Table of Contents
- What is an aortic aneurysm?
- What are the symptoms of an aortic aneurysm?
- What are the causes of aortic aneurysm?
- Aort anevrizması nasıl tedavi edilir? EVAR nedir? TEVAR nedir?
- How many cm of aortic aneurysm requires surgery or EVAR/TEVAR?
- What should people with aortic aneurysm pay attention to?
- References
What is an aortic aneurysm?
The aorta is the largest vessel in the body and the main artery that distributes blood pumped from the heart throughout the body. The aorta has thick walls that can withstand blood pressure. However, these walls can weaken in some medical or genetic conditions. Blood pressure inside the vessel, especially if it is high, can cause an aneurysm (ballooning) in weakened or damaged walls. An aneurysm can form anywhere in the aorta - at the beginning, middle or end. If the aortic aneurysm becomes too large, it can rupture (aortic dissection) or perforate (aortic rupture). With early diagnosis and treatment, this growth of the aortic vessel can be slowed down or even prevented.
What are the symptoms of an aortic aneurysm?
- Most aortic aneurysms do not cause any signs (symptoms). Mostly, they are caused by computed tomography (CT)It is detected incidentally during MRI or ultrasound examinations. In some patients, it may cause symptoms. If it causes symptoms, this depends on the location and size of the aneurysm:
- Difficulty swallowing or pain during swallowing due to aneurysm compression of the esophagus
- Difficulty breathing due to compression of the trachea or lung
- Hoarseness due to compression of the nerves of the vocal cords
- Swelling of the face, neck or arms as a result of compression of the main vessels in the upper body that bring blood to the heart
- Pain or throbbing sensation in the abdomen
Unfortunately, sometimes the first symptom can be a rupture or perforation of the aorta. In general, the larger the aneurysm and the faster it grows, the greater the risk of these emergencies occurring. There can be many different symptoms in an emergency, but the most common symptom is very severe pain in the chest, abdomen or back.
What are the causes of aortic aneurysm?
- Genetic causes: Some genetic diseases have an increased risk of aortic aneurysm. These include; bbicuspid aortic valve, Marfan syndrome Ehlers-Danlos syndrome, Loeys-Dietz syndrome, Turner syndrome and other aare the primary aortic aneurysm syndromes. To a certain extent, these diseases can also be transmitted to children. Bbicuspid aortic valve The so-called "so-called" situation is particularly important, because is the most common congenital heart disease. In this disease, aort kaThe puck was born with two parts, not three. In these people, the structure of the aortic vessel is also prone to being loose and weak and therefore prone to aneurysms. The narrowing or leakage of the valve also puts additional pressure on the aortic wall. Therefore, a bicuspid aortic valve is often accompanied by an aortic aneurysm.
- Uncontrolled hypertension
- Cigarette
- Trauma
- Vaskülitler (Damar iltihapları)
Aort anevrizması nasıl tedavi edilir? EVAR nedir? TEVAR nedir?
- Surgery: If the aortic aneurysm is too large, intervention is necessary because of the risk of rupture or perforation. One of the options is surgery. In surgery, the ballooning area is cut open. A tube (graft), usually made of polyester, is inserted into the aneurysm. One end of this graft is sewn into the vessel, one end before the aneurysm and the other end after, and the vessel walls are closed again. Blood enters at one end of the graft and exits at the other end without entering the ballooning area. Thus, blood pressure cannot reach the aneurysm and the risk of rupture or perforation is reduced.
- Non-surgical method: In most patients with aneurysms in the abdomen or chest, a graft (more precisely, a graft stent) can alternatively be implanted nonoperatively. Aneurysms at the beginning of the aorta (ascending aorta) cannot be treated nonoperatively at present; however, it is expected that in the near future aneurysms in this area will also be able to be treated nonoperatively thanks to advances in technology. Non-surgical treatment of abdominal aneurysms EVARnon-surgical treatment of aneurysms in a certain part of the chest (descending aorta) TEVAR is called With these methods, no incision is made in the chest or abdomen; the procedure is performed through the groin (leg) vein: First, the groin area is numbed so that the patient does not feel pain. A needle is inserted into the leg vein and a long wire is sent into the aorta. Then, the graft stent covered with polyester The catheter is slid over this wire and advanced into the aorta. The graft stent is positioned at the aneurysm site. The graft stent is removed from the tip of the catheter by a mechanism outside the patient and expands spontaneously into the factory production shape. Additional graft stents are sometimes required due to the branches branching off into the right and left legs. As a result, blood is prevented from entering the aneurysm.
How many cm of aortic aneurysm requires surgery or EVAR/TEVAR?
4.0 cm’e kadarki aort genişlemelerde sorun çıkma ihtimali son derece azdır. Ama, aort çapı arttıkça risk de artar. Çoğu hastada aort çapı 5.0-5.5 cm’e ulaşınca ameliyat, EVAR ya da TEVAR gerekir. Bu değerde, artık anevrizmanın yırtılma veya delinme riski, müdahale riskinden (ameliyat ya da EVAR / TEVAR riski) daha yüksektir. Bu nedenle, artık anevrizmaya müdahale etmek gerekir. Ancak, unutulmamalıdır ki; her hasta farklıdır ve bazı durumlarda daha erken ya da daha geç çaplarda müdahale kararı alınabilir. Örneğin; genetik nedenler söz konusuysa (Marfan sendromu vb.) veya doktor takiplerinde anevrizmanın çok kısa sürede büyüdüğü saptanırsa daha erken müdahale gerekebilir. Benzer şekilde, boyu 1.50 m olan birinin doğal olarak aortu da orantılı bir biçimde küçük olacağından daha küçük çaplarda müdahale kararı alınabilir.
What should people with aortic aneurysm pay attention to?
Take the following measures slow or even stop the growth of the aneurysm:
- Hipertansiyonu ve yüksek kolesterolü kontrol altına almak; varsa, ilaçları düzenli kullanmak (Özellikle, beta bloker grubu ilaçları kullanmanın faydalı olduğu düşünülmektedir. Kontrolsüz hipertansiyon, anevrizmanın büyümesine neden olan en önemli faktördür.)
- Adopting healthy eating habits (low salt, Mediterranean diet, etc.)
- Quit smoking
- Increasing movement (walking, etc.)
- Avoiding situations that cause straining, such as constipation or lifting very heavy loads (straining momentarily increases blood pressure in the aorta)
- Focus on stress management (not always possible and may require medication)
References
- Mazzolai L, Teixido-Tura G, Lanzi S, et al. ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J. 2024 Sep 29;45(36):3538-3700.
- Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al. ACC/AHA Guideline for the diagnosis and management of aortic disease. Circulation. 2022 Dec 13;146(24):e334-e482.
- Libby P, Bonow RO, and Mann DL, eds. Braunwald's heart disease: A textbook of cardiovascular medicine, 12th ed. Philadelphia PA: Elsevier; 2022.