Functions of the human aorta. Aorta: why is it needed and where is it located? What is aortic aneurysm

aorta

The aorta is the main arterial trunk of the systemic circulation (Fig. 1). The aorta belongs to the elastic type arteries. The wall of the aorta is well supplied with blood vessels and nerves. In some places its nerve elements are especially numerous; these are the so-called reflexogenic zones involved in the regulation of blood distribution. The aorta starts from the left ventricle of the heart with the aortic bulb (diameter about 3 cm). Here, on the inner wall of the aorta, there is an aortic valve formed by three semilunar valves (Fig. 2), and, accordingly, three protrusions of the wall - the aortic sinuses, or Valsalva sinuses. In the right sinus is the opening of the right coronary artery, in the left - the left coronary artery. The initial section of the aorta - the ascending aorta - with a length of 5-6 cm, is almost entirely located inside the pericardium (it is sometimes called the cardiac aorta). Ascending upward, the aorta behind the sternum handle makes a left turn in the form of an arc. On the border of the ascending aorta and the arch with age, an oval expansion is formed, which is due to the pressure of blood ejected from the heart at the time of contraction of the left ventricle. This place can be the starting point for the formation of true aneurysms. The shoulder-head trunk, the left common carotid and left subclavian arteries depart from the aortic arch. Throwing over the left bronchus, the aortic arch at the level of the IV thoracic vertebra (aortic isthmus) passes into the descending aorta. The descending aorta in the chest cavity lies in the posterior mediastinum to the left of the spine, then deviates to the right and passes through the aortic opening of the diaphragm into the abdominal cavity, located in front of the spine and to the left of the inferior vena cava. At level IV of the lumbar vertebra, the aorta gives off the right and left common iliac arteries.

The length of the descending aorta is about 30 cm, the average diameter is 2.5 cm. The segment of the descending aorta lying in the chest cavity is called the thoracic aorta, in the abdominal cavity - the abdominal aorta. Bronchial, esophageal, pericardial and mediastinal branches, upper diaphragmatic, posterior intercostal, lying in the intercostal spaces (from III to XI inclusive), and subcostal arteries (under the twelfth ribs) depart from the thoracic aorta.

The internal and parietal branches extend from the abdominal aorta. The unpaired internal branches include the celiac trunk, superior and inferior mesenteric arteries; the paired internal branches include the middle adrenal, renal, testicular (ovarian) arteries; parietal branches - lower phrenic and lumbar arteries; the terminal branches are the common iliac arteries and the median sacral artery descending into the pelvis.

The most common aortic anomalies are: congenital narrowness of the aorta, double aortic arch, right-sided aorta, non-closure of the arterial (botallova) duct, stenosis and atresia of the isthmus (coarctation of the aorta). In the latter case, between the proximal and distal segments of the aorta, blood circulation is maintained by dilated collateral arteries. At the same time, there is an increase in pressure in the vessels of the upper half of the body and a decrease in the vessels of the lower half.

Diseases of the aorta - see Aortic aneurysm, Aortitis, Atherosclerosis. See also Blood vessels.

Aorta (Greek aorte) is the main artery and the largest vessel in the human body (Fig. 1); leaves the left ventricle of the heart.

The aorta is formed from paired embryonic vessels. The initial section of the ascending aorta is formed from the primary bulbus of the heart, the ascending aorta - from the primary truncus arteriosus, the arch - from the primary IV left branchial artery, and the descending A. - from the left primary dorsal A. Anonymous artery is formed from the right primary ventral aorta.

There are the following sections of the aorta: ascending, arch, descending, abdominal.

Wall A. consists of three shells - 1 inner, middle, and outer. The inner shell of A. (tunica intima) consists of a layer of endothelial cells facing the lumen of A., a subendothelial layer containing Langhans sprout cells, and an internal elastic membrane (membrana elastica interna). The latter, in turn, consists of two sheets of elastic and collagen fibers with different direction of the bundles. The middle shell (tunica media) - a strong elastic frame A. - consists of several dozen rows of elastic fibers, intertwined in different directions, and bundles of smooth muscle fibers. The outer shell (tunica adventitia) is formed by bundles of connective tissue fibers.

The blood supply to the aortic wall is carried out through the vasa vasorum from the bronchial, intercostal arteries, as well as the vessels of the mediastinal tissue. Venous outflow goes to the system of azygos and semi-unpaired veins. A. is innervated from the system of vagus nerves (arch A.), sympathetic plexus (cervical spine), and branches of the spinal nerves. The plexus located in the aortic arch plays an important role in the regulation of blood pressure.

The ascending aorta - the section from the exit from the ventricle to the outlet of the anonymous artery - goes behind the sternum, from the upper edge of the third left costal cartilage to its right edge. In front and on the left is the pulmonary artery, in front and on the right - the auricle of the right atrium; on the right - the superior vena cava; behind - the left atrium. The caliber of the ascending aorta is up to 30 mm. In its initial section, there are three protuberances corresponding to the semilunar valves - the Valsalva sinus (sinus Valsalvae). Coronary arteries originate from the right and left sinuses (Fig. 1, a). Above is the extension A. (bulbus aortae).

The aortic arch is a segment between the origin of the anonymous and left subclavian arteries. It goes transversely from the lower edge of the first costal cartilage to the right, from front to back and to the left, passing from the anterior to the posterior mediastinum. Arc caliber - 21 - 22 mm. At the place of transition to the descending A., the arch has a narrowing - the isthmus (isthmus aortae). Above the arch, closer to the front, lies the left unnamed vein (v. Anonyma sin.). The left vagus and phrenic nerves pass along the anterior-left wall of the arch. The return branch of the vagus nerve covers the arc A., passing from the front from the bottom to the back. The arch bends over the division of the pulmonary artery and the left main bronchus; from its lower surface a ligament (lig.arteriosum) departs to the artery, which in the embryo functions as a ductus arteriosus (ductus arteriosus). The nameless, left common carotid and left subclavian arteries successively depart from the arch. The nature of their discharge (loose or main) is quite variable. The height of the arc is also different depending on the physique: in persons with a short and wide chest, it is higher, in asthenics, on the contrary, it is lower. Anomalies of the discharge of the main branches of the arc A. can cause compression of the trachea or esophagus.

The descending aorta starts from the ThIV level, goes vertically down the left side of the spine, at the diaphragm it moves somewhat anteriorly. In front of it are the root of the left lung, the pericardium; the esophagus goes to the right, and at the level of ThVIII-IX (near the aortic opening of the diaphragm) - in front of the descending A. On the left, the descending A. is covered with mediastinal pleura; 10 pairs of intercostal arteries, bronchial vessels, branches to the tissue of the mediastinum and to the esophagus depart from it. The number of these vessels is not constant.

The abdominal aorta begins after leaving the aortic opening of the diaphragm (ThXII) and ends at the LIV level with a bifurcation - a branching into two common iliac arteries, between which the middle sacral artery departs. With age, the bifurcation descends by one or two vertebrae. To the right of the abdominal A. lies the inferior vena cava, in front - the pancreas and the mesentery root. The parietal branches of abdominal A. are the lower phrenic arteries and lumbar branches (4 pairs), the visceral ones are the celiac, superior mesenteric, renal (two), lower mesenteric, adrenal arteries and internal seminal arteries. With a loose type of bifurcation, the external and internal iliac arteries can branch off separately.

Figure: 1. Aorta (front view): a - Valsalva sinuses. Figure: 2. Abnormal discharge of the right subclavian artery from the aortic arch. Compression of the esophagus and trachea. Figure: 3-5. Coarctation of the aorta and its surgical treatment. Figure: 6 and 7. Occlusion of truncus brachiocephalicus and a. carotis communis and its surgical treatment.

Aortic anomalies
X-ray diagnosis of aortic anomalies

- pathological local expansion of a section of the main artery due to the weakness of its walls. Depending on the location of the aortic aneurysm, it can manifest itself as pain in the chest or abdomen, the presence of a pulsating tumor-like formation, symptoms of compression of neighboring organs: shortness of breath, cough, dysphonia, dysphagia, swelling and cyanosis of the face and neck. The basis for the diagnosis of aortic aneurysm is X-ray (chest and abdominal X-ray, aortography) and ultrasound methods (ultrasound, ultrasound of the thoracic / abdominal aorta). Surgical treatment of aneurysm involves performing its resection with aortic prosthetics or closed endoluminal aneurysm replacement with a special endoprosthesis.

General information

Aortic aneurysm is characterized by an irreversible expansion of the lumen of the arterial trunk in a limited area. The ratio of aortic aneurysms of different localization is approximately the following: aneurysms of the abdominal aorta account for 37% of cases, ascending aorta - 23%, aortic arch - 19%, and descending thoracic aorta - 19.5%. Thus, the share of aneurysms of the thoracic aorta in cardiology accounts for almost 2/3 of all pathology. Aneurysms of the thoracic aorta are often combined with other aortic defects - aortic insufficiency and aortic coarctation.

Causes

According to etiology, all aortic aneurysms can be divided into congenital and acquired. The formation of congenital aneurysms is associated with hereditary diseases of the aortic wall:

erdheim syndrome
hereditary elastin deficiency, etc.

Acquired aortic aneurysms can have inflammatory and non-inflammatory etiology:

Post-inflammatory aneurysms arise as a result of specific and nonspecific aortitis with fungal infections of the aorta, syphilis, postoperative infections.
Non-inflammatory degenerative aneurysms caused by atherosclerosis, defects in suture material and aortic prostheses.
Hemodynamic-post-stenotic and traumatic aneurysms associated with mechanical damage to the aorta
Idiopathic aneurysms develop with medionecrosis of the aorta.

The risk factors for the formation of aortic aneurysms are old age, male gender, arterial hypertension, tobacco smoking and alcohol abuse, hereditary burden.

Pathogenesis

In addition to the defectiveness of the aortic wall, mechanical and hemodynamic factors are involved in the formation of an aneurysm. Aneurysms often occur in functionally tense areas experiencing increased stress due to high blood flow velocity, the steepness of the pulse wave and its shape. Chronic trauma to the aorta, as well as increased activity of proteolytic enzymes, cause the destruction of the elastic frame and nonspecific degenerative changes in the vessel wall.

The formed aortic aneurysm progressively increases in size, since the stress on its walls increases in proportion to the expansion of the diameter. The blood flow in the aneurysmal sac slows down and becomes turbulent. Only about 45% of the blood volume in the aneurysm enters the distal arterial bed. This is due to the fact that, getting into the aneurysmal cavity, blood rushes along the walls, and the central flow is restrained by the mechanism of turbulence and the presence of thrombotic masses in the aneurysm. The presence of blood clots in the aneurysm cavity is a risk factor for thromboembolism of distal aortic branches.

Classification

In vascular surgery, several classifications of aortic aneurysms have been proposed, taking into account their localization by segments, shape, structure of the walls, and etiology. In accordance with the segmental classification, there are

ascending aortic aneurysm
aneurysm of combined localization - the thoracoabdominal part of the aorta.

Assessment of the morphological structure of aortic aneurysms allows them to be divided into true and false (pseudoaneurysms):

True aneurysm characterized by thinning and bulging out of all layers of the aorta. By etiology, true aortic aneurysms are usually atherosclerotic or syphilitic.
Pseudoaneurysm... The wall of the false aneurysm is represented by connective tissue formed as a result of the organization of a pulsating hematoma; own aortic walls are not involved in the formation of a false aneurysm. By origin, they are more often traumatic and postoperative.

Saccular and fusiform aortic aneurysms are found in shape: the former are characterized by a local protrusion of the wall, the latter by diffuse expansion of the entire diameter of the aorta. Normally, in adults, the diameter of the ascending aorta is about 3 cm, the descending thoracic aorta is 2.5 cm, the abdominal aorta is 2 cm. Aortic aneurysm is said to be when the diameter of the vessel in a limited area increases by 2 or more times.

Taking into account the clinical course, uncomplicated, complicated, exfoliating aortic aneurysms are distinguished. Among the specific complications of aortic aneurysms are ruptures of the aneurysmal sac, accompanied by massive internal bleeding and the formation of hematomas; thrombosis of aneurysm and thromboembolism of the arteries; phlegmon of surrounding tissues due to infection of the aneurysm.

