What Are the Pros and Cons of Aortic Aneurysm Surgery?

The pathological expansion of the aorta, which exceeds 50% of the normal blood vessel diameter, is called an aortic aneurysm. Aortic aneurysms are classified into true aortic aneurysms and pseudoaortic aneurysms. True aneurysms are three-layer structures that involve vascular wall widening. Pseudoaneurysms are local ruptures of the arteries that are formed by clots or adjacent tissue.

Basic Information

English name

aortic aneurysm

Visiting department

surgical

Common locations

Thoracic aorta, abdominal aorta, descending aorta

Common causes

Atherosclerosis, vascular cystic necrosis, syphilis infection, bacterial infection, rheumatic aortic inflammation and trauma, etc.

Common symptoms

Symptoms of pain and compression of adjacent tissues: dyspnea, cough, wheezing, secondary infection, hemoptysis, hoarseness, difficulty swallowing, vomiting, etc.

Causes of aortic aneurysms

Can be caused by atherosclerosis, vascular cystic necrosis, syphilis infection, bacterial infection, rheumatic aortic inflammation and trauma. The most common cause is atherosclerosis.

Aortic aneurysm classification

1. According to the shape, it can be divided into 3 types:

(1) Fusiform;

(2) saclike;

(3) Interlayer.

2. It can be divided into:

(1) Ascending aortic aneurysm including valsalva sinus tumor;

(2) aortic arch aneurysm;

(3) descending aortic aneurysm, between the left subclavian and diaphragm, the three are collectively referred to as thoracic aortic aneurysms;

(4) Abdominal aortic aneurysms are the most common.

Aortic aneurysm clinical manifestations

Symptoms

Generally, pain occurs when the aneurysm gradually increases, and the nature is deep drilling. The thoracic aortic aneurysm is mostly in the upper chest or back, and radiates to the left shoulder, neck, and upper limbs under the scapula. Abdominal aortic aneurysms complain of lower back pain. If the intensity of the pain increases, it may indicate an impending rupture. Compression of adjacent tissues such as the superior vena cava, pulmonary arteries, trachea, bronchi, lung and recurrent laryngeal nerve, esophagus can cause superior vena cava syndrome, dyspnea, cough, wheezing, and even Secondary infections, hemoptysis, hoarseness, difficulty swallowing, vomiting blood, etc., descending aortic aneurysms can invade the vertebral body and cause spinal cord compression due to paraplegia.

2. Signs

Aortic arch aneurysms can touch abnormal pulsations in the upper fossa of the sternum. The thoracic aorta can touch a ductile mass from the left to the middle of the abdomen. The pulsation is obvious. The systolic murmur can be heard in the tumor body. If the arch tumor affects the aortic root, Causes aortic valve insufficiency, auscultation of the aortic valve area can be heard and diastolic murmur. If the upper vena cava is compressed, edema of the face, neck and upper limbs may occur.

Aortic aneurysm

1. X-ray of chest and abdomen

The calcified outline of the aneurysm can be seen, but 25% of patients have no calcification, and can not be seen on plain radiographs.

2. Ultrasound

The diameter and length of the aneurysm and the mural thrombus can be depicted.

3. CT angiography (CTA) and magnetic resonance angiography (MRA) examination

The size and location of the tumor can be determined and become the gold standard for diagnosis.

4. Arteriography

A means of evaluating aneurysms before surgery or endovascular treatment, but with the risk of complications such as bleeding, allergies and arterial embolism, and the presence of mural thrombus may underestimate the actual size of the aneurysm.

Aortic aneurysm treatment

Medical treatment

Control of hypertension, treatment of concomitant diseases such as diabetes, hyperlipidemia, coronary heart disease and cardiac insufficiency.

2. Surgical treatment

For ruptured aortic aneurysms, emergency treatment should be performed as soon as possible. For unruptured aortic aneurysms, if there are symptoms such as abdominal pain and low back pain, there are indications for surgical intervention. For unruptured and asymptomatic aortic aneurysms, if the diameter increases to a certain degree or the growth rate is faster, and the risk of rupture increases, it also has the indication of surgical intervention. For example, in abdominal aortic aneurysms, the diameter is generally greater than 4.5cm, or the growth rate is greater than 5mm in half a year, which is an indication of surgical treatment. At present, there are two main types of surgical treatment methods:

(1) Open Surgery Open surgery or thoracotomy, aneurysm resection and artificial blood vessel placement, are traditional treatment methods. Surgical trauma is high, the risk is high, and the corresponding requirements for the patient's physical conditions are also high.

(2) Intraluminal repair Through percutaneous puncture or small incision, a stent graft is implanted in the aorta to isolate the tumor cavity and reconstruct the blood flow path in situ. Because there is no need to open the chest and open the abdomen, it has the advantages of less trauma and faster recovery.

Aortic aneurysm prognosis

It is mainly related to the size of the aneurysm and the severity of underlying diseases such as coronary heart disease and cerebrovascular disease. As the tumor grows, the risk of rupture increases.