Nowadays, the frequency of aortic aneurysms is increasing due to the increase in cardiovascular diseases. In many patients, emergency intervention is required when diagnosed.
Aneurysm can be most easily described as a type of ballooning in the artery that causes the vessel diameter to expand 50% more than normal. The normal diameter of the aorta varies slightly depending on age, gender, height and weight in adults, but it is generally between 2.5-3.5 centimeters. Aneurysms can occur for many different reasons depending on where they occur. Generally, high blood pressure, arthritis, some infections and connective tissue diseases can cause aneurysms. In some groups of aneurysms, genetic factors play a major role. Lack of normal strength of the vascular wall structure resulting from chromosome disorders can be given as an example of this type of aneurysm.
What are the Causes of Aortic Aneurysm?
High Blood Pressure:
strong> Of course, it is not possible to say that high blood pressure alone is effective in the formation of aneurysms. Many people with high blood pressure do not develop aneurysms; But available data show that a significant portion of patients with aneurysms have high blood pressure.
Smoking: One of the main causes of atherosclerosis or calcification is smoking. Vascular calcification, loss of vascular flexibility causes aneurysm formation. There is a strong connection between smoking and aneurysms in the abdomen.
Age:Aging occurs in the vessels as well as in the whole body. Age is of great importance in aneurysm formation. Aneurysms, especially those occurring in the abdomen, are often seen in people over the age of 65. Aneurysms are a disorder that usually occurs in later ages if the person does not have a connective tissue disease.
Genetic disorders due to congenital weakness of the vascular wall:This includes connective tissue diseases, such as being tall and long-limbed. We can show structural diseases such as Marfan that cause it. Structural reactions occurring within the vascular wall, which we call degeneration and inflammation (such as syphilis, Behçet's disease), can also be examples of this.
Eating Fatty Foods, diabetes, high blood lipid levels, obesity, and chronic lung diseases that cause coughing for a long time are among the causes of aortic aneurysm. Sudden straining and lifting heavy loads cause an increase in intra-chest pressure and are among the causes of aneurysm.''If I give an example from two of my recent patients; When one of my patients came to the emergency clinic with back pain after diving underwater for a long time, it was understood that he had a ruptured aortic aneurysm. Another patient was diagnosed with aortic rupture when he came to the emergency clinic with sudden back pain after suddenly lifting a load of nearly 60 kilos. Both patients underwent emergency surgery and were discharged.''
The dilatation of the aortic vessel in the abdominal area generally progresses silently. Half of the patients may have symptoms of mild abdominal pain; But abdominal pain is a very vague complaint. Sometimes there may be complaints of back pain and constipation. Sometimes a pulsating swelling can be felt in the abdomen or groin. It is a very important sign that this swelling pulses like a vein. Those in the chest cavity are more insidious and can remain inside for years without showing any symptoms. Sometimes the first complaint may be the sudden pain caused by the rupture. Enlargements in the chest, hoarseness, difficulty in swallowing, and cough can be counted among the complaints of aneurysms. The disease usually occurs when an ultrasound or tomography is performed for another reason. Or it may occur due to severe abdominal pain or internal bleeding as a result of rupture.
If the diagnosis is made without rupture, this is a great chance for the patient. Because its rupture can have very serious consequences. If the patient is lucky, the diagnosis is made before the rupture. If the rupture occurs, unfortunately half of these patients cannot apply to the hospital and unfortunately some of the patients may be lost in the hospital during the diagnosis and treatment preparation phase. Success rates are high when diagnosed patients are applied a planned treatment protocol.
There are two methods of treatment. These are;
- Invasive method: surgical and non-invasive method
- Invasive method: treatment with angiography.
The determination of the treatment method depends on the age of the patient, the location and size of the aneurysm, and whether there are other diseases accompanying the aneurysm. It also determines whether or not it is used.
Closed surgical (endovascular) method:
Without open surgery, catheters placed in the vein and the stent advanced on them are called It is applied by placing the grafts we provide into the aneurysm and closing it.
Endovascular procedures, in which stents are placed by entering the groin or intravenously, are a frequently used method, especially in the last 10 years. Because endovascular procedures provide significant advantages, especially in certain areas, when compared to open surgery. These advantages are of great importance to the patient. The first of these is that the patient does not undergo an open surgery, and therefore the recovery period, hospital stay, and intensive care unit stay are short, and the rate of blood usage in the surgery is almost negligible. In the short term, patient quality of life is quite high compared to surgical intervention. Most importantly, the risk of death is much lower compared to open surgery. However, the quality of life and life advantages provided by these treatments in the early period may disappear after one or two years. Interventional procedures are repeated, and follow-up procedures are much more common than open surgery.
< br /> Open Surgery Method:
These are major operations compared to endovascular procedures. Although open surgical procedures are performed with smaller incisions today, open surgery is perceived as major operations compared to endovascular procedures. The aim is to completely eliminate the diseased aneurysm area and replace it with an artificial vessel to ensure continuity. Since there is no other large vessel such as the aorta in the body, an artificial vessel is necessarily placed. Aneurysms are disabled by using body-compatible grafts. Although intensive care and hospital stays are longer in open surgery, both methods are preferred in the treatment of aneurysms in selected cases. Both methods have a high success rate during the treatment process. The main problem is early diagnosis.
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