A definition for an aortic aneurysm may be as follows: An aortic aneurysm is a prolapse of the main artery of various types and locations, which may burst and cause fatal internal bleeding. In the following, among other things causes, classification, symptoms and treatment are discussed.
Aortic aneurysm: causes and forms
The aneurysm is defined as the emergence of arterial vessels at certain sites, which mainly affect the main artery. Basically, three different types can be distinguished from each other:
- Aneurysm verum
- Aneurysm dissecans
- Aneurysm spurium
The "true" or "right" aneurysm verum (verum = true in Latin) represents the most common of the three aneurysm forms. It is characterized by an increasing bulge at a certain point of the vascular cord, resembling a rubber bladder on a water hose. Despite Ausackung remains the vessel wall as a whole intact.
In most cases, the aneurysm verum is based on vascular calcification of the main artery, which damages the vessel wall and favors their bulge. Increased blood pressure is an important risk factor for the development of vascular calcification as well as for the increasing extent of the aneurysm. An aneurysm that has developed once is always distended by the high pressure pulsating bloodstream.
In rarer cases comes also a congenital weakness of the vessel wall or a chronic syphilis or fungal infection as a trigger of an aneurysm verum into consideration.
The aneurysm dissecans (dissecting Latin), which is found in about 25 percent of cases of an aortic aneurysm, characteristically entrains the intima of the vessel at a specific location in the longitudinal or transverse direction. The blood, which is pressed with high pressure into the main artery, can pre-rage in the wake of the vessel wall and cut out the main artery. In contrast to the aneurysm verum congenital defects predominate as the cause of the vascular wall, to which vein calcification tends to take a back seat.
The aneurysm spurium (spurius = Latin spurious) occupies a special position insofar as it corresponds less to an aneurysm than to a small tear of the vessel, through which blood can pass outward. Clotted blood eventually surrounds the resulting vascular defect like a plug, preventing further bleeding in most cases. The aneurysm spurium occurs predominantly as a complication after operations or punctures on arterial vessels.
Aortic aneurysm: symptoms and signs
The aneurysm verum of the aorta is preferably found in the abdominal area and can be felt there, at least in slender patients as a pulsating large node centrally below the costal arch. While this so-called abdominal aortic aneurysm mainly leads to abdominal pain, flatulence, irregularities in bowel movements or sometimes to increased urination, are in aneurysm verum in the chest area back pain in the foreground.
Hoarseness, dyspnoea, dysphagia and circulatory disorders of the arms or the head can also occur due to pressure of the pulsating aortic aneurysm on surrounding structures.
A similar symptom picture can also originate from the rarer aneurysm dissecans, which usually begins immediately above the aortic valve and can involve the entire main artery into the abdomen. The aneurysm spurium rarely reaches the same size as the other two types of aneurysm, but may produce similar symptoms depending on its location.
Aortic aneurysm: course
The decisive criterion for the assessment of the danger of an aneurysm verum is the Diameter of the Aussackung. This value can vary between 3 cm and in extreme cases up to 8 or 9 cm, whereby from a critical diameter of 5 to 6 cm there is a risk that the outpouring bursts and a life-threatening internal bleeding occurs.
Statistically, for example, abdominal aortic aneurysms with a diameter of 5 to 6 cm burst in up to 40 percent of cases within 2 years.
Even more dangerous than with aneurysm verum is the situation with the aneurysm dissecans, in which the already weakened and additionally torn vessel wall can often not withstand the pressure of the blood stream for long. If the first internal tear of the main artery wall, which is associated with severe chest or abdominal pain survives, the repeated tear of the damaged vessel wall, this time outward, often leads to a fatal internal bleeding.
Aortic aneurysm: diagnosis and diagnosis
The diagnosis of an aneurysm is made either by ultrasound examination, computed tomography or direct vascular imaging with X-ray contrast agent. In the latter method, the vascular tree with all irregularities, bottlenecks and also Aussackungen can be directly visible in the X-ray image.