The aortic rupture: causes, symptoms and treatment

Among the celebrities who have died because of that insidious disease, you can call albert Einstein, Andrei Mironov, Charles de Gaulle, Zhenya Belousov. The phenomenon occurs suddenly and anticipate its occurrence is almost impossible, although destructive processes in the vessel starts a bit earlier if aortic pathology is not caused by trauma.

As the disease evolves

First, the vessel wall begins to delaminate between the layers penetrates the blood, which facilitates further delamination of the tissues and rupture the outer layers of the shell of the vessel (there are three). The blood creates a pressure, and the outer layers are stretched (there aneurysm). When violated the integrity of the last layer - diagnose aortic rupture. From the beginning of the stratification of the wall prior to rupture is rarely more than a day (usually takes no more than a few hours).

Happens another scenario: self-healing of the patient. After the formation of aneurysm (bulging of a thinned vascular wall) the pressure of the blood coming from the heart, inside the layers of the shell breaks the outer, and the inner layer (the intima). Then the pressure between the layers of normal cells, and the aneurysm samothracians.

Factors contributing to the beginning of the destructive process in the blood vascular

Revealed that people suffering from certain diseases are more prone to aneurysm and its subsequent rupture. The causes can hide in the following processes:

• Atherosclerosis and ischemia of the walls of the aorta.
• Syphilis.
• Hypertension, or frequently occurring, significant fluctuations of blood pressure level.
• Diseases associated with pathologies of the large vascular of the heart (nezareatmene ducts, hypoplasia, coarctation, Marfan syndrome, double arc, etc.).
• Acute illness of infectious nature, causing focal necrosis (or necrosis) of tunica media of the vessel.
• The damage to the wall of the aorta concomitant diseases of the gastrointestinal tract (esophageal cancer, spondylitis, penetration of gastric ulcer of the duodenum or esophagus) or mechanical (foreign body).
• Trauma to the abdomen, a thorax (usually closed trauma).
• The extra weight combined with a sedentary lifestyle.
• Smoking.
• Genetic predisposition.
• Diabetes.

Symptoms

Most often, the aorta ruptures into the abdominal cavity, although the possible violation of its integrity in the thoracic cavity or in the field of its divergence into smaller arteries.

Upon rupture of the vascular wall and the person experiences the following symptoms:

• Compression of the bronchi and trachea causes persistent coughing (often dry) and shortness of breath.
• Compression of the recurrent nerve (responsible for muscular work of the larynx) can cause osiplosti, hoarseness or complete loss of voice. You may also be difficulty and pain when swallowing, in the case of compression of the esophagus.

Bradycardia is often observed in the initial stages of damage to the wall of the abdominal aorta (dissecting aneurysm), in the later stages it may move to the tachycardia (when there has occurred a rupture of the vessel wall).

How is the diagnosis of aortic rupture

To identify gaps in