneurysm?
The aortic aneurysm, in its simplest description, can be described as an
anomalous ballooning in an artery, leading to a 50% greater expansion of the
vessel diameter than normal.
Aneurysms can be caused by many different reasons depending on where they are
formed. Generally high blood pressure, calcification, some infections and
connective tissue diseases are among the causes of aneurysm. The effect of
genetic factors on some group aneurysms is large. Examples of such
aneurysms are the lack of normal force of the vessel wall structure resulting
from chromosomal abnormalities.
The most common aneurysms in the aorta are those seen in the region after the
renal vessels under the kidney called infrarenal and in the aortic vein in the
aortic artery, which we call the ascending region, immediately after the
heart. However, aneurysm may occur in every region, and sometimes it is
possible to encounter with all the aorta.
The diameter of the aorta varies depending on the body surface area, ie the
patient’s weight, height, and region. Normally, when we talk about an
adult patient, we can perceive the upper limit of the aortic diameter as four
centimeters. The size of the aortic aneurysm varies according to the
structure of the aneurysm. The structure of the aneurysm is different in
the style of pouch and in different pear style. In the aneurysm of the
vessel, the width of the vessel increases by more than 50% of its normal
size. By way of example, a four-centimeter vessel can reach six
centimeters.
What are the causes of aortic aneurysm?
1- Degeneration due to high blood pressure: It is not possible to say that high
blood pressure alone is effective in the formation of aneurysm. Many
people with high blood pressure do not have an aneurysm. However, the data
show that a significant number of patients with aneurysm suffer from high blood
pressure.
2- Structural reactions in the vessel wall, which we call degeneration and
inflammation.
3. Genetic disorders due to congenital weakness of the vessel wall: We can show
structural diseases such as connective tissue diseases, eg marfan.
4 – Smoking: It is a scientific fact that there is a direct connection of
smoking with aneurysm under the renal vessels. The connection of smoking
with aneurysms in the abdomen is very strong.
5- Age: Age has an important role in the formation of aneurysm. Aneurysms,
especially in the abdomen, are usually seen over 65 years of
age. Aneurysms are usually problems in older people if they do not have a
connective tissue disease.
What are the symptoms of aortic aneurysm?
Aneurysms usually do not give symptoms in advance, but sometimes they can be
felt with different findings depending on their region. The aortic
aneurysms of the abdomen may be in the form of aortic rupture if the initial
diagnosis is not performed. For example, a continuous and uncomfortable pain
in the abdomen that spreads towards the waist, or a tremor that can be seen
from the outside in the abdomen, may feel like a ball is hitting a belly when
the patient puts his hand. Aneurysms in the chest can only be seen in
chest pain or chest pain that strikes the back, and aneurysm can even cause
hoarseness in the descending veins of the back.
How to Diagnose Aortic Aneurysm?
It is now very easy to diagnose aneurysm with developing medical
technologies. After physical examination, the diagnosis of aneurysms in the
abdomen can be made especially in weak patients. But of course, this
cannot be regarded as a definitive conclusion. According to the point of
the aneurysm, in the aorta in the chest can be used as an initial x-ray in the
diagnosis stage. Only an X-ray can be observed in the aorta. The most
commonly used diagnostic method is the ultrasound method that works with sound
waves. When used in the heart ‘echocardiography’, when used in the abdomen
‘abdominal ultrasonography’ this device called the aneurysm can be
diagnosed. According to the results of ultrasound can be further
examined. Tomographic evaluation, sometimes MR,
How to Treat Aortic Aneurysm?
The most important data for the treatment decision is the size of the aneurysm
and the settlement. Different treatment methods are applied according to
aneurysm, location and size. Location, size, whether the patient has any
complaints, affects the way of treatment.
If the aneurysm diameter in the aorta reaches around 5.5 or six centimeters,
and the patient does not have any other connective tissue disease, he or she
falls within the limits of treatment or interventional treatment. The
aneurysms located within the abdomen are usually treated at 5.5 cm. The
aneurysm that develops from the back to the back descending aorta should be
treated when the diameter of the vessel reaches six centimeters.
It is not possible to decide on the size of the aneurysm for
treatment. The growth rate of the aneurysm is also an important
factor. If an aneurysm of four centimeters has reached 4.5 cm in two
months, it shows a very rapid growth and should be treated. The high
growth rate necessitates treatment. In addition, if the patient creates a
complaint, such as severe abdominal pain, then the aortic diameter is treated
even if it is not over-extended. Symptoms and symptoms should be taken
very seriously as the aneurysm of the aorta explodes. The shape of the
treatment determines whether the patient has other diseases that accompany the
aneurysm.
Treatment is evaluated at certain stages, if the aneurysm has not reached
certain sizes, medical treatment is applied. Blood pressure should be kept
under control during the patient’s follow-up period. Because one of the
most important factors in aneurysm is the pressure inside the vein. It is
important that this pressure is low. Keeping the blood pressure under
control is very important in what we call ‘follow-up window’. Keeping the
blood pressure low is provided by drugs.
Two treatment methods are used in the aneurysms of the intervention
border.
1-Endovascular method:
Without open surgery, the catheters placed inside the vein and the stents which
are advanced on them are applied by placing and closing the grafts into the
aneurysm.
Endovascular procedures are frequently used in the last 10 years. Because
endovascular procedures provide significant advantages especially in certain
areas when compared with open surgery. These advantages are very important
for the patient. The first one is that the patient does not undergo an
open operation and therefore the duration of recovery, the duration of hospital
stay, the duration of the intensive care unit stay is short, and the rate of
blood use in the surgery is negligible. Early life quality of the patient
is quite high compared to surgical intervention. Most importantly, the
risk of mortality is much lower compared to open surgery. However, the
quality of life and life advantages that these treatments provide in the early
period may disappear after a year or two.
2-Open surgical procedures:
Large operations compared to endovascular procedures. Although open
surgery is now performed with smaller incisions, open surgery is perceived as
major operations compared to endovascular procedures. The aim is to
completely eliminate the diseased area of the aneurysm and provide continuity
by inserting an artificial vein. Since there is no other large vessel in
the body such as aorta, an artificial vein is required. Aneurysms are
disabled by using polyester, PTF, Dakon style grafts.
Although the duration of intensive care and hospital stay is longer in open surgery, the advantage of open surgery is higher as the patient’s life expectancy is longer. Open surgical procedures are still considered the gold standard of this work.
