AORTIC ANEURYSM TREATMENT
Aortic aneurysm can be described as a kind of ballooning in an artery that causes the vessel diameter to expand 50% more than normal.
Aneurysms can be caused by many different reasons, depending on where they form. Generally, high blood pressure, calcification, some infections and connective tissue diseases can be counted among the causes of aneurysm. In some group of aneurysms, the effect of genetic factors is great. An example of this type of aneurysm is that the vessel wall structure is not in its normal strength, resulting from defects in chromosomes.
WHAT IS AORTIC ANEURYSM ?
Aortic aneurysm is a condition in which a vesicle is formed as a result of regional enlargement of the artery originating from the left heart and called the aorta. Sudden ruptures may occur at these enlargement points, which can often be seen in hypertension patients over 60 years of age. This is called aortic rupture or aortic dissection.
The risk of developing aortic aneurysm increases with age. This is because the vessel wall structure changes over the years. As age progresses, the vessel wall loses its elasticity and its resistance to pressure on the vessel wall decreases.
In more than 50% of cases, atherosclerosis is the cause of the aneurysm. It is also common in patients with high blood pressure. High blood pressure causes tension in the vessel wall and prepares the ground for aneurysm. Hypertension is also a risk factor for atherosclerosis.
Bacterial infections may play a role as another causative factor in the development of aneurysms. Infection causes inflammation in the vessel wall and predisposes to aneurysm. This sac caused by infection is called a mycotic aneurysm.
Among the rarer causes of aortic aneurysm is vascular wall inflammation seen in diseases such as tuberculosis and syphilis. The risk of aortic aneurysm is increased in some congenital genetic diseases such as Marfan syndrome and Ehler-Danlos syndrome.
IN WHICH CASES AORTIC ANEURYSM SHOULD BE TREATED ?
Aortic aneurysms can grow over the years after their formation. The aneurysm, which usually does not cause any symptoms, is usually noticed during examinations for the diagnosis of a different disease or during routine health checks. However, in some cases, symptoms may occur. These symptoms are usually persistent or intermittent pain in the chest or abdomen. In addition, symptoms such as back pain, difficulty swallowing or shortness of breath may be seen in thoracic aortic aneurysms.
It is also known that some people feel a pulsating movement in the abdomen, such as a pulse. However, in case of rupture of the aneurysm, sudden and very severe pain usually occurs and the person loses consciousness in a short time and goes into shock. This condition requires immediate medical attention.
With the developing medical technologies, it has become much easier to diagnose aneurysm. After the physical examination, aneurysms in the abdomen can be diagnosed, especially in thin patients. But of course, this cannot be considered a definitive conclusion. According to the point where the aneurysm is, X-ray can be used as a starting point in the diagnosis phase, in the aorta in the chest. Enlargement of the aorta can be observed only with x-ray film. The most commonly used diagnostic method is ultrasound, which works with sound waves. Aneurysm can be diagnosed with this device, which is called 'echocardiography' when used in the heart and 'abdominal ultrasonography' when used in the abdomen. Depending on the results of the ultrasound, further examinations may be performed. In these examinations, it is possible to clarify the diagnosis with tomographic evaluation, sometimes MRI, and sometimes angiography.
HOW IS AORTIC ANEURYSM
Aortic aneurysms are made in different ways depending on the size of the aneurysm. Small aneurysms are followed without treatment, while large aneurysms are treated surgically. Beta-blocker types of drugs are used in drug therapy. It is strongly recommended that the person quit smoking. In addition, additional diseases such as hypertension and hyperlipidemia must be kept under control.
In the endovascular treatment method, which can also be defined as intravenous intervention, the treatment is performed with 2-3 cm incisions made in the arterial region under local anesthesia. In the presence of larger aneurysms, the treatment is performed surgically under general anesthesia. The dilated vasculature is removed and a stent is placed in its place.
It is applied without open surgery, by placing the catheters placed in the vein and the grafts we call the stent advanced on them, into the aneurysm and closing it.
Endovascular procedures, in which a stent is placed by entering through the groin or through the vein, are the methods frequently applied especially in the past 10 years. Because endovascular procedures provide significant advantages, especially in certain areas, when compared to open surgery. These advantages are very important for the patient. The first of these is that the patient did not have an open surgery, and accordingly, the recovery period, hospital stay, the length of stay in the intensive care unit were short, and the rate of blood use in the surgery was negligible. The quality of life of patients in the early period is quite high when compared to surgical intervention. Most importantly, the risk of mortality is much lower when 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. Repetitions and follow-up procedures are seen much more frequently in interventional procedures than in open surgery.
