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Endovascular treatment of abdominal aortic aneurysm

Definition

An aneurysm of the abdominal part of the aorta or a AAA/Abdominal aortic aneurysm is a local or diffuse expansion of its diameter of more than 4 cm.

The progressive expansion of the aorta leads to thinning of the walls of the aneurysm and at any time can be complicated by rupture of the vessel and fatal bleeding.

The disease is mainly acquired and is caused by atherosclerosis, nonspecific aortoarteritis, specific arteritis (tuberculosis, syphilis, rheumatism, salmonellosis). Among the congenital causes of the formation of abdominal aortic aneurysms, fibromuscular dysplasia is distinguished.

Risk factors

The risk of developing an aneurysm are higher in men, smokers, and the elderly, so for male smokers aged 65-75 years, a physician or family doctor may recommend screening for the presence of an aneurysm. The risk of developing the disease is further increased in people whose relatives have had an aortic aneurysm. This group of patients should undergo regular examination (ultrasound of the abdominal cavity) to detect aneurysm, starting at the age of 60 years. Age, smoking, and a family history of aneurysm significantly increase the risk of aneurysm in men, whether these factors affect women is currently unknown.

Symptoms

The majority of aortic aneurysms are asymptomatic: the rate of aneurysm growth is different in different patients, and it is almost impossible to predict how quickly the risk of complications will arise. At the same time, it is known that the faster the aneurysm grows, the higher the risk of aneurysm wall rupture and bleeding.

As the size of the aneurysm grows, symptoms of the disease appear, including:

  • a feeling of pulsation in the area near the navel;
  • constant pain in the depth of the abdomen or in the side;
  • backache;
  • severe sudden pain in the abdomen or lower back may be a sign of an aortic dissection;
  • in rare cases, there may be pain in the feet, blanching due to blockage of the vessels of the lower extremities by blood clots.

Any of the symptoms listed in this section require immediate medical attention.

Diagnostics

Evaluation for a suspected abdominal aortic aneurysm includes assessment of the patient’s personal and family history and physical examination. To confirm the diagnosis are carried out:

  • Ultrasound examination (ultrasound) of the abdominal cavity.
  • Computed tomography (CT). Sometimes during this study, a contract substance is injected into the vessels, which makes it easier to visualize the arteries, in this case the technique is called CT angiography.
  • Magnetic resonance imaging (MRI).

Abdominal aortic aneurysms are often discovered incidentally during examination for other indications. For example, during a routine examination, the doctor may feel a pulsating swelling in the abdomen or hear a specific murmur on auscultation of the abdomen. An aneurysm may also be found incidentally on a chest X-ray or an ultrasound of the heart or abdomen performed for other reasons.

Complications

The most common and severe complication of an abdominal aortic aneurysm is rupture of the aneurysm wall. The rupture may be incomplete (aortic dissection) or complete (with a violation of the integrity of the vessel). The rupture of the aneurysm leads to internal bleeding, which often ends in the death of the patient.

Another common complication of an abdominal aortic aneurysm is an increased risk of blood clots. Thrombotic masses are deposited along the walls of the aneurysm; blood clots break off and spread through the bloodstream and can block blood vessels, disrupting blood flow in various organs (kidneys, abdominal organs) and parts of the body (legs). The result of thromboembolism is a violation of the blood supply to organs with severe tissue damage.

Treatment

The most modern treatment for aortic aneurysms is endovascular stenting. The operation is performed inside the vessel using a special catheter, which is inserted into the lumen of the vessel. This type of surgery is minimally invasive. To perform the operation, the interventional radiology only makes a small incision in the inguinal fold, through which the catheter is inserted. During the operation, an X-ray image is taken in real time, which allows the surgeon to control the process of passing the catheter into the vessel. Next, the surgeon inserts a special device, a stent, into the lumen of the aorta. It is a cylindrical wire frame that reinforces the wall of the aorta. The rehabilitation period after this type of operation is only 2-3 days. The main advantages of endovascular intervention are less trauma (invasiveness) and faster patient recovery compared to open access surgery. The type of operation is chosen by a council of doctors, taking into account the location and size of the aneurysm, the age of the patient and other indicators that can affect the effectiveness and risk of the intervention.

This high-tech operation is performed by our qualified specialists using the latest methods of endovascular technology.

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