WHAT IS BALLOONING IN THE abdominal vein?
AORTIC ANEURYSM
- What is the Aorta? The aorta is the main artery leaving the heart.
- Its main task is to bring oxygenated blood and other substances to the body. All arteries arise from the aorta and its branches.
1. Ascending Aorta (first part coming out of the heart)
2. Transverse Aorta (horizontal section where cerebral vessels exit)
3. Descending Aorta (the section starting from the transverse aorta and descending)
4. Thoracic Aorta (section in the rib cage)
5. Abdominal Aorta (section inside the abdomen)
WHAT IS ANEURYSM?
Aneurysm means enlargement in Greek. An aneurysm, in its simplest terms, is an enlargement of more than 50% of the diameter of the vessel in an artery. It can be described as “ballooning” among the people. They are divided into two as true and false. A true aneurysm includes all layers of the checkerboard. A false aneurysm is the opposite.
WHAT ARE THE CAUSES OF ANEURYSM?
Aneurysms can be caused by high blood pressure, smoking calcification, some infections and connective tissue diseases. With age, arteries gradually lose their elasticity. The enlargement of the arteries is also associated with aging to some extent. In Marfan Syndrome, which is congenital and originates from a structural defect in the vascular wall, aneurysm can be seen in the aortic vessel exiting the heart.
The most common regional aneurysms in the aorta are seen in the abdomen. This type, which is seen below the kidneys (infrarenal), is followed by the aorta, which is the first region that comes out of the heart (ascending=ascending). The one inside the abdomen is called “Abdominal Aortic Aneurysm”. In this article, we will cover this issue.
Normally, the diameter of the aorta in this region is around 2-2.5 cm. If this diameter is 4 cm or more, it is the limit. After that, it is considered an aneurysm. The intervention limit is 5-5.5 cm.
Abdominal aortic aneurysm is an insidious and asymptomatic disease that can rupture suddenly and become life-threatening. Its incidence is 6-10/100 000 over the age of 50. There is no condition that every patient will be treated. Approximately 15,000 deaths are due to abdominal aortic aneurysms in the United States each year. The cause of this death is the shock picture due to rupture. It is seen in 2-7% of autopsies. 3 times more common in men than women
What Are the Symptoms of Aortic Aneurysm?
It may not show any symptoms. It creates a very heavy painting when suddenly torn.
- PAIN: It is a pain that radiates from the abdomen towards the waist. It can also go towards the back of the abdomen.
- A mass in the abdomen: A pulsating mass can be seen on examination in the abdomen. This is called “pulsating mass = pulsatile mass” because it beats with each pulse. It is detected by examination. The abdominal wall can be seen more easily in thin and thin people. It is difficult for the patient to notice.
- HYPOTENSION: Low blood pressure.
These three symptoms are classic symptoms. In general, hypotension is due to ruptured or pre-ruptured oozing bleeding. For this reason, it is seen in patients with anemia and tachycardia.
Asymptomatic (asymptomatic) cases are very high.
HOW IS AORTIC ANEURYSM DIAGNOSED?
Abdominal aortic aneurysms are placed incidentally. It is usually detected in those who have had an abdominal ultrasound for another reason. The enlarged vein can be easily seen with ultrasound.
Abdominal Abdominal Computed Tomography comes second.
MR Angiography is also helpful.
It is not performed in patients with suspected Abdominal Aortic Aneurysm due to the risk of groin angiography. Sometimes, ultrasound for screening in patients who will have coronary angiography allows diagnosis. For those over a certain age (65), both carotid and abdominal ultrasound are appropriate for screening.
HOW IS ABDOMINAL AORTIC ANEURYSM TREATED?
In diameters below 5 cm, ultrasound follow-up is performed at 6-month intervals.
The intervention limit is 5.5 cm for men and 5.0 cm for women.
Classically, synthetic two-legged trousers graft surgery is performed by opening the abdomen and placing the aneurysm from the top to the groin.
Today, instead of this method, trousers graft stent is placed into the ballooning vessel with the angiography method in suitable patients. This method, called “Endovascular Repair”, is advantageous in terms of both risk and patient comfort. Patients stay in the hospital for a shorter time. It also has important contributions in terms of blood usage and infection.
It may not be suitable for every abdominal aortic aneurysm patient. After the necessary measurements are made, it is decided to apply it technically.
While it was claimed that every patient would be suitable in the early stages, its emergency practice has gained importance recently due to problems such as leakage due to endovascular repair and continued growth of the aneurysm.
The greatest benefit of endovascular repair has been for ruptured aneurysms. In this way, the high risk in classical surgery is reduced.
VIDEO: BALLOON IN THE abdominal vein
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