Why is an aneurysm dangerous?
The aortic wall is constantly under blood pressure. When its elastic fibers are destroyed, the area begins to stretch, and then simple physics comes into force: the wider the vessel, the stronger the tension of its wall at the same pressure. Therefore, an aneurysm grows with acceleration - a small aneurysm grows slowly, a large one grows much faster, and the risk of rupture does not increase smoothly, but abruptly after a certain diameter.
- The normal diameter of the abdominal aorta in an adult is about 2 cm; an extension of 3 cm is already considered an aneurysm
- With a diameter of up to 5 cm, the risk of rupture during the year is low; with a diameter of 6 cm or more, it becomes high
- The rupture causes massive internal bleeding; most patients do not have time to get to the hospital
- In addition to rupture, blood clots form in the aneurysmal sac, their fragments can clog the arteries of the legs
- A separate dangerous form is aortic dissection, when blood penetrates between the layers of the wall.
The growth rate varies from person to person and averages a few millimeters per year, but it is noticeably higher in smokers and people with poorly controlled blood pressure. It is these two factors that are in the zone of influence of the patient himself: there are no drugs that stop the expansion of the aorta, and quitting smoking works and is confirmed by observations. In addition, an aneurysm is almost never an isolated problem - it occurs against the background of general vascular damage, and this determines the entire management plan.
Who needs screening
Since there are no symptoms, the only approach that works is targeted screening of people at risk. We are talking about a simple ultrasound examination of the abdominal aorta: without preparation, without radiation, in a few minutes.
- Men 65–75 years of age who smoke or have ever smoked are the most reasonable group for one-time screening
- Men over 65 years of age with an aortic aneurysm in a parent, brother or sister
- Women over 65 years of age with a long history of smoking or hereditary history
- People with already identified atherosclerosis of other arteries - carotid, coronary, leg arteries
- Patients with long-term, poorly controlled hypertension
- First-degree relatives of a person with an aneurysm—regardless of gender, usually starting at age 50–55
If a single ultrasound shows a normal aortic diameter, most people do not need to repeat it in the future: the likelihood that an aneurysm will form later is very small. If an expansion is detected, the person switches to a scheduled observation mode at a predetermined frequency. The study itself does not require any preparation or referral to expensive equipment - just a regular ultrasound machine and a specialist who was asked to look at the aorta.
Symptoms, if they appear
Complaints occur only in some patients, usually with large aneurysms, and they are nonspecific - they can easily be attributed to the spine or stomach. That is why you cannot focus on your well-being.
- Feeling of pulsation in the abdomen, especially when lying on your back
- Dull, aching pain in the abdomen, lower back or side, not associated with eating or movement
- Feeling of rapid satiety and heaviness with compression of the stomach and intestines
- With a thoracic aneurysm - hoarseness, persistent cough, difficulty swallowing, back pain
- Coldness and pain in the legs if blood clots from the aneurysm clog the arteries
An aneurysm is often first seen not by vascular surgeons, but by ultrasound doctors - during an examination for lower back pain, kidney stones or stomach problems. Therefore, it makes sense, when doing an ultrasound of the abdominal cavity after sixty years, to ask the specialist to additionally evaluate the diameter of the aorta: this adds a minute to the study, and to the patient - information that otherwise may never appear.
Observation: how often to measure
If an aneurysm is found, but its size is still far from the operating size, the person goes into observation mode. This is not “do nothing,” but a very specific plan: a known control interval, target blood pressure and complete cessation of smoking. The frequency depends only on the diameter, because there are no complaints here to guide you.
- Диаметр 3,0–3,9 см — ультразвуковой контроль обычно раз в 2–3 года.
- Диаметр 4,0–4,9 см — контроль примерно раз в год.
- Диаметр 5,0–5,4 см — контроль каждые 6 месяцев и обсуждение сроков операции с сосудистым хирургом.
- На любом этапе — полный отказ от курения: это единственный доказанно влияющий на скорость роста фактор, который зависит от самого пациента.
- Контроль артериального давления: чем ниже нагрузка на стенку, тем медленнее растёт аневризма.
- Статины и лечение сопутствующего атеросклероза — они не уменьшают аневризму, но снижают общий сердечно-сосудистый риск, от которого такие пациенты чаще всего и погибают.
One practical point: Ultrasound and CT scans measure the aorta slightly differently, and a 2-4mm difference between the methods is common and not a sign of growth. Therefore, in dynamics, results obtained by the same method are compared and previous conclusions are retained. It’s even better to be observed where there is access to previous photographs: then growth is assessed on the same scale.
When and how to operate
Elective surgery is discussed when the risk of rupture becomes higher than the risk of the operation itself. Commonly accepted guidelines are that the abdominal aorta has a diameter of 5.5 cm in men and about 5.0 cm in women, rapid growth, and pain associated with the aneurysm, regardless of size.
- Open prosthesis - the aneurysmal area is replaced with a synthetic prosthesis. The operation is more traumatic, but the result is long-lasting and does not require lifelong visual monitoring with the same frequency
- Endoprosthesis replacement with a stent graft - through punctures in the inguinal arteries, a coated frame is delivered into the aorta, which excludes the aneurysmal sac from the bloodstream from the inside. Less trauma, faster recovery
- The choice of method is determined by anatomy: the length and angle of the aneurysm neck, the condition of the iliac arteries, as well as age and concomitant diseases
- After endoprosthetics, regular monitoring is required in order to promptly notice the leakage of blood into the bag past the frame
Emergency surgery for a rupture is technically similar, but its results are radically worse: the body has already suffered massive blood loss. The difference between planned and emergency intervention is the price of timely ultrasound.
What reduces the risk of rupture
Patients almost always ask what depends on them. The answer is shorter than it seems: it is impossible to influence the existing expansion of the aorta with drugs, but it is quite possible to slow down its growth and reduce the likelihood of rupture, and the contribution of the person himself is significant here.
- Полностью бросить курить — самый значимый шаг, напрямую замедляющий рост аневризмы.
- Держать артериальное давление в целевых значениях, принимая препараты регулярно, а не «когда голова болит».
- Не пропускать назначенные контрольные исследования: интервал определяется размером, а не самочувствием.
- Избегать экстремальных натуживаний и подъёма предельных тяжестей, при этом сохраняя обычную умеренную активность.
- Лечить хронический кашель и запоры, при которых резко повышается внутрибрюшное давление.
- Иметь при себе информацию о диагнозе и размере аневризмы: при внезапной боли в животе это ускоряет постановку правильного диагноза в приёмном отделении.