A special type is a stratified aortic aneurysm, when through the rupture of the inner lining, blood penetrates between the layers of the artery wall and spreads under pressure along the vessel, gradually stratifying it.

Aortic aneurysm symptoms

Clinical manifestations of aortic aneurysms are variable and are determined by the localization, size of the aneurysmal sac, its length, and the etiology of the disease. Aneurysms may be asymptomatic or be accompanied by scanty symptoms and be detected during routine examinations. The leading manifestation is pain caused by damage to the aortic wall, its stretching or compression syndrome.

Abdominal aortic aneurysm

The clinic of an abdominal aortic aneurysm is manifested by transient or persistent diffuse pain, abdominal discomfort, belching, heaviness in the epigastrium, a feeling of fullness in the stomach, nausea, vomiting, intestinal dysfunction, weight loss. Symptoms can be associated with compression of the cardiac part of the stomach, duodenum, involvement of the visceral arteries. Often, patients independently determine the presence of increased pulsation in the abdomen. On palpation, a tense, dense, painful pulsating formation is determined.

Thoracic aortic aneurysm

For aneurysms of the ascending aorta, pain in the region of the heart or behind the sternum is typical, due to compression or stenosis of the coronary arteries. Patients with aortic insufficiency are worried about shortness of breath, tachycardia, dizziness. Large aneurysms cause the development of superior vena cava syndrome with headaches, swelling of the face and upper half of the body.

Aortic arch aneurysm leads to compression of the esophagus with symptoms of dysphagia; in case of compression of the recurrent nerve, hoarseness (dysphonia), dry cough occurs; interest in the vagus nerve is accompanied by bradycardia and salivation. With compression of the trachea and bronchi, dyspnea and stridor breathing develop; with compression of the root of the lung - congestion and frequent pneumonia.

With irritation by the aneurysm of the descending aorta of the periaortic sympathetic plexus, pain occurs in the left arm and scapula. In the case of involvement of the intercostal arteries, spinal cord ischemia, paraparesis and paraplegia may develop. Compression of the vertebrae is accompanied by their usuration, degeneration and displacement with the formation of kyphosis. Compression of blood vessels and nerves is clinically manifested by radicular and intercostal neuralgia.

Complications

Aortic aneurysms can be complicated by rupture with the development of massive bleeding, collapse, shock and acute heart failure. A breakthrough of an aneurysm can occur in the superior vena cava system, pericardial and pleural cavities, esophagus, abdominal cavity. In this case, severe, sometimes fatal conditions develop - the superior vena cava syndrome, hemopericardium, cardiac tamponade, hemothorax, pulmonary, gastrointestinal or intra-abdominal bleeding.

When thrombotic masses are detached from the aneurysmal cavity, a picture of acute occlusion of the vessels of the extremities develops: cyanosis and soreness of the toes, livedo on the skin of the extremities, intermittent claudication. Renal artery thrombosis results in renovascular arterial hypertension and renal failure; with damage to the cerebral arteries - a stroke.

Diagnostics

Diagnostic search for aortic aneurysm includes the assessment of subjective and objective data, X-ray, ultrasound and tomographic studies. The auscultatory sign of an aneurysm is the presence of systolic murmur in the projection of the aortic dilatation. Aneurysms of the abdominal aorta are found on palpation of the abdomen in the form of a tumor-like pulsating formation. Instrumental diagnostics:

Radiography.The plan for X-ray examination of patients with aneurysm of the thoracic or abdominal aorta includes fluoroscopy and chest X-ray, plain X-ray of the abdominal cavity, X-ray of the esophagus and stomach. At the final stage of the examination, aortography is performed, according to which the localization, size, length of the aortic aneurysm and its relation to adjacent anatomical structures.
Ultrasound. When recognizing aneurysms of the ascending aorta, echocardiography is used; in other cases, ultrasound (ultrasound) of the thoracic / abdominal aorta is performed.
CT scan. CT (MSCT) of the thoracic / abdominal aorta makes it possible to accurately and visually represent aneurysmal expansion, reveal the presence of dissection and thrombotic masses, paraaortic hematoma, and foci of calcification.

Based on the results of a comprehensive instrumental examination, a decision is made on the indications for surgical treatment. Thoracic aortic aneurysm should be differentiated from tumors of the lung and mediastinum; aneurysm of the abdominal aorta - from the volumetric formations of the abdominal cavity, damage to the lymph nodes of the mesentery, retroperitoneal tumors.

Aortic aneurysm treatment

In asymptomatic, non-progressive course of aortic aneurysm, they are limited to dynamic observation by a vascular surgeon and X-ray control. To reduce the risk of possible complications, antihypertensive and anticoagulant therapy is performed, and cholesterol levels are lowered.

Surgical intervention is indicated for abdominal aortic aneurysms with a diameter of more than 4 cm; aneurysms of the thoracic aorta with a diameter of 5.5-6.0 cm or with an increase in smaller aneurysms by more than 0.5 cm in six months. In case of rupture of an aortic aneurysm, the indications for emergency surgical intervention are absolute.

In hemodynamically significant aortic insufficiency, resection of the ascending thoracic aorta is combined with aortic valve replacement. An alternative to open vascular intervention is endovascular aortic aneurysm replacement with stent placement.

Forecast and prevention

The prognosis of an aortic aneurysm is mainly determined by its size and concomitant atherosclerotic lesions of the cardiovascular system. In general, the natural course of aneurysm is unfavorable and is associated with a high risk of death from ruptured aorta or thromboembolic complications. The probability of rupture of an aortic aneurysm with a diameter of 6 cm or more is 50% per year, of a smaller diameter - 20% per year. Early detection and planned surgical treatment of aortic aneurysms is justified by the low intraoperative (5%) mortality and good long-term results.

Preventive recommendations include monitoring blood pressure, organizing a correct lifestyle, regular monitoring by a cardiologist and angiosurgeon, drug therapy for concomitant pathology. Individuals at risk of developing an aortic aneurysm should undergo screening ultrasound.

What is a vascular aneurysm?

Aneurysm - local ( saccular) wall protrusion or diffuse ( circular, fusiform) an increase in the lumen of the vessel several times as a result of structural disturbances in inflammatory processes, mechanical damage to the vessel, congenital and acquired pathologies ( marfan syndrome, atherosclerosis, syphilis).

Aneurysms of the thoracic aorta are classified depending on its location, shape, etiology ( causes), clinical course and other factors. When formulating a diagnosis, a classification is used to describe the pathology in more detail.

Due to aortic aneurysm disease, there are:

inflammatory etiology ( causes) - with syphilis, nonspecific aortoarteritis ( takayasu's disease - an autoimmune inflammatory disease of the aorta and its branches), fungal infection and others;
non-inflammatory etiology - with atherosclerosis, trauma, arterial hypertension;
congenital - with Marfan syndrome ( hereditary connective tissue disorder), coarctation ( congenital local narrowing of the lumen) aorta, hypoplasia ( underdevelopment of tissue or organ) and others.

Aortic aneurysm can be localized anywhere - from the exit of the aorta from the left ventricle of the heart to its transition into the abdominal part of the aorta.

Depending on the localization, there are:

aortic sinus aneurysm ( sinuses of Valsalva);
aortic sinus aneurysm ( sinuses of Valsalva) and the ascending part of the aorta ( cardio-aorta);
aneurysm of the ascending aorta ( cardio-aorta);
aneurysm of the ascending part of the aorta and its arch;
aneurysm of the aortic arch;
aneurysm of the ascending aorta, arch and descending aorta;
aneurysm of the arch and the descending thoracic aorta;
aneurysm of the descending aorta ( thoracoabdominal aneurysm).

The type of aneurysm is distinguished:

True aneurysms ( aneurysma verum). With a true aneurysm, the expansion of the aortic lumen occurs due to the thinning and protrusion of all three layers of the wall with pathological changes in the structure. The aneurysm has a smooth expansion and is 50% or more in diameter than the aorta.
Pseudoaneurysms or false aneurysms ( aneurysma spurium). False aneurysms are not an expansion of the vessel lumen, but only create its "appearance". They occur when the inner layer of the aortic wall is damaged. As a result, through the defect, blood flows out of the lumen of the vessel and accumulates in a capsule of connective tissue called a pulsating hematoma. It looks like a one-sided protrusion of the aortic wall.

By the size of the aneurysm are:

small- 4 - 5 centimeters in diameter;
average- 5 - 7 centimeters in diameter;
big- more than 7 centimeters.

The form is distinguished:

fusiform ( fusiform) aneurysms - the area of \u200b\u200bthe aorta is evenly expanded along its entire circumference;
saccular ( saccular) aneurysms - protrusion of the wall of the aorta in the form of a sac, in size not exceeding half of its diameter;
dissecting aneurysms ( aneurysma dissecans) - characterized by blood flow between the internal ( tunica intima) and average ( tunica media) by layers of the wall through the damaged inner shell with subsequent delamination of the vessel.

A dissecting aneurysm is a very dangerous pathology. It can be an independent pathology or a complication of a true aneurysm. This process extends along the length of the vessel and can lead to rupture of the outer layer of the wall ( tunica externa) within hours of aortic dissection. Rupture of the aortic aneurysm almost always leads to the death of the patient, regardless of the timely performed surgical intervention. Separate classifications exist for dissecting thoracic aortic aneurysms.

According to DeBakey's classification, aortic dissection is distinguished:

Type I - damage to the inner layer ( tunica intima) at the level of the ascending aorta ( cardio-aorta) with wall dissection to the level of the thoracic and abdominal aorta of the descending section;
Type II - damage to the intima and stratification of the vessel wall in the ascending section ( cardio aorta) or in the aortic arch, without involving the descending aorta in the process;
Type III - Intimal tear and wall dissection affect the descending part of the thoracic aorta, sometimes with the spread of the process in the abdominal aorta or retrograde in the arch and ascending part of the aorta.

According to the Stanford classification, dissecting aortic aneurysms are:

type A - proximal ( near) - delamination of the ascending aorta ( cardio-aorta);
type B - distal ( remote) - delamination of the aortic arch and the descending section.

Downstream, dissecting aneurysms are:

sharp - from several hours to several days ( 12 o'Clock in the noon) from the onset of the disease;
subacute - from several days to several weeks ( 3-4 weeks) from the onset of the disease;
chronic - several months from the onset of the disease.

Causes of aortic aneurysm

Many diseases, injuries and age-related changes can lead to changes in the structure of the aortic wall and its aneurysm. Etiological ( causal) factors and diseases are divided into two groups - congenital and acquired. Acquired diseases, in turn, are divided into inflammatory and non-inflammatory diseases.