Open Surgical ProceduresThey are large operations when compared to endovascular procedures. Although open surgical procedures are performed with smaller incisions today, open surgery is perceived as large operations compared to endovascular procedures. The aim is to completely remove the diseased aneurysm area and to provide continuity by replacing it with an artificial vein. Since there is no other large vessel such as the aorta in the body, an artificial vein is obligatory. Aneurysms are disabled by using polyester, PTF, Dakon-style grafts. Although the length of intensive care and hospital stay is longer in open surgery, it is seen that the advantage of open surgery is higher as the patient's life expectancy increases. Open surgical procedures are still considered the gold standard of this business.
FREQUENTLY ASKED QUESTIONS
What Is The Frequency Of Aortic Aneurysm?
The disease is insidious and usually asymptomatic. Its incidence is 25/100,000 over the age of 50. The diagnosis is often made by chance during examinations performed for another reason.
Who Has Aortic Aneurysm More Frequently?
People with a family history of aortic aneurysm
In people with aneurysms in the brain vessels
Advanced age (over 70 years old)
In patients with high blood pressure
In people who smoke
In people whose aortic valve is congenitally composed of two leaflets
Is It Possible To Prevent Aortic Aneurysm?
Aortic aneurysm is more common in people who smoke, have high blood pressure, and have a family history of aneurysm disease. In short, smoking and high blood pressure are the factors that can be controlled among these factors, which we define as general risk factors for cardiovascular diseases. Human genetics cannot be changed. On the other hand, it is not possible to treat the disease with medication.
What Consequences Does Aortic Aneurysm Cause?
The most important consequence of the disease is the bursting of the vessel when it reaches a certain diameter. In this event, which we call “rupture”, the chance of death is high. Therefore, the disease should be treated before it reaches this point. Generally, this rate increases when the vessel diameter is 5 cm or more. Therefore, the follow-up of these aneurysms and their treatment when it reaches the intervention limit are of great importance in order to prevent unexpected rupture of the aneurysm.
How do I know if I have an aneurysm?
If you are thin and have a medium or large aneurysm, you may feel a hard, pulsating stiffness in your navel or above your navel. However, ultrasonography, CT or MRI should be performed to reach a definitive decision.
What are the symptoms when an aneurysm ruptures?
Symptoms of shock include sudden onset of severe back and abdominal pain, fainting, nausea, vomiting, low blood pressure, rapid pulse, pallor, cold sweats, and dry mouth.
Will I die as soon as the aneurysm bursts?
Although a balloon example is always given for an aneurysm, the situation when it bursts is not always like a balloon burst example. In 20% of patients, the aneurysm opens into the abdomen and blood flows rapidly into the abdomen without any obstruction, killing the patient immediately. However, most of the time, the aneurysm bleeds into the area behind the peritoneum, the tissues there and the clot that forms slows down the bleeding a little. In this case, patients may have a chance to survive.
What is the closed treatment of aneurysm?
Another treatment method that may cause less discomfort compared to open surgery is to enter the vein with some special catheters and place the artificial vein from the inside of the vein where the aneurysm is located. In this method, known as endovascular (EVAR), closed or stent graft repair, the artificial vessel placed on a catheter (thin plastic tube) is advanced from the groin to the artery and then to the diseased part of the aorta in the abdomen, and the artificial vessel is placed in that part. The artificial vein brought to the site of the aneurysm is inflated and attached to the vein with stents that provide support from the inside instead of the suture. In this way, the aneurysm can be treated from the inside without making any incisions other than the incision in the groin. The aneurysm, in which there is an artificial vessel carrying blood, deflates over time and is treated. This method is performed under x-ray in special environments. After the procedure, the patients stay in the hospital for a day or two and are discharged. Treatment with endovascular or stent graft is suitable for only a fraction of patients with aneurysms.
What are the advantages of endovascular aneurysm treatment?
No surgical incision is made outside the groin, Local anesthesia (only by numbing the groins) can be performed, The procedure time is much shorter than the operation, the blood anxiety is much less than the operation, the postoperative pain and discomfort is less than the operation, the hospital stay is shorter than the operation The procedure is compared to the operation less risk of death during and after
What are the disadvantages of endovascular aneurysm treatment?
It is expensive. If unsuccessful, open surgery is required. Rarely, the aneurysm may rupture during the procedure and open surgery may be required. The implanted artificial vessel may dislodge and disintegrate. Even after years, blood may leak from the periphery of the artificial vessel and fill the aneurysm.
How long does the closed (endovascular) aneurysm treatment process take?
It normally takes an hour or two. However, in problematic cases, the process may take 2-4 hours.
Will I get narcosis during the treatment of a closed (endovascular) aneurysm?
Generally, general anesthesia (narcosis) is not required in closed repair. Most of the time, numbing that area with a needle made from the groin is sufficient for the procedure.
How long is the hospital stay after closed (endovascular) aneurysm treatment?
After the procedure, the average stay in the hospital is 1-2 days. In problematic cases, this period may be extended.
When will I return to normal after closed (endovascular) aneurysm treatment?
You may feel some discomfort in the first days. However, within 7-10 days, you will become pre-operative.