What is aortic aneurysm, what are the symptoms?

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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.

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