Congenital diseases include:

Marfan syndrome. A genetic inherited disorder of the connective tissue in which abnormalities of the eyes, bones, cardiovascular and skeletal systems occur. Manifested by deformation of the chest ( Chicken breast, depressed breast), abnormally long fingers ( arachnodactyly, "spider fingers"), hypermobility ( pathological increased mobility and flexibility) joints, long limbs, farsightedness or myopia and many others. Damage to the cardiovascular system is manifested by an aortic aneurysm ( often ascending), rupture of the aorta, insufficiency of heart valves, which in 90% of cases leads to death.
Ehlers-Danlos syndrome type IV ( vascular type). A rare genetic systemic disease of connective tissue caused by impaired collagen synthesis ( protein - the basis of connective tissue). There are several types of the disease, differing in symptoms and prevalence - vascular type, classic type, type of hypermobility and others. The vascular type occurs in 1 person per 100,000 population. The disease is manifested by bruising, hypermobility of the fingers and toes, pallor and thinning of the skin. As well as the fragility of the vessel walls, which leads to aortic aneurysm and subsequently rupture.
Lois-Dietz Syndrome. Hereditary genetic disease, often affecting the cardiovascular and skeletal systems. Pathology is manifested by a triad - cleft palate ( cleft palate) or uvula, wide-set eyes ( hypertelorism), aortic aneurysms. Other symptoms include scoliosis ( curvature of the spinal column), clubfoot ( deformity of the feet, in which they are turned inward), abnormal connection of the brain and spinal cord, and others. Symptoms of damage to the cardiovascular system are similar to those of Marfan's disease. But they are characterized by the development of aneurysms not only of the aorta, but also of small arteries, as well as earlier dissection and rupture of the aorta.
Shereshevsky-Turner syndrome. Refers to chromosomal pathologies. In this syndrome, one X chromosome from a pair of XX or XY chromosomes is missing. More often, pathology occurs in the female sex. It is characterized by short stature, irregular physique, barrel deformity of the chest, amenorrhea ( lack of a menstrual cycle), underdevelopment of internal and external genital organs, infertility. About 75% of patients with Turner syndrome have pathologies of the cardiovascular system. Aortic aneurysm and aortic dissection are often diagnosed. Aortic dissection is 100 times more common in women with Turner syndrome than in other women. Usually these are people between the ages of 30 and 40.
Arterial tortuosity syndrome.A rare genetic disorder that is transmitted in an autosomal recessive manner, that is, when both parents are carriers of the defective gene. The vessels are affected - tortuosity, lengthening, narrowing appears ( stenosis), aneurysm of the arteries, in particular the aorta. The connective tissue of the skin is affected ( excessive stretching of the skin), skeleton ( deformity of the chest, pathological excessive joint mobility), facial features change ( lengthening of the face, underdevelopment of the upper jaw, narrowing of the palpebral fissure). About 40% of patients die before the age of 5.
A syndrome that combines aneurysm and osteoarthritis. An inherited disorder causing joint abnormalities, aneurysm, and aortic dissection. It accounts for 2% of all hereditary aortic diseases. The patient has osteoarthritis - damage to the cartilage tissue of the surface of the joints. And also dissecting osteochondritis or Koenig's disease - the separation of part of the cartilage from the bone and displacement into the joint cavity. Excessive tortuosity of the vessel, aneurysms and dissection of the aorta appear in all its parts.
Coarctation of the aorta. It is a congenital malformation of the aorta, which is manifested by partial or complete narrowing of its lumen. The main symptoms are shortness of breath, weakness, pain in the region of the heart, a more developed upper half of the body, cold lower limbs, and others. A complication of coarctation is an aneurysm ( bulging of walls) and bundle ( detachment of the inner membrane - intima) the aorta.

Acquired diseases of inflammatory etiology include:

Takayasu syndrome ( nonspecific aortoarteritis). This is a chronic inflammation of the walls of the aorta and its branches with their subsequent narrowing ( stenosis). This syndrome can be found under other names - Takayasu's disease, nonspecific aortoarteritis, Takayasu's arteritis, aortic arch syndrome. The nature of the disease is autoimmune ( immunity attacks the body's own cells), but recently the hypothesis of a genetic predisposition to the disease has become more relevant. In Takayasu syndrome, the aortic arch is more often affected. With inflammation, the inner surface of the vessel is damaged, and the inner and middle layers of the vessel thicken. There is a destruction of the middle membrane and its replacement by connective tissue with the appearance of granulomas ( connective tissue nodules). This leads to damage to the aortic wall in the form of stretching, protrusion, and thinning.
Kawasaki Syndrome. A rare inflammatory disease of arteries of various sizes. The disease is more common in children, between the ages of several months and five years. The disease develops when exposed to bacteria and viruses against the background of a genetic predisposition. Kawasaki syndrome is manifested by fever, swollen lymph nodes, loose stools, vomiting, pain in the heart and pain in the joints, skin rashes, inflammation of the outer lining of the eyes ( conjunctivitis), redness of the mouth and throat ( enanthem) and other symptoms. One of the complications of this disease is aortic aneurysm against the background of damage to the vessel wall by the inflammatory process.
Adamantiadis-Behcet disease. The disease belongs to the group of systemic vasculitis ( inflammatory process in the walls of blood vessels). The disease is caused by viral and bacterial infections, toxins and autoimmune reactions. Heredity plays an important role. Patients develop ulcers in the genital area, oral mucosa, inflammation of the joints ( arthritis), inflammation of the mucous membrane and choroid of the eye, nausea, diarrhea and others. Vascular lesions are manifested by stenosis ( narrowing of the lumen), thrombophlebitis ( thrombosis and vascular inflammation) and aortic aneurysm.
Specific and non-specific aortitis. Aortitis is an inflammation of a single layer or the entire thickness of the aortic wall, as a result of which the walls become thinner, stretched and perforated. This leads to a protrusion of the aortic wall - an aneurysm. Specific aortitis develops with certain diseases. These include syphilis ( venereal disease), tuberculosis ( infectious disease of the lungs, bones), rheumatoid arthritis ( inflammatory joint damage). Nonspecific aortitis appears after transferred infectious ( osteomyelitis, sepsis, bacterial endocarditis), fungal and allergic diseases.
Gsel-Erdheim syndrome ( idiopathic cystic medionecrosis of the aorta). A rare disease of unknown etiology ( reasons for the appearance), in which the elastic frame of the middle shell is affected ( tunica media) the wall of the aorta. Pathological changes occur in the middle shell, leading to tissue death - necrosis. Such a wall defect leads to aortic dissection in a limited area or throughout its entire length. Often the disease is complicated by rupture of the aorta located above the aortic valves, in the aortic arch, in the area in front of the aortic bifurcation. The disease is more common in young and middle-aged males ( 40 - 60 years old).

Acquired diseases of non-inflammatory etiology include:

Atherosclerosis. Atherosclerosis is the main cause of aortic aneurysm. It is a chronic disease, manifested by the compaction of the walls of the vessel and the narrowing of its lumen, which leads to a violation of the blood supply to the organs. Calcium, cholesterol and other fats are deposited on the inner wall of the aorta in the form of plaque and plaque. The walls lose their elasticity and become brittle and brittle. An aneurysm appears in the weakest and most stressed place of the aorta.
Arterial hypertension. Hypertension is a persistent increase in blood pressure ( above 140/90 millimeters of mercury). With an increase in blood pressure, the load on the vessel walls increases. A high risk of aortic aneurysm formation appears with prolonged arterial hypertension against the background of atherosclerosis, syphilis, Marfan syndrome and other diseases in which there are already defects in the vessel wall.
Injuries. Chest injuries are dangerous because the consequences can appear much later. A thoracic aortic aneurysm may develop within twenty years after injury. On impact in the chest area ( usually in a head-on collision in a car accident) different forces act on relatively immobile parts of the aorta. This leads to displacement, compression of the vessel, and increased blood pressure. As a result, the integrity of the aortic wall is damaged, which gradually progresses to an aneurysm.
Iatrogeny. Iatrogeny is the appearance of pathological processes in a patient, unintentionally caused by the manipulations of medical personnel. In the case of the aorta, these can be various diagnostic procedures or surgical interventions. Damage to the aortic wall during these procedures can slowly progress to form an aneurysm. The risk is especially high in people with arterial hypertension, atherosclerosis and other diseases that cause pathological changes in the aortic wall.

The group at increased risk of developing aortic aneurysm includes:

people with a hereditary predisposition;
men;
persons over 60 years old;
hypertensive patients ( patients with high blood pressure);
obese people;
patients with diabetes mellitus;
smokers;
patients with a history of chest trauma ( medical history).

Aortic aneurysm symptoms

Symptoms of an aortic aneurysm directly depend on its location, size and rate of progression. This is due to the fact that the aorta borders on various organs, which, when compressed, give a different clinical picture. The larger the aneurysm, the more severe the symptoms will be. With the rapid progression of pathology, the anatomical position and function of the organs will be sharply impaired. With the slow progression of the aneurysm, the body begins to adapt to the disease to some extent. Symptoms will appear gradually and will not bother the patient much.
In this case, the aneurysm can be diagnosed at a late stage. Often, an aortic aneurysm in the final stage breaks into the adjacent hollow organ, chest or abdominal cavity.

Depending on the localization of the aortic pathology, there are:

symptoms of aortic sinus aneurysm;
symptoms of aneurysm of the ascending aorta;
symptoms of aortic arch aneurysm;
symptoms of aneurysm of the descending aorta;
symptoms of aneurysm of the thoracoabdominal aorta.

Aortic dissecting aneurysm deserves special attention, since it can reach enormous sizes in a fairly short period of time.

Symptoms of aortic sinus aneurysm

Damage to the sinuses of the aorta leads to insufficiency of the aortic valves or narrowing of the lumen of the coronary arteries supplying the heart. These changes lead to the onset of symptoms. Insufficiency of the aortic valve is manifested by its inability to prevent the return flow of blood from the aorta to the left ventricle of the heart during diastole ( relaxation of the muscles of the ventricles of the heart). This is expressed by an accelerated heartbeat, shortness of breath, pain in the heart, dizziness, short-term loss of consciousness. Stenosis ( constriction) coronary arteries can lead to heart failure, coronary artery disease ( a decrease in blood circulation in a certain part of the organ) heart, myocardial infarction.

A small aneurysm usually does not appear. Symptoms appear only if it breaks through to neighboring organs. Often, an aneurysm bursts into the pulmonary trunk, a large blood vessel that runs from the right ventricle of the heart to the lungs. This is manifested by chest pain, rapidly increasing shortness of breath, cyanosis ( cyanosis of the skin), enlarged liver, edema, progressive left ventricular and right ventricular failure. A similar clinical picture is observed when the aortic aneurysm breaks into the right heart. Such complications lead to the rapid death of the patient.

Large aneurysms squeeze adjacent organs and vessels. With compression of the pulmonary trunk, right atrium and right ventricle, subacute right ventricular failure develops. It manifests itself by swelling of the veins of the neck, enlargement of the liver and the development of edema of the lower extremities. The rapid progression of compression of the pulmonary trunk can lead to the sudden death of the patient. In some cases, the aneurysm compresses the superior vena cava with the appearance of the so-called Stokes collar - swelling of the neck and head, edema of the upper extremities and the area of \u200b\u200bthe shoulder blades.

Ascending aortic aneurysm symptoms

Aneurysm of the ascending aorta differs in that it does not lead to compression of organs and vessels and reaches a sufficiently large size. With this type of aneurysm, the patient may complain of dull chest pain, reflex shortness of breath, and in some cases atrophy ( exhaustion, decrease) ribs and sternum with protrusion of the chest. With compression of the superior vena cava - swelling of the head and neck, hands.

When an aneurysm breaks into the superior vena cava, superior vena cava syndrome appears. The syndrome of cyanosis ( cyanosis) skin, swelling of the face and neck, expansion of superficial veins on the face, neck, upper limbs. Some patients may experience cough, swallowing disorder, chest pains, esophageal and nosebleeds. The symptoms are aggravated in the supine position, so patients assume a forced semi-sitting position.

Aortic arch aneurysm symptoms

The increasing in size aneurysm of the aortic arch compresses the trachea, bronchi and nerves, which manifests itself in a variety of symptoms.

With compression of the bronchi, trachea, lungs, shortness of breath appears ( rapid, labored breathing), which is more pronounced when inhaling. Hemoptysis may also occur, which usually precedes the breakthrough of the aneurysm. In severe cases, stridor breathing may appear - noisy wheezing. When the aneurysm is located at the end of the aortic arch, the left bronchus is compressed. The left bronchus is narrower and longer, so when it is compressed, air will not enter the lung. This can lead to a fall ( atelectasis) lung and the absence of gas exchange in it. This condition is manifested by pain in the area of \u200b\u200bthe collapsed lung, cyanosis of the skin, shortness of breath, increased heart rate and arterial hypotension ( low blood pressure).

When the left lower laryngeal nerve is compressed ( more often the right lower laryngeal nerve is affected) the timbre of the voice changes, coughing and choking appear ( more often when inhaling). When the aneurysm compresses the veins, swelling and cyanoticity appear ( cyanosis) of the face, swelling of the veins of the neck.

Aortic arch aneurysm may be complicated by a breakthrough into the esophagus or trachea. First, there is hemoptysis, scanty vomiting of blood, and then profuse bleeding.

Descending aortic aneurysm symptoms

The anatomical location of the aneurysm of the descending aorta leads to compression of the nerve roots, bodies of the thoracic vertebrae, the left lung and the esophagus.

