What is it?
It is localized aortic dilation.
The aneurysm may sit on one of the five segments of the aorta:
-The thoracic aorta: bottom-up part, horizontal portion, top-down portion;
-The sus-renal abdominal aorta (above the start of the renal arteries);
–Abdominal aortic aneurysm sous-renale (at the bottom of the departure of the renal arteries).
-Men are much more affected than women.
-Abdominal aortic aneurysm button 6 to 7% of the general population.
Causes and risk factors
Atherosclerosis is the main cause. Syphilis often causes of aneurysms of the thoracic aorta. Other causes (thoracic trauma, infective endocarditis, sepsis, elastic fabric, polyarteritis nodosa… disease) are more rare.
Spontaneous evolution is dominated by the risk of rupture often heralded by the appearance of painful signs in the territory of the aneurysm. If broken, death is immediate.The probability of failure is greater for large aneurysms (more than 6 cm in diameter).
The signs of disease and diagnosis
Aneurysm of the thoracic aorta is usually discovered during a routine chest x-ray.
Symptoms may occur: chest pain, discomfort breathing (Dyspnea), bronchial irritation syndrome (cough), gene for swallowing (dysphagia), upper bitonal voice by paralysis of the recurrent nerve, compression of the superior vena cava syndrome.
Clinical examination can sometimes hear a diastolic blood pressure of aortic insufficiency breath, perceive an unequal pulses and blood pressure of the upper limbs.Ultrasound and fluoroscopy facilitate diagnosis as well as computed tomography and magnetic resonance imaging which specify the size and shape of the aneurysm. The aortogram intravenously is sometimes useful.Abdominal aortic aneurysm is sometimes discovered by the doctor who palpates the abdomen and who collects a mass oblong, vertical, swing and expansive.
The presence of symptoms often translated a cracking of the aneurysm: deaf or violent, lower back or abdominal pain. More and more often, the asymptomatic abdominal aortic aneurysm was discovered during an abdominal ultrasound done in routine.
Abdominal x-rays, ultrasound, magnetic resonance, scanner, angiography scanned through venous Imaging enable the diagnosis.Medical treatment controls possible hypertension.
Surgical treatment is very urgent in certain forms. Sous-renale abdominal aortic aneurysm requires followed by resection of a prosthesis, which can even be asked by Transfemoral Endovascular. The sus-renal aortic aneurysm requires intervention under hypothermia.
Aneurysms of the thoracic aorta are operated under hypothermia or shunt pulsed to avoid discontinuation of the vasculature of kidney and marrow. Aneurysm of the ascending aorta is operated under extracorporeal circulation (CEC) and coronary perfusion.
Aneurysms of the horizontal portion pose difficult problems due to the departure of arteries in cerebral destiny. The operative risk is high.