What Are Common Abdominal Aneurysm Symptoms?

Abdominal aortic aneurysm refers to an aortic aneurysm of the abdominal aorta, which is usually defined as an aneurysm when the diameter increases by more than 50%. Abdominal aortic aneurysms are more common in older men, with a male to female ratio of 10: 3. Especially for smokers, smoking also significantly increases the risk of aneurysm rupture. Most abdominal aortic aneurysms are lesions below the level of the renal artery.

Basic Information

English name: abdominal aortic aneurysm
Visiting department: Vascular surgery
Multiple groups: Older men

Common locations: abdomen
Common causes: Atherosclerosis is a common cause of this disease
Common symptoms: Most are asymptomatic, a few have compression symptoms, and abdominal discomfort is common

Causes of abdominal aortic aneurysms

A common cause is atherosclerosis. Other rare causes include arterial middle cystic degeneration, syphilis, congenital dysplasia, trauma, infection, and connective tissue disease. Common risk factors for abdominal aortic aneurysms include smoking, hypertension, advanced age, and men.

Clinical manifestations of abdominal aortic aneurysms

Most patients are asymptomatic, often found by accident for physical examination for other reasons. A typical abdominal aortic aneurysm is a swelling mass that pulsates laterally and anteroposteriorly. Half of the patients are accompanied by vascular noise. A small number of patients have symptoms of compression, and abdominal distension and discomfort are common. Symptoms of abdominal aortic aneurysms often require surgery, and their symptoms include:

Pain

It is a common symptom before rupture, and is mostly located around the umbilicus and mid-upper abdomen. When an aneurysm invades the lumbar spine, there may be pain in the lumbosacral region. If severe abdominal or lumbar pain recently occurs, it often indicates that the tumor is on the verge of rupture.

2. rupture

Patients with acute rupture present with sudden severe back pain with shock manifestations and even die before admission. If the peritoneum is broken into, the hemorrhage is limited to form a hematoma. Abdominal pain and hemorrhagic shock can last for several hours or days. However, the hematoma often ruptures again into the peritoneal cavity and can cause death. The tumor can also break into the inferior vena cava, resulting in aortic venous fistula, which can lead to heart failure. The tumor can occasionally break into the duodenum and cause major gastrointestinal bleeding.

3. Other serious complications

Intratumor can form acute thrombosis, and thrombolysis can cause lower extremity arterial embolism. Duodenal compression can cause intestinal obstruction, and inferior vena cava compression can cause peripheral edema.

Abdominal aortic aneurysm

Abdominal x-ray

With typical eggshell-shaped calcified shadows, a diagnosis can be established.

2. Color Doppler ultrasound

It is very valuable for the diagnosis of abdominal aortic aneurysms. The accuracy of detecting aneurysms is high. It can be found that the lumen of the abdominal aorta is thickened and its shape and mural thrombus are clearly displayed. It is currently the preferred diagnostic method.

3.CTA

It is the most commonly used examination method for abdominal aortic aneurysms. Compared with ultrasound examination, it can more clearly show the whole picture of abdominal aortic aneurysms and its relationship with surrounding tissues such as renal arteries, retroperitoneum and spine, and retroperitoneal hematoma. . The diagnostic accuracy rate is almost 100%.

4.MRA and angiography

Although the two can also be used as diagnostic methods for abdominal aortic aneurysms, they are relatively rare, especially the latter, which are mainly used as evaluation methods in intraluminal repair of abdominal aortic aneurysms. For patients with renal insufficiency, MRA may be considered.

Abdominal aortic aneurysm diagnosis

According to the history and abdominal umbilical cord or mid-upper abdominal crest and bulging pulsating mass, sometimes there is mild tenderness, which may be accompanied by acute or chronic ischemic symptoms of the lower extremity. Some patients can hear abdominal murmurs and tremors, which can be suspected. Abdominal aortic aneurysm. Further color ultrasound, CTA, or MRA examinations can establish the diagnosis. CTA can be used as a clear diagnosis method for abdominal aortic aneurysms.

Differential diagnosis of abdominal aortic aneurysm

Renal colic

Abdominal pain, shock, and low back pain are the most common manifestations of ruptured abdominal aortic aneurysms. When the symptoms of shock are absent, severe low back pain, obvious throbbing pain in the kidney area, and microscopic hematuria are often misdiagnosed as urinary stones, kidneys. colic.

2. Celiac disease

Abdominal aortic aneurysm rupture produces symptoms similar to intestinal hemorrhage and rupture, sigmoid colon diverticulitis, intestinal obstruction, cholecystitis, cholelithiasis, pancreatitis and other diseases, which may be related to abdominal aortic gastrointestinal fistula, tumor wall mural thrombosis, Acute ischemia of the inferior mesenteric artery and other factors. A retroperitoneal mass may lift the abdominal aorta forward, causing a suspected abdominal aortic aneurysm, which needs to be identified by abdominal CT examination.

3. Other

Less common diseases requiring differential diagnosis include acute myocardial infarction and blunt abdominal trauma.

Abdominal aortic aneurysm treatment

The treatment methods of abdominal aortic aneurysms include drug therapy, surgical treatment, and intracavitary treatment. Surgical treatment is the main treatment method, but with the advancement of intracavitary materials and technologies, more and more abdominal aortic aneurysms tend to be treated intraluminally. .

Drug treatment

Control of blood pressure, heart rate, blood lipids, smoking cessation and other measures can control the increase in aneurysm diameter to a certain extent.

2. Surgical treatment

Abdominal aortic aneurysm resection and vascular prosthesis replacement are still the classic methods of treating this disease. Indications for surgery include:

(1) The diameter of abdominal aortic aneurysm is greater than or equal to 5.5cm.

(2) Those whose diameter increased by more than 1 cm each year during follow-up.

(3) Symptoms of abdominal aortic aneurysm.

3. Endovascular treatment

Abdominal aortic aneurysm (EVAR) is a minimally invasive surgical method for the treatment of abdominal aortic aneurysms. Its surgical indications and contraindications are basically the same as those of open surgery. It is characterized by less trauma and avoids the traditional surgery Huge trauma and pain, reducing the incidence and mortality of important heart and lung complications, especially for patients with severe comorbidities who are not expected to tolerate traditional open surgery or may have serious complications after surgery Cases provide opportunities for treatment. With the maturity of "window opening technology" and "chimney technology" and the emergence of branched stents and multi-layer stents, more and more complex abdominal aortic aneurysms that originally required open surgery were favored for intraluminal treatment. In addition, for some patients involving splanchnic arteries that are not suitable for endoluminal treatment and cannot be treated with open surgery combined with other serious diseases, in order to reduce surgical trauma and create conditions for minimally invasive endoluminal repair surgery, combined open surgery and cavity Endoprosthetic hybrid technology to treat.

Abdominal aortic aneurysm prevention

First, the occurrence of atherosclerosis should be actively prevented (primary prevention). If it has occurred, it should be actively treated to prevent the development of the lesion and fight for its reversal (secondary prevention). Those who have had complications should be treated in time to prevent their deterioration and prolong the life of the patient (tertiary prevention).