With the pressure of the aneurysm on the nerve roots, the patient develops severe and excruciating pains in the corresponding sections that cannot be treated with painkillers. The bodies of the thoracic vertebrae can deform and collapse under constant pressure from the aortic protrusion. In severe cases, this can lead to loss of voluntary movement of the lower limbs.

Collapse of the lung, pulmonary hemorrhage, development of pneumonia ( pneumonia) - all this is the result of compression of the lung by the aortic aneurysm.

When an aneurysm breaks into the lung tissue, bronchus, pleural cavity ( the space between the lung and its shell) hemoptysis, shortness of breath, cyanotic skin, accumulation of blood in the pleural cavity appear.

Thoracoabdominal aortic aneurysm symptoms

Thoracoabdominal aneurysm is rare. With this location of the pathology, the esophagus, stomach, and large blood vessels are affected. The patient will complain of impaired swallowing, frequent belching, pain in the stomach, vomiting, and weight loss.

In case of compression of blood vessels ( celiac trunk, superior mesenteric artery) collaterals are formed - lateral bypass vessels that provide normal blood supply to the organs. Therefore, the internal organs will not suffer from a lack of oxygen and nutrients, but the patient will experience excruciating pressing pains in the abdomen ( abdominal toad). When the aneurysm is large, the renal arteries are compressed, which can lead to a persistent increase in blood pressure.

Symptoms of aortic dissecting aneurysm

Symptoms of aortic dissecting aneurysm depend on the location, extent and size of the pathology. Aortic dissecting aneurysm may manifest as an extensive hematoma ( accumulation of blood), breakthrough of the aneurysm into the lumen of the vessel or into the surrounding space. There is a rupture of the aorta without wall dissection.

A dissecting aneurysm appears suddenly and mimics the symptoms of neurological, cardiovascular, and urological diseases. There is a sharp, unbearable, increasing pain along the course of aortic dissection, which spreads to various areas ( along the spine, behind the sternum, between the shoulder blades, in the lower back and others). The patient's blood pressure first rises, and then drops sharply. The asymmetry of the pulse on the upper and lower extremities, severe weakness, cyanosis of the skin, increased sweating are noted. When the size of the dissecting aneurysm is large, the nerve roots, vessels, and neighboring organs are compressed.

This is manifested:

ischemia ( decreased blood supply) myocardium- pain, burning sensation in the region of the heart;
ischemia of the brain or spinal cord - impaired consciousness in the form of fainting or coma, loss of sensitivity or movement in the lower extremities;
compression of the mediastinal organs ( with dissecting aneurysm of the ascending aorta) - hoarseness, shortness of breath, superior vena cava syndrome and others;
ischemia and compression of the abdominal organs ( with dissecting aneurysm of the descending aorta) - acute renal failure, hypertension, ischemia of the digestive system and others.

When the aortic dissecting aneurysm ruptures, the patient's condition deteriorates sharply. There is severe weakness, loss of consciousness, pulse deficit ( difference between heart rate and pulse in peripheral vessels). As well as a significant decrease in blood pressure, severe pain in the area of \u200b\u200brupture of the aortic aneurysm, impaired breathing and heartbeat.

Complications of aortic aneurysm

The aorta is the main largest vessel in the human body that carries blood from the heart. Large arteries branch off from the aorta, supplying all organs. Therefore, the pathology of the aorta and its functional insufficiency leads to damage to other organs due to a lack of oxygen and nutrients.

Complications of the thoracic aortic aneurysm are:

heart, pulmonary, renal failure;
rupture of the aorta;
dissection of the aortic wall;
blood clots.

According to statistics, up to 38% of patients die from complications of the thoracic aortic aneurysm within 3 years after the diagnosis is made, and within 5 years - up to 58% of patients.

The main complications leading to death are:

ruptured aneurysm - 40% of deaths;
heart failure - 35% of deaths;
pulmonary insufficiency - 15 - 25% of deaths.

Diagnostics of the aortic aneurysm

Diagnosis of aortic aneurysm begins with taking an anamnesis - a history of the disease. The patient is asked in detail about the complaints, the period of symptoms and the duration of their course. Family history is also collected. The doctor asks about the diseases of the next of kin. Much attention is paid to genetic diseases - Marfan syndrome, Turner syndrome, Lois-Dietz syndrome and others. In some cases, genetic testing of patients is performed.

After the anamnesis, the doctor proceeds to examine the patient. The body type, appearance, the presence of physical defects ( characteristic of genetic diseases), skin color, breathing type ( shortness of breath). Blood pressure is measured, an electrocardiogram is performed ( ECG) hearts. Most often, there is no change on the ECG. In some cases, there may be signs of myocardial infarction, angina pectoris. In the presence of an aortic aneurysm on palpation ( probing) a pulsating formation may be felt. On auscultation ( listening) vascular murmurs are heard.

The doctor may order a number of laboratory tests - complete blood count and biochemical blood test. The main attention is paid to lipid profile ( blood lipid analysis). Lipid levels help assess the risk of developing atherosclerosis. Investigate the level of cholesterol - a fat-like structural component of cells. Low density lipids ( LDL - "bad" cholesterol) contribute to the formation of atherosclerotic plaques. High density lipids ( HDL - "good" cholesterol) prevent plaque formation. Blood sugar levels indicate the presence of diabetes.

All of the above methods for diagnosing a patient do not allow for accurate diagnosis of aortic aneurysm. To confirm or refute the diagnosis, the doctor prescribes instrumental imaging of the aorta. This helps to study in detail its structure, detect defects, determine the exact location and size of the aneurysm.

Instrumental methods of examination of the aorta

Method	How is it done?	What symptoms does it reveal?
*X-ray*	X-rays are passed through the human body in the area under study, which are projected onto special paper or film. Harder structures absorb more X-rays and appear lighter on film, while soft tissues appear darker.	Using X-ray, the contours and sizes of the ascending and descending aorta are examined. With the expansion of the shadow of the aorta, changes in the contours of the mediastinum, an aneurysm is diagnosed. Compression of the surrounding organs is also characteristic. Therefore, in addition, fluoroscopy can be prescribed ( projection of x-rays onto a screen) and X-ray of the esophagus, stomach and duodenum.
*Intravascular ultrasound* *(IVUS)*	It is invasive ( with penetration into the human body) method of ultrasound examination. A special guide is inserted into the aortic lumen, at the end of which there is an ultrasonic sensor. When ultrasonic waves pass through the walls of the aorta, they are reflected and captured by the transducer. The received data is converted into an image on the monitor screen. Image recording occurs during the entire study.	All three layers of the aortic wall reflect ultrasonic waves in different ways, due to different thicknesses and densities. This makes it possible to study the aortic wall in layers and obtain information about its thickness, shape and structure. Intravascular ultrasound can detect atherosclerotic plaques, blood clots, damage to the aortic wall in the form of rupture or dissection. This research method is often used during surgery.
*Echocardiography* *(transthoracic and transesophageal)*	It is an ultrasound method for examining the heart and thoracic aorta. For transthoracic echocardiography, the transducer is placed on the patient's chest. The sensor emits ultrasonic waves and picks up the reflected images on the screen. For transesophageal echocardiography, a transducer is inserted into the esophagus. The procedure is performed under general anesthesia.	This method allows you to study the structure of the walls of the aorta, identify their defect and establish the location and size of the aneurysm. It is safer and more minimally invasive, in contrast to intravascular ultrasound ( IVUS).
*Doppler ultrasound* *(UZDG)*	Combination of methods of ultrasound examination of blood vessels with Doppler sonography. This method is based on the reflection of sound waves from a moving object ( moving erythrocytes). The data is then processed by the computer and converted into an image on the monitor.	Doppler ultrasound allows you to determine the degree of damage to the aortic wall by sclerotic formations, the degree of narrowing ( stenosis) the lumen of the vessel, damage and thinning of the walls of the aorta. Unlike other methods, it allows you to assess the nature of blood flow in the aorta.
*CT scan* *(CT scan)*	The research method is based on the passage of X-rays through the human body at different angles and from different points. The image is projected onto a computer monitor. The doctor can study the anatomical structures in layers and at any angle.	This method allows you to study in detail the structure of the aorta, detect defects in the wall, determine the longitudinal and transverse diameter of the expansion and its exact location, identify parietal thrombi, calcification ( calcium salt deposition process).
*Aortography*	Aortography is a method of examining the aorta, based on the introduction of a contrast agent into a vessel and further visualization using an X-ray machine. Contrast substance ( cardiotrast, diodon) is introduced through the catheter ( tube) directly into the aorta or through large arteries - radial, brachial, carotid or femoral.	Aortography allows you to identify structural and functional changes in the aorta. When the aorta is filled with contrast, the lumen of the vessel will be clearly visible in the image. This will make it possible to diagnose wall protrusion, narrowing of the lumen, dissection of the aortic wall, since blood with contrast will flow between the layers of the vessel wall.
*Computed tomography angiography* *(KTA)*	This is a combination of computed tomography and angiography ( studies of a vessel using a contrast agent). Through a special catheter ( tube) inject a contrast agent ( iodine preparations). X-rays are then passed through. The contrast absorbs X-rays and allows you to more clearly distinguish the contours of the vessel against the background of the surrounding soft tissue and bones.	The method allows you to clearly visualize the aorta, detect narrowing ( stenosis) its lumen, protrusion of the wall into the lumen. It will also be possible to visualize the dissection of the aortic wall, pseudoaneurysm, since blood with a contrast agent flows between the layers of the aortic wall. The delamination boundaries will be clearly visible on the image.
*Digital subtraction angiography* *(CSA)*	A method for studying a vessel using contrast and further computer processing. This method can significantly reduce the dose of contrast agent. In the resulting image, the doctor can remove all structures that have no diagnostic value, leaving only the vascular network.	Allows to reveal structural defects of the aorta, protrusion of its wall, stenosis, developmental anomalies.
*Magnetic resonance imaging* *(MRI)*	The principle of operation is the effect of electromagnetic waves on the atoms of hydrogen nuclei. The computer registers the electromagnetic response of atomic nuclei with its transformation into an image of anatomical structures on the monitor.	It makes it possible to visualize the border between the blood flow and the vessel wall. This allows you to determine the diameter of the enlargement of the aorta, its shape and extent. Often, MRI is performed using a contrast agent, which allows you to more clearly visualize the pathology of the aorta.
*Estimation of pulse wave velocity and augmentation index*	The release of blood from the left ventricle during systole increases the pressure on the vascular wall, causing it to stretch. This pressure wave is called pulse pressure. The speed of propagation of pulse waves allows you to assess the rigidity of the vessels. The lower the speed, the higher the degree of rigidity of the vessel wall. The pulse wave velocity is determined by sensors located in the carotid and femoral arteries.	This method allows you to assess the degree of stiffness of the aortic wall. Structural changes in the aorta occur with age. As a result, its walls become fragile, which increases the risk of aneurysm, rupture of the aortic wall, pseudoaneurysm.

There are quite a few methods of instrumental examination of the aorta. Each of them has its own advantages and disadvantages, as well as contraindications. The doctor will select the necessary research methods individually for each patient. If necessary, several studies will be performed using contrast.

Aortic aneurysm treatment

Aortic aneurysm is treated by a cardiologist and vascular surgeon. After the examinations, the doctor will determine the exact location, degree, size of the aneurysm. This will affect the choice of treatment tactics and the future life prognosis for the patient. Basically, the treatment of aortic aneurysm is surgical. But surgery is a complex treatment with many risks and complications. Therefore, it is carried out only in the case of direct indications.

If there are no indications for surgical treatment, then the doctor chooses expectant tactics and supportive medication. Expectant tactics consists in constant observation of a patient with a small aortic aneurysm. Once every six months, the patient must undergo diagnostic examinations in order to monitor changes in the aorta over time.

Supportive drug treatment is aimed at eliminating the causes of the aneurysm and maintaining concomitant diseases in the compensation stage, that is, the minimum negative effect of pathology on the body. Also, drug treatment is aimed at reducing the effect of deforming force on the walls of the aorta by lowering blood pressure and contractile function of the heart.

The goals of supportive drug therapy are:

Blood pressure control. The optimal blood pressure values \u200b\u200bfor patients with concomitant diabetes mellitus and chronic kidney disease are 130/80 millimeters of mercury. For the rest, 140/90 millimeters of mercury is allowed. Α-receptor blockers are used - prazosin, urapidil, phentolamine, β-receptor blockers - bisoprolol, metoprolol, nebivolol, angiotensin-converting enzyme inhibitors ( APF) - captopril, enalapril, lisinopril.
Decreased contractility of the heart. They use drugs from the group of β-receptor blockers ( atenolol, propranolol), which reduce myocardial contractility, oxygen demand and heart rate.
Normalization of lipid levels. Dyslipidemia ( violation of lipid metabolism) leads to atherosclerosis - the deposition of cholesterol and lipoproteins ( complexes of proteins and fats) on the vessel wall. To normalize lipid levels, drugs of the statin group are used ( simvastatin, rosuvastatin, atorvastatin).

Patients with aortic aneurysm should also change their lifestyle. It is necessary to quit smoking, as it provokes an acceleration of the expansion of the aortic aneurysm. Strenuous physical activity, stress and injury should be avoided.

When is surgery for aortic aneurysm necessary?

Surgical treatment is divided into planned and emergency. Planned surgical intervention is carried out with an increase in the size of the aortic aneurysm, with impaired blood circulation, with severe symptoms. Preparing a patient for surgery can take from several days to a month. Usually, elective surgery involves patients who have been under the supervision of a doctor for a long time, have periodically undergone examinations and have taken medication.

An emergency operation is performed according to vital indications, regardless of concomitant diseases and the patient's condition. The indications are the threat of rupture or dissection of the aorta, as well as the ruptured aneurysm. Preparation for the operation is carried out as quickly as possible. This can be the necessary instrumental examinations, blood tests, blood group determination, carried out directly in the operating room.

Before the operation, the patient will undergo the necessary instrumental examinations and laboratory tests. There will be a consultation with an anesthesiologist, cardiologist, cardiac surgeon, vascular surgeon, as well as other specialists in case of concomitant diseases. The anesthesiologist will select the type of anesthesia depending on the type of surgery. After surgery, the patient will have a long recovery period and a change in lifestyle. He will be registered with a cardiologist and periodically undergo instrumental examinations.

The indications for surgical treatment of aortic aneurysm are:

expansion of the thoracic aorta more than 5 centimeters ( normally the diameter does not exceed 3 centimeters), since the risk of dissection or rupture of the aorta is significantly increased when its diameter is more than 6 centimeters for the ascending aorta and more than 7 centimeters for the descending aorta;
expansion of the thoracic aorta up to 5 centimeters in patients with Marfan syndrome ( the risk of rupture of the aorta with a diameter of up to 6 centimeters in such patients is 4 times higher) and other genetic diseases that provoke the development of aneurysm;
dissecting aortic aneurysm ( is the leading cause of death and disability in patients);
fast growth rate of aneurysm ( more than 3 millimeters per year);
patients with aortic aneurysm rupture in relatives;
pronounced symptoms of aortic aneurysm;
high risk of aneurysm rupture.

Contraindications for surgical treatment of aortic aneurysm ( the exception is life-threatening conditions) are:

myocardial infarction ( less than 3 months);
severe pulmonary insufficiency;
renal, liver failure;
malignant neoplasms of the last stage;
acute violation of cerebral circulation ( ischemic, hemorrhagic stroke);
acute infectious diseases;
chronic diseases in the acute stage;
inflammatory processes.

For surgical intervention, it is necessary to compensate for the patient's condition. Weakened immunity, organ failure, and severe comorbidities can lead to serious complications and death.

Surgical operations for aortic aneurysm are divided into:

open - prosthetics of the aorta;
endovascular ( intravascular) - installation of a stent graft ( cylindrical metal frame);
hybrid - combined operations.

Aortic replacement

Aortic replacement is a surgical procedure in which the damaged portion of the aorta is excised and replaced with a synthetic prosthesis. Refers to open transactions. To access the aorta, open the chest - thoracotomy, incision of the abdominal wall - laparotomy or a combination of thoracotomy and laparotomy.

The advantage of this method of treatment is:

good visualization and the ability to correct all disorders caused by aneurysm;
treatment of aneurysms of any shape and size;
higher reliability and long-term effect.

But the open method of operation has many disadvantages, such as:

difficult surgical access - the need to open the chest or abdominal wall;
long-term anesthesia - from 2 to 6 hours;
the need for artificial blood circulation and patient cooling;
high risk of complications during and after surgery;
the presence of a large number of contraindications;
long recovery period;
large postoperative scars.

The main techniques for aortic replacement include:

operation Bentalla-De Bono - simultaneous prosthetics of the aortic valve, aortic root and ascending aorta, which is used for pathology of the aortic valve and ascending aorta ( with Marfan syndrome);
david's operation - Prosthetics of the ascending aorta with preservation of its own aortic valve;
borst technique - simultaneous prosthetics of the ascending aorta, aortic arch and descending aorta ( "elephant's trunk").

After open surgical intervention on the aorta with a stable course, a dynamic study is performed every six months during the first year after the operation. Then the interval between examinations can be increased at the discretion of the doctor.

Endovascular ( intravascular) operations

Endovascular surgery consists in introducing a special frame - an endoprosthesis or stent-graft into the lumen of the affected aorta. It allows you to strengthen the aortic wall and make it more resistant to external factors ( high blood pressure). The aneurysm sac is retained, but surgery prevents further growth.

Endovascular surgery is minimally invasive ( minor damage to the skin). Under local anesthesia into the vessel ( usually in the femoral artery) a special catheter ( tube). Under X-ray control, a stent is delivered through this catheter to the site of the aorta with an aneurysm. The stent is a cylindrical metal frame, which is folded and opened at the site of the aneurysm. The patient is discharged the next day after surgery. This method has more advantages over aortic prosthetics.

The advantages of this operation are:

the use of local anesthesia;
low trauma of the operation;
no need for artificial blood circulation;
minimal blood loss during surgery;
the possibility of carrying out in severe concomitant diseases;
minimal risks and complications;
quick rehabilitation ( up to two weeks);
minor pain after surgery.

The disadvantages are the need for repeated surgical interventions, less visualization, limited manipulation, treatment of small aneurysms.

Hybrid operation

Hybrid surgery is a modern method of surgical treatment of aneurysms. It is used for the defeat of several vessels. Its essence lies in the simultaneous stenting of one vessel and bypassing the other.

Bypass surgery is the creation of a bypass ( artificial branch), providing blood flow bypassing the affected area of \u200b\u200bthe vessel. The advantage of this method is low trauma, the ability to avoid volumetric surgical intervention and multiple stenting.

Surgical treatment of thoracic aortic aneurysm

Aortic department	Types of surgical procedures	Features:	Complications
*Ascending aorta*	supracoronary prosthetics; reconstruction of the aorta with supracoronary prosthetics; aortic prosthetics according to the Bentall-De-Bono technique; prosthetics of the aorta about David's technique; aortic valve replacement; aneurysmorrhaphy ( longitudinal or transverse excision of the protruding areas of the aorta, followed by suturing of the wall); stenting; prosthetics according to the Borst technique.	Pathological processes can affect not only the ascending department, but also the aortic valve. This creates problems during surgery, as the surgeon must temporarily stop the heart and provide a bypass without forgetting to supply the heart.	The risk of complications depends on the duration of the operation and the duration of the aortic clamping. For example, the risk of paraplegia - paralysis of both limbs - depends on these parameters. Mortality with planned prosthetics of the ascending aorta is 1.6 - 4.8%. These indicators are influenced by age, gender, concomitant diseases.
*Aortic arch*	complete prosthetics of the aortic arch of the "end-to-end", "elephant trunk" type; prosthetics of a part of the aortic arch; reconstructive surgery on the aortic arch; prosthetics or reconstruction of the aortic arch with prosthetics of the ascending aorta.	During the operation, it is necessary to provide nutrition to the brain, since it is from the aortic arch that the arteries supplying the brain depart. More often, operations on the aortic arch are repeated after emergency interventions for dissecting aneurysm.	Mortality in operations on the ascending aorta and aortic arch is 2.4 - 3.0%. For patients under 55 years of age - 1.2%, and the risk of stroke ( acute circulatory disorders of the brain) – 0,6 – 1,2%.
*Descending aorta*	prosthetics of the descending aorta; stenting.	During the operation, various methods of bypass blood circulation, artificial circulation are used.	Surgical interventions in the thoracic aorta have common complications due to the trauma of access, the need for artificial circulation, and large blood loss. This can lead to neurological failure, ischemia of internal organs.
*Thoracoabdominal aorta*	stenting; aortic prosthetics.	The peculiarity of the operation on the thoracoabdominal aorta is access - opening the chest ( thoracotomy) and abdominal wall ( laparotomy).	Complications from the heart, lungs, kidneys, intestines. The risk of paraplegia after surgery on the thoracoabdominal aorta is 6 - 8%.

Postoperative period with aortic aneurysm

The postoperative period is a very important and crucial stage in the treatment of aortic aneurysm. And the further prognosis of the disease depends on how seriously the patient treats him.

The patient will stay in the hospital for several days. If the attending physician notes the satisfactory and stable functioning of the cardiovascular and other body systems, then the patient is discharged home.

Moderate physical activity. It is necessary to observe physical activity as much as the patient's well-being after the operation allows. You need to start with a short walk, then move on to light physical exercises that do not lead to the appearance of pain. Early physical activity prevents the formation of blood clots in the lower extremities, improves blood circulation to organs and tissues, and improves the function of the digestive system.
Diet. In the first days after the operation, the patient will be prescribed diet No. 0, which is used in the patient's rehabilitation. It includes rice broths, low-fat broths, compotes. Further, the patient must follow the diet number 10, prescribed for diseases of the cardiovascular system. It consists in limiting the intake of fluids and salt, excluding alcohol, fatty, fried foods. More fruits, vegetables, light soups, lean fish are recommended in the diet.
Work and rest mode. It is recommended to stay in bed and rest during the first few days after the operation. After being discharged from the hospital for a month or more, do not drive a vehicle, do not lift heavy objects ( more than 10 kilograms), take a shower instead of a bath, observe the daily regimen.
Medication. It is necessary to strictly adhere to the medical prescription of a doctor, aimed at maintaining a normal level of blood pressure, preventing thrombus formation, and improving blood circulation.
Healthy lifestyle. The patient should quit smoking, lose weight, eliminate alcohol, and avoid stress. Also, adhere to all the doctor's recommendations on physical activity, daily regimen, diet.

The patient should carefully monitor his health after surgery. If the temperature rises to 38 ° C, pain in the legs, back, pain in the area of \u200b\u200bthe wound with discharge ( after open surgery), you need to urgently seek medical help.

After the operation, the doctor will explain the need and frequency of consultations and diagnostic procedures. This is necessary for dynamic monitoring and exclusion of postoperative complications. The frequency will depend on the type of surgery performed and the individual characteristics of the patient.

The full recovery period lasts from several weeks to 2-3 months, depending on the type of aneurysm and the volume of the operation. A healthy lifestyle and regular exercise play an important role.

Prognosis for aortic aneurysm

The prognosis for aneurysm of the thoracic aorta is determined by its size, the rate of its progression and concomitant diseases of the cardiovascular and other systems of the body. In the absence of timely diagnosis and treatment, the prognosis of aortic aneurysm is poor. But, thanks to modern surgical treatment, it is possible to save the lives of most patients. With the planned surgical treatment of aortic aneurysm, the mortality rate is 0-5%, in the case of aneurysm rupture - up to 80% ( regardless of the urgency of the intervention). Within 5 years, the survival rate of operated patients is 80%, and non-operated - 5-10%.

The main causes of death in aortic aneurysm are:

ruptured aneurysm ( 35 - 50% of cases);
coronary heart disease ( 35-40% of cases);
strokes ( 20% of cases).

The threat of rupture of an aneurysm depends on the size of the aneurysm - an expansion of the vessel more than 5 centimeters is considered life-threatening for the patient. Mortality in this case is 50% of cases during the first year. Extremely poor prognosis in the first days with dissection of the aneurysm without surgical treatment. By the end of the second day, about 50% of patients die, by the end of the first week - 30%, and by the end of the second week, only 20% of patients survive.

What is the difference between thoracic and abdominal aortic aneurysms?

Aneurysms of the thoracic and abdominal aorta differ in symptoms, treatment, and the occurrence of complications. This is due to their anatomical location.

The main differences between the abdominal and thoracic aortic aneurysms are:

The frequency of the disease. Aneurysm of the thoracic aorta occurs in 6-10 cases per 100,000 people per year, the ratio of men to women is 2/1, 4/1. At autopsy, it occurs in 0.7% of cases. Abdominal aortic aneurysms account for 80 - 95% of all diagnosed aneurysms. About 200,000 cases are registered in the world every year. The ratio of men and women is 5/1, 10/1. An aneurysm of the abdominal aorta at autopsy occurs in 0.6 - 1.6% of people ( 5 - 6% of cases in patients over 65 years old).
Anatomical structure and location. The thoracic aorta includes the ascending part, the aortic arch and the descending part. The thoracic part of the aorta is closely adjacent to the organs - the heart, bronchi and lungs, the esophagus. This leads to the appearance of varied and rapidly manifested symptoms.
Symptoms.Due to its anatomical features, aneurysm of the thoracic aorta has a varied and pronounced symptomatology. Shortness of breath, cyanosis of the skin, impaired swallowing, pain in the heart, palpitations, swelling of the head and neck, and others appear. An aneurysm of the aorta of the abdominal region for a long time can be asymptomatic up to its rupture. The main symptoms are pain and a pulsating sensation in the abdomen, heartburn, constipation, urinary disorders, back pain, numbness of the legs, impaired movement and sensitivity in the lower extremities.
Complications. Due to its proximity to vital organs, aneurysm of the thoracic aorta can lead to serious complications from the organs with further death. In abdominal aortic aneurysm, the most formidable complication is rupture of the aorta.
Treatment. Aneurysms of the aorta of the thoracic and abdominal regions with small sizes are treated with medication. Surgical treatment has a number of features. Surgical treatment of a thoracic aortic aneurysm is much more difficult. This is due to access to the aorta - thoracotomy, that is, opening the chest wall, accompanied by a violation of the integrity of the ribs. In operations on the thoracic aorta, the surgeon is significantly limited in time, since the blood supply to vital organs suffers. Access to the abdominal aorta is obtained by incision of the abdominal wall - laparotomy.

How common is thoracic aortic rupture?

On average, the aortic aneurysm expands to 2.5 millimeters per year. Descending aortic aneurysms grow faster ( up to 3 millimeters per year) compared with aneurysms of the ascending aorta ( 1 millimeter per year). There is a pattern - the larger the aneurysm, the faster it grows. So with an aneurysm size of 4 centimeters - an increase of 1 - 4 millimeters per year, with a size of 4 - 6 centimeters - an increase of 4 - 5 millimeters per year, with large sizes - up to 8 millimeters per year. The faster the aneurysm grows, the higher the risk of fatal aortic dissection and rupture. In most cases, a ruptured fusiform aneurysm is more common than a saccular aneurysm. This is due to the accumulation of thrombotic formations in the saccular enlargement, which strengthen the aortic wall.

The probability of rupture of an aneurysm with its diameter:

less than 5 cm - the risk is less than 1%;
more than 5 cm - the risk is more than 10%;
more than 7 cm - the risk is more than 30%.

More often, an aortic aneurysm is asymptomatic and is accidentally detected during preventive diagnosis or for another disease. In this case, the patient will undergo a planned operation. But if the patient is unaware of his pathology, then the rupture of the aneurysm can become a life-threatening complication with a fatal outcome. This condition requires urgent surgery. Every minute counts, since the aorta is the largest vessel in the human body and its rupture leads to rapid and voluminous blood loss.

The main signs of aortic rupture are:

sudden intense pain in the chest or abdomen ( can spread to the area between the shoulder blades, jaw, neck, perineum, legs);
headache - sharp, throbbing in the back of the head;
severe weakness;
nausea and repeated vomiting;
violation of consciousness ( short-term or long-term, mild or comatose);
threadlike pulse;
low blood pressure;
the presence of a rapidly growing hematoma ( accumulations of blood);
hyperthermia ( increased body temperature).

Aortic replacement is the main treatment for rupture. During the operation, the integrity of the vessel and blood flow are restored, as well as the volume of blood loss by blood transfusion ( human blood transfusion). After such an operation, there is a high risk of developing serious complications, since the internal organs and tissues suffer from a lack of blood circulation. This can lead to renal, heart, pulmonary failure, neurological complications, tissue death. Despite the successful operation, complications can lead to the death of the patient some time after the intervention. Therefore, the lethal outcome after aortic rupture is quite high - only 10% of the operated patients survive.

What to do to prevent aortic rupture?

The disease is easier to prevent than to cure. Aortic aneurysm is often asymptomatic and is detected by chance during physical examinations or when complications develop. The risk of aortic rupture varies from case to case.

Among the causes of aortic rupture are:

significant increase in blood pressure;
pregnancy and childbirth;
psycho-emotional overexcitation;
heavy physical activity.

Every year, you should undergo preventive medical examinations, regardless of health status. Consultation with a cardiologist and instrumental examinations for patients at risk are especially important ( with arterial hypertension, atherosclerosis, burdened by heredity).

Patients diagnosed with aortic aneurysm should undergo a thorough evaluation. The doctor must accurately determine the type of aneurysm, its location and size, and then choose a treatment. The risk of aortic rupture depends not only on the size of the aneurysm, but also on the underlying medical conditions and the patient's lifestyle. In the presence of an aneurysm, the best prevention of aortic rupture is surgery. The doctor may suggest more gentle surgeries such as aortic stenting and hybrid surgeries.

To prevent aortic rupture, you should:

observed by a cardiologist;
periodically undergo instrumental examinations ( EchoCG, MRI, ultrasound);
maintain a healthy weight;
maintain blood pressure within normal limits;
eliminate the factors of atherosclerosis ( high cholesterol levels, smoking, sedentary lifestyle);
surgery ( especially patients with genetic diseases of the aorta);
avoid heavy physical exertion ( weight lifting, air travel, baths, sports).

How to register a disability group for aortic aneurysm?

Disability is determined by a medical commission for labor expertise, consisting of doctors of various specialties, including a cardiologist. The family doctor deals with paperwork and referral to the commission. The examination assesses the patient's ability to self-care and perform physical activity without harm to health.

During the examination, medical and even surgical treatment, there is no question of determining the disability group. After the diagnosis of the aneurysm for several months, the patient undergoes a full course of drug therapy, if necessary, surgical removal of the aneurysm is performed with a long course of rehabilitation measures. And only after that, if the patient has persistent disorders of the body's functioning, it makes sense to send the patient to a medical and social examination to determine the disability group.

When determining disability, the following are taken into account:

the patient has heart failure due to impaired blood flow, with aneurysm;
the presence of concomitant diseases that interfere with surgical treatment and aggravate the patient's condition ( diabetes mellitus, renal and hepatic pathology);
the patient's age, profession and working conditions.

Heart failure is manifested by peripheral edema, shortness of breath on exertion, a feeling of increased heartbeat and interruptions in the work of the heart. The degree of heart failure is determined on the basis of patients' complaints, as well as with the help of additional instrumental examinations - electrocardiography, echocardiography and others.

What are the features of the thoracic aortic aneurysm during pregnancy?

Pregnancy is a serious test for a woman's body. At this time, chronic diseases can manifest or worsen, as well as new pathological conditions, in particular, aortic aneurysm, can arise. This is due to hormonal changes in the whole body - an increased level of estrogen and progesterone plays an important pathological role in the disruption of the structure and loss of elasticity of the aorta.

During pregnancy, the load on the initial sections of the aorta also increases, cardiac output of blood increases, followed by an increase in heart rate and volume of circulating blood, especially in the last trimester of pregnancy.
All this, ultimately, can lead to the formation of an aortic aneurysm or expansion with dissection of an existing aneurysm.

The causes of aortic aneurysm during pregnancy do not differ from the main causes. It can also be congenital and acquired diseases. Of the congenital pathologies accompanied by the formation and dissection of the aorta, the most studied is Marfan syndrome ( congenital connective tissue pathology), occurring at a frequency of 1/3000 - 1/5000.

The causes of acquired aortic aneurysm are:

hereditary predisposition;
injuries, road accidents;
arterial hypertension;
vascular atherosclerosis;
syphilis in an advanced stage with a violation of the architectonics of the vascular wall;
wrong lifestyle of a woman, obesity, smoking.

Symptoms of aneurysm in pregnant women often appear rather quickly and depend on the location and size of the aneurysm.

With an aneurysm of the thoracic aorta, a pregnant woman may complain of:

back pain, aggravated by inhalation;
labored breathing;
feeling of a lump in the throat with difficulty swallowing;
snoring during sleep.

An aneurysm of the abdominal aorta is characterized by:

feeling of numbness in the fingers and feet with chilliness due to circulatory disorders;
pain in the abdomen and lower back;
a throbbing sensation in the abdomen;
fainting;
jumps in blood pressure.

For a pregnant woman with an aortic aneurysm, dangerous complications are:

Aortic aneurysm rupture. This is an extremely dangerous condition for a woman's life. If the aneurysm is small, then a pregnant woman must follow a certain mode of work and rest, a diet.
High risk of thrombosis. This is due to a violation of normal blood circulation in the aneurysm cavity. Blood clots can clog arteries and veins, and in some cases wander through the circulatory system and enter the heart valves, followed by cardiac arrest.
Spontaneous abortion. Termination of pregnancy can be caused by insufficient blood circulation of the fetus due to compression of the vascular aneurysm.
Detachment of the placenta followed by severe uterine bleeding. This complication often leads to the death of the fetus and the mother.

There are no specific methods for examining the aortic aneurysm during pregnancy.

According to health indications, they carry out:

chest x-ray;
contrast-enhanced computed tomography ( intravenous administration of contrast agent), which allows tracing the accumulation of contrast in the aneurysm;
contrast-enhanced aortography;
Ultrasound of the abdominal and chest cavity.

Depending on the size and location of the aneurysm, they resort to different methods of treatment. If a large aneurysm is found with a risk of rupture, then doctors resort to urgent surgical intervention. A woman is caused premature birth or a cesarean section is performed, so it is very dangerous to remove an aneurysm while the fetus is in the womb. If the aneurysm is small and there is no threat of rupture, then its removal is postponed until the moment of delivery. After the birth of a child, a woman must be operated on to avoid the growth and rupture of the aneurysm.

The basis for the prevention of aneurysm formation is timely medical control of blood pressure, coagulation and anticoagulant systems of the body, as well as adherence to a healthy lifestyle with proper nutrition and moderate physical activity.

In medical practice, there are rarely cases of aortic aneurysm during pregnancy with the ensuing formidable complications.

Does aortic aneurysm occur in children?

Aortic aneurysm is extremely rare in children. It can develop in the womb or appear after birth. For children, the location of the aneurysm at the bend of the aorta is characteristic. The main causes of aortic wall protrusion are genetic diseases and congenital aortic defects.

Aortic aneurysm in children is caused by:

marfan syndrome;
ehlers-Danlos syndrome;
turner syndrome;
lois-Dietz syndrome;
congenital malformation of connective tissue ( gene defect, deficiency of magnesium, collagen);
coarctation of the aorta;
arterial tortuosity syndrome;
kawasaki syndrome.

Such diseases as syphilis, arterial hypertension, atherosclerosis are very rare in children. Therefore, these pathologies are rarely the cause of aortic aneurysm. Also, sports injuries, injuries after an accident can lead to damage to the wall of the aorta and its aneurysm.

Symptoms of an aortic aneurysm in children do not differ from those in adults. This is a cough, hoarseness, difficulty breathing, chest pain with irradiation ( recoil) in the back. The difficulty of diagnosing aneurysm in children is that the child cannot always explain what worries him. This is especially true for newborns.
Diagnosis of aortic aneurysm in children consists in genetic and instrumental examination ( x-ray, MRI, CT, ultrasound, EchoCG).

Treatment of aortic aneurysm in children is usually surgical. The enlarged section of the aorta is excised and replaced with a prosthesis. The operation is followed by a long rehabilitation period and regular preventive examination by a doctor. Life prognosis for aortic aneurysm ( even after her surgical treatment) is often unfavorable. This is due to severe concomitant pathologies ( insufficiency of heart valves, heart and aortic defects, collagen deficiency) and complications ( ruptured aorta).

Can aortic aneurysm be treated with folk methods?

Aortic aneurysm cannot be treated with alternative methods. This is a very serious and dangerous disease. In advanced cases, the aneurysm ruptures with heavy bleeding, leading to death in 90%. The disease is asymptomatic for a long time and is often an accidental finding on ultrasound and MRI examination of the abdominal and chest cavity.

The treatment tactics are selected by the doctor individually for each patient. Treatment can be surgical or only medication, depending on the size and location of the aneurysm, as well as the risk of complications. In any case, supportive drug therapy is prescribed, which can be combined with traditional medicine. But you should not self-medicate, and before treatment with folk remedies, you must definitely consult with your doctor.

Medicinal herbs are used to strengthen the vascular wall, regulate blood pressure, and lower cholesterol levels.

These include:

infusion of jaundice levkoin - Pour 2 tablespoons of dry herbs with a glass of boiling water, leave for 30 minutes and strain, take 4 - 5 times a day, 1 tablespoon;
hawthorn infusion - 4 tablespoons of dried and chopped fruits, pour 3 cups of boiling water, leave for 30 minutes, strain and drink 200 milliliters three times a day before meals;
dill infusion - Pour 1 tablespoon of dry herbs with 1 cup of boiling water, leave for 15 - 20 minutes, strain and take 1/3 cup 3 times a day before meals;
infusion of Siberian elderberry - Pour 1 tablespoon with 200 milliliters of boiling water, leave for 30 minutes, strain and take 1 tablespoon once a day;
decoction of yarrow, St. John's wort and arnica mountain - Leaves of yarrow, St. John's wort and arnica in a ratio of 4/3/1 dry, grind and pour 200 milliliters of cold water for 4 hours, then boil for 5 minutes, cool, strain and take 3 times a day in equal portions.

During treatment with folk remedies, it is important to monitor the general condition, monitor blood pressure and blood sugar levels. Make no mistake that medicinal herbs can replace pills.

Can I fly on an airplane with aortic aneurysm?

In case of aneurysm of the thoracic aorta, air travel is contraindicated. During flights, the body experiences increased stress. So during takeoff and landing, significant pressure drops occur, which negatively affect the functioning of blood vessels and the heart. In addition to physiological blood pressure, other forces act on the vessels. Healthy vessels are able to withstand this pressure, since the anatomical structure allows them to stretch under the influence of external forces and then return to their normal state. In case of thinning of the vessel wall, atherosclerosis, loss of elasticity, existing aneurysm, arterial hypertension, a rupture may occur in this area. Therefore, it is extremely dangerous for patients with aortic aneurysm to fly on airplanes. This does not depend on the size and type of aneurysm, since aneurysm rupture can occur even with its small size.

Blood clots can form with an aortic aneurysm. They can be attached to the vessel wall and not disturb the patient. But during a flight under pressure, a blood clot can break off and be carried with the blood flow through the human body. This is extremely dangerous, as it can lead to pulmonary embolism ( blockage of a vessel with a thrombus), ischemic stroke ( acute circulatory disorders of the brain due to blockage of the vessel by a thrombus) and death. Long flight, immobility, sitting position, pressure drops lead to vasoconstriction in the lower extremities, slowing blood flow and increasing blood viscosity. All this significantly increases the risk of thrombosis.

Also, when climbing to altitude, atmospheric pressure drops, which leads to a decrease in the oxygen concentration in the aircraft. It is extremely dangerous for people with a sick heart and blood vessels, as it can lead to a heart attack. These patients require an additional source of oxygen. But due to the explosive nature of oxygen, not all aircraft are allowed to take oxygen on board.

During the flight, the patient cannot be provided with the necessary medical care. Especially in critical conditions requiring immediate surgical intervention ( ruptured aortic aneurysm). This can lead to the death of the patient.

Before flying, a patient with aortic aneurysm or cardiovascular disease should:

get advice from a cardiologist;
undergo instrumental examinations;
carry out the necessary medication;
familiarize yourself with the airline's rules ( clarify what medicines you can take with you, is it allowed to take oxygen on board).

Air travel can be hazardous to patients:

recently had a stroke or myocardial infarction ( less than half a year);
with an aortic aneurysm of medium and large size;
with dissecting aneurysm ( increased pressure contributes to further stratification of the vessel wall);
with an increased risk of aneurysm, blood clots;
with the risk of rupture of the aneurysm;
with arterial hypertension;
with heart disease;
after aortic or heart surgery ( period after surgery less than a month or half a year, depending on the operation).

To minimize the negative impact of air travel, you should:

try to move more ( get up every 30 minutes, do leg exercises);
provide additional inhalation of oxygen;
take medicines to reduce anxiety, blood pressure, to prevent blood clots, and others.

How long do people live with an aortic aneurysm?

It is impossible to unequivocally answer the question of life expectancy in aortic aneurysm. Aortic aneurysm is called a "time bomb". In any case, without appropriate monitoring and treatment, the prognosis is poor.

Not all patients are diagnosed on time with aortic aneurysm. In this case, the aneurysm can develop asymptomatically for a long time. The patient, unaware of his illness, continues to smoke, physically work hard, and does not monitor blood pressure. This leads to an increase in the bulging of the aortic wall in size and an increased risk of rupture and death of the patient. Also, not all patients can undergo surgical treatment.
This is due to the general condition and severe concomitant diseases, in which the patient may not survive anesthesia and surgery.

Aortic rupture and dissection can occur at any time, regardless of the size and location of the aneurysm. The survival rate in such cases is low - from 20% to 50% of patients.

After the diagnosis of aortic aneurysm is established, patients' life expectancy depends on:

The age of the patient. Patients under the age of 50 have fewer comorbidities, but at the same time, they are more prone to stress, heavy physical exertion.
Causes of the aortic aneurysm. In genetic diseases of the aorta, life expectancy is short, since often genetic diseases are accompanied by complications incompatible with life and lack of treatment. After a chest injury, a thoracic aortic aneurysm may develop for decades. In hypertensive disease, atherosclerosis, the aneurysm progresses in proportion to the progression of these diseases. Life expectancy in these cases depends on compensation for diseases.
The size of the aneurysm and the rate at which it increases.If the aneurysm is large, the risk of rupture increases. Also, the rapid progression of an aneurysm can lead to complications incompatible with life.
Lifestyle and bad habits.Overweight, heavy physical activity ( some sports, weight lifting), smoking leads to accelerated development of aortic aneurysm. For example, smoking can increase the growth rate of an aortic aneurysm by up to 35 millimeters per year.
Concomitant diseases.Diabetes mellitus, arterial hypertension, atherosclerosis and other diseases that cause pathological changes in the vessel wall, significantly accelerate the development of aortic aneurysm.
Supportive care and regular check-ups.The patient's life expectancy significantly depends on treatment and monitoring. Thus, the doctor can detect an aortic aneurysm at the earliest stage of its development and delay the time of surgical treatment for many years thanks to supportive medication and adjustments to the patient's lifestyle. Also, regular check-ups can help prevent dangerous complications such as aortic rupture and aortic dissection.

Under certain conditions, an aortic aneurysm can be lived for years. But the percentage of such people is very small. In 7% of deceased patients, aortic aneurysm is found that is not the cause of death. At any time ( in case of impact, car accident, physical stress) aortic rupture with subsequent death may occur. To increase life expectancy, it is necessary to undergo regular examinations, observe a correct lifestyle and carry out surgical treatment on time ( also for preventive purposes).

Aorta I Aorta (Greek aorte)

The aorta belongs to the vessels of the elastic type. Its wall consists of three shells ( fig. 3 ) - internal (intima), middle (media) and external (adventitia). A. is lined with endothelium, the middle is represented by elastic membranes containing smooth muscle cells, fibroblasts, and elastic fibers. The outer shell is formed by loose connective tissue. different layers of A. wall is carried out by branches of nearby arteries. In the wall A. there are several receptor zones, which, in particular, respond to changes in blood pressure.

Research methods... In the diagnosis of diseases A. of great importance are carefully collected and examination of the patient. Finding out the patient's complaints, pay special attention to those that may be due to ischemia of various organs associated with diseases of the aorta. Such complaints include headaches, visual impairments, memory loss, pain in the heart and behind the breastbone, abdominal pain, coldness of the lower extremities, etc. Of the transferred and concomitant diseases, diffuse connective tissue diseases, trauma, especially chest cells.

When examining a patient, it is necessary to compare the characteristics of the pulse on both the right and left arms, as well as on the legs. Revealing a significant difference between blood pressure in the arms and legs allows us to suspect the presence of narrowing in the thoracic and abdominal parts of A. In cases of aortic aneurysm (aortic aneurysm), palpation of the abdomen can detect a pulsating tumor-like formation. During clinical examination of all patients, and especially those over 40 years old, the carotid arteries and the abdominal part A are required; detection of pathological murmurs can be a sign of A. stenosis of various etiology or aortic aneurysm.

X-ray examination of A. includes fluoroscopy and radiography in various projections, roentgenokymography and tomography. When evaluating the data of an x-ray examination, attention is paid to the change in the diameter of A., in particular, to its diffuse and limited expansion and contraction, and the changes in the pulsation of the walls are assessed. In outpatient settings, it is possible to accurately determine the presence of A.'s aneurysm and assess changes in its size in dynamics using ultrasound diagnostic equipment.

Pathology. Developmental defects... The most common malformations of A. include an open arterial duct and coarctation of the aorta (Coarctation of the aorta) . Other aortas are much less common. These include, in particular, complete transposition of the aorta and pulmonary trunk, when A. departs from the right ventricle of the heart, and the pulmonary trunk - from the left. This disease is characterized by shortness of breath, lag in physical development. Signs of hypertrophy of the right heart are recorded on the PCG - an emphasis of the II tone on the pulmonary artery. Radiographically marked expansion of the vascular bundle, "retraction" of the middle segment of the heart, an increase in the diameter of the pulmonary trunk. surgical. Without surgery, the patient's life expectancy usually does not exceed 2 years.

Damage to the aorta can be open and closed. A. most often observed in car accidents and falls from a height. all layers of the wall A. leads to the death of the victim at the scene. The rupture of the inner and middle membranes of A. with intact adventitia is accompanied by the formation of a traumatic aortic aneurysm. Damage A. usually combined with fractures of the ribs and sternum, ruptures of the liver and spleen. In most cases of aortic injury, the victim is in shock. When examining the victim, attention is paid to the difference in the pulse on the right and left arms, as well as on the legs, which may be due to the compression of blood vessels by a hematoma located at the site of rupture A. When auscultation of the supraclavicular region, systolic murmur may be heard. and tachycardia can be caused by the accumulation of blood in the mediastinal cavity with compression of large vessels and lungs. X-ray examination reveals an expansion of the shadow of the mediastinum, an increase in A.'s size in the antero-oblique projection. If you suspect aorta, the victim must be urgently taken to the surgical department.

Operations on A. are performed in specialized departments of vascular surgery and cardiac surgery. The most common types of surgery are patent ductus arteriosus and coarctation of the aorta. Interventions for aneurysms A are among the most complex operations. They consist in replacing the aneurysmal area with a prosthesis, which can (if necessary) contain an aortic valve. Similar operations are performed with temporary clamping of the distal and proximal parts of A., which is accompanied by ischemia of the corresponding organs. Therefore, a number of surgical interventions on A. are carried out in conditions of artificial blood circulation (artificial blood circulation) or artificial hypothermia (artificial hypothermia) .

Bibliography: Pokrovsky A.V. Diseases of the aorta and its branches, M., 1979.

front view): 1 - left common carotid artery; 2 - left subclavian artery; 3 -; 4 - the thoracic part of the aorta; 5 - posterior left intercostal arteries; 6 -; 7 - (partially removed); 8 - celiac trunk; 9 - spleen; 10 - superior mesenteric artery; 11 - left; 12 - left renal artery; 13 - the abdominal part of the aorta; 14 - left testicular (ovarian) artery; 15 - inferior mesenteric artery; 16 - bifurcation of the aorta; 17 - left common iliac artery; 18 - sigmoid colonic; 19 - the median sacral artery; 20 - the right common iliac artery; 21 - right lumbar artery; 22 - right testicular (ovarian) artery; 23 - ascending colon; 24 - right kidney; 25 -; 26 - the ascending part of the aorta; 27 -; 28 - right subclavian artery; 29 - right common carotid artery "\u003e

Figure: 1. Diagram of the aorta, its parts and branches (front view): 1 - left common carotid artery; 2 - left subclavian artery; 3 - aortic arch; 4 - the thoracic part of the aorta; 5 - posterior left intercostal arteries; 6 - diaphragm; 7 - stomach (partially removed); 8 - celiac trunk; 9 - spleen; 10 - superior mesenteric artery; 11 - left kidney; 12 - left renal artery; 13 - the abdominal part of the aorta; 14 - left testicular (ovarian) artery; 15 - inferior mesenteric artery; 16 - bifurcation of the aorta; 17 - left common iliac artery; 18 - sigmoid colon; 19 - the median sacral artery; 20 - the right common iliac artery; 21 - right lumbar artery; 22 - right testicular (ovarian) artery; 23 - ascending colon; 24 - right kidney; 25 - liver; 26 - the ascending part of the aorta; 27 - brachiocephalic trunk; 28 - right subclavian artery; 29 - right common carotid artery.

Figure: 2. Macrodrug of a part of the opened left ventricle of the heart and the ascending aorta: 1 - the mouth of the left coronary artery; 2 - a knot of the rear semilunar flap; 3 - the mouth of the right coronary artery; 4 - hole of the front semilunar damper; 5 - left ventricular myocardium; 6 - tendon chords; 7 - the anterior cusp of the mitral valve; 8 - the wall of the outgoing part of the aorta.

Figure: 3. Schematic representation of the microscopic structure of the aortic wall: 1 - inner membrane (intima); 2 - middle shell (media); 3 - outer shell (adventitia).

II Aorta (aorta, BNA, JNA; Greek aortē from aeirō to raise)

1. Small Medical Encyclopedia. - M .: Medical encyclopedia. 1991-96 2. First aid. - M .: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M .: Soviet encyclopedia. - 1982-1984.

Synonyms:

See what "Aorta" is in other dictionaries:

Aorta - (aorta) (Fig. 201, 213, 215, 223) the largest arterial vessel in the human body, from which all the arteries that form the systemic circulation depart. The ascending part (pars ascendens aortae), the arch of the aorta (arcus aortae) are distinguished in it ... ... Human Anatomy Atlas

On the diagram, the Aorta (lat..arteria ortha, a.ortha is a straight artery [source not specified 356 days]) is the largest unpaired arterial vessel of the great circle ... Wikipedia

- (Latin aorta, from the Greek aorte). The main large artery that emerges from the top of the left ventricle of the heart. Dictionary of foreign words included in the Russian language. Chudinov AN, 1910. AORTA is the main arterial trunk, coming out of the left ... ... Dictionary of foreign words of the Russian language

- (Greek aorte) the main artery of the circulatory system, leaving the left ventricle of the heart; supplies arterial blood to all tissues and organs of the body. In humans, mammals and birds, the aorta is the main vessel of the systemic circulation ... Big Encyclopedic Dictionary

The initial section of the aorta - the ascending aorta - with a length of 5-6 cm is almost entirely located inside the pericardium (it is sometimes called the cardiac aorta). Ascending upward, the aorta behind the sternum handle makes a left turn in the form of an arc. On the border of the ascending aorta and the arch with an oval expansion is formed, which is due to the pressure of blood ejected from the heart at the time of contraction of the left ventricle. This place can be the starting point for the formation of the true. The brachiocephalic trunk, the left common carotid and the left subclavian arteries depart from the aortic arch. Throwing over the left, the aortic arch at the level of the IV thoracic vertebra (aortic isthmus) passes into the descending aorta. The descending aorta lies in the posterior to the left of, then deviates to the right and passes through the aortic opening of the diaphragm into the abdominal cavity, located in front of the spine and to the left of the inferior cavity. At level IV of the lumbar vertebra, the aorta gives off the right and left common iliac arteries.

Figure: 1. Topography of the aorta: 1 - aortic arch; 2 - thoracic aorta; 3 - abdominal aorta; 4 - bifurcation of the aorta; 5 - right bronchus; 6 - aortic bulb; 7 - ascending aorta.

Figure: 2. Aortic valve.

The length of the descending aorta is about 30 cm, the average diameter is 2.5 cm. The segment of the descending aorta, which lies in the chest cavity, is called the thoracic aorta, in - the abdominal aorta. The bronchial, esophageal, pericardial and mediastinal branches, upper diaphragmatic, posterior intercostal, lying in the intercostal spaces (from III to XI inclusive), and subcostal arteries (under the twelfth ribs) depart from the thoracic aorta.

Internal and parietal branches extend from the abdominal aorta. The unpaired internal branches include the celiac trunk, superior and inferior mesenteric arteries; to the paired internal branches belong the middle adrenal, renal, testicular (ovarian) arteries; parietal branches - lower phrenic and lumbar arteries; terminal branches - common iliac arteries and median sacral, descending into.

The most common developmental anomalies of the aorta are: congenital narrowness of the aorta, double aortic arch, right-sided aorta, non-closure of the arterial (botall's) duct, and isthmus (coarctation of the aorta). In the latter case, between the proximal and distal segments of the aorta, blood circulation is maintained by dilated collaterals. At the same time, there is an increase in pressure in the vessels of the upper half of the body and a decrease in the vessels of the lower half.

Aorta (Greek aorte) is the main artery and the largest vessel in the human body (Fig. 1); leaves the left ventricle of the heart.

Figure: 1. Aorta (front view): a - Valsalva sinuses.
Figure: 2. Abnormal discharge of the right subclavian artery from the aortic arch. Compression of the esophagus and trachea.
Figure: 3-5. Coarctation of the aorta and its surgical treatment.
Figure: 6 and 7. Occlusion of truncus brachiocephalicus and a. carotis communis and its surgical treatment.

The aorta is formed from paired embryonic vessels. The initial section of the ascending aorta is formed from the primary bulbus of the heart, the ascending aorta from the primary truncus arteriosus, the arch from the primary IV left branchial artery, and the descending aorta from the left primary dorsal aorta. The unnamed artery forms from the right primary ventral aorta.

There are the following sections of the aorta: ascending, arch, descending, abdominal.

The wall of the aorta consists of three sheaths - inner, middle and outer. The inner lining of the aorta (tunica intima) consists of a layer of endothelial cells facing the lumen of the aorta, a subendothelial layer containing Langhans germ cells, and an inner elastic membrane (membrana elastica interna). The latter, in turn, consists of two sheets of elastic and collagen fibers with different direction of the bundles. The middle shell (tunica media) - a strong elastic frame of the aorta - consists of several tens of rows of elastic fibers, intertwined in different directions, and bundles of smooth muscle fibers. The outer shell (tunica adventitia) is formed by bundles of connective tissue fibers.

The blood supply to the aortic wall is carried out through the vasa vasorum from the bronchial, intercostal arteries, as well as the vessels of the mediastinal tissue. Venous outflow goes into the azygos and semi-unpaired veins. The aorta is innervated from the vagus nerve system (aortic arch), the sympathetic plexus (cervical spine) and branches of the spinal nerves. The plexus located in the aortic arch plays an important role in the regulation of blood pressure.

The ascending aorta - the section from the exit from the ventricle to the outlet of the anonymous artery - goes behind the sternum, from the upper edge of the third left costal cartilage to its right edge. The pulmonary artery is adjacent to the front and to the left, the auricle of the right atrium is in front and to the right; on the right - the superior vena cava; behind - the left atrium. The caliber of the ascending aorta is up to 30 mm. In its initial section, there are three protuberances corresponding to the semilunar valves - the Valsalva sinuses (sinus Valsalvae). Coronary arteries originate from the right and left sinuses (Fig. 1, a). Above there is an enlargement of the aorta (bulbus aortae).

The aortic arch is a segment between the origin of the anonymous and left subclavian arteries. It goes transversely from the lower edge of the first costal cartilage to the right, from front to back and to the left, passing from the anterior to the posterior mediastinum. Arc caliber - 21-22 mm. At the place of transition to the descending aorta, the arch has a narrowing - the isthmus (isthmus aortae). Above the arch, closer to the front, lies the left unnamed vein (v. Anonyma sin.). The left vagus and phrenic nerves pass along the anterior-left wall of the aortic arch. The return branch of the vagus nerve covers the aortic arch, passing from the front to the bottom to the back. The arch is bent over the division of the pulmonary artery and the left main bronchus; from its lower surface a ligament (lig.arteriosum) departs to the artery, which in the embryo functions as a ductus arteriosus (ductus arteriosus). The nameless, left common carotid and left subclavian arteries sequentially depart from the arch. The nature of their discharge (loose or main) is quite variable. The height of the arc is also different depending on the physique: in persons with a short and wide chest, it is higher, in asthenics, on the contrary, it is lower. Abnormalities in the discharge of the main branches of the aortic arch can cause compression of the trachea or esophagus.

The descending aorta starts from the Th IV level, goes vertically down the left side of the spine, at the diaphragm it moves somewhat anteriorly. The root of the left lung, the pericardium, are adjacent to it in front; the esophagus goes to the right, and at the level of Th VIII-IX (near the aortic opening of the diaphragm) - in front of the descending aorta. On the left, the descending aorta is covered with mediastinal pleura; 10 pairs of intercostal arteries, bronchial vessels, branches to the tissue of the mediastinum and to the esophagus depart from it. The number of these vessels is not constant.

The abdominal aorta begins after exiting the aortic opening of the diaphragm (Th XII) and ends at level L IV with a bifurcation - a branching into two common iliac arteries, between which the middle sacral artery departs. With age, the bifurcation descends by one or two vertebrae. To the right of the abdominal aorta lies the inferior vena cava, in front - the pancreas and the mesentery root. The parietal branches of the abdominal aorta are the lower phrenic arteries and lumbar branches (4 pairs), the visceral ones are the celiac, superior mesenteric, renal (two), lower mesenteric, adrenal arteries and internal seminal arteries. With a loose type of bifurcation, the external and internal iliac arteries can branch off separately.

Functions of the human aorta. Aorta: why is it needed and where is it located? What is aortic aneurysm

General information

Causes

Pathogenesis

Classification

Aortic aneurysm symptoms

Abdominal aortic aneurysm

Thoracic aortic aneurysm

Complications

Diagnostics

Aortic aneurysm treatment

Forecast and prevention

What is a vascular aneurysm?

Causes of aortic aneurysm

Aortic aneurysm symptoms

Symptoms of aortic sinus aneurysm

Ascending aortic aneurysm symptoms

Aortic arch aneurysm symptoms

Descending aortic aneurysm symptoms

Thoracoabdominal aortic aneurysm symptoms

Symptoms of aortic dissecting aneurysm

Complications of aortic aneurysm

Diagnostics of the aortic aneurysm

Aortic aneurysm treatment

When is surgery for aortic aneurysm necessary?

Aortic replacement

Endovascular ( intravascular) operations

Hybrid operation

Postoperative period with aortic aneurysm

Prognosis for aortic aneurysm

What is the difference between thoracic and abdominal aortic aneurysms?

How common is thoracic aortic rupture?

What to do to prevent aortic rupture?

How to register a disability group for aortic aneurysm?

What are the features of the thoracic aortic aneurysm during pregnancy?

Does aortic aneurysm occur in children?

Can aortic aneurysm be treated with folk methods?

Can I fly on an airplane with aortic aneurysm?

How long do people live with an aortic aneurysm?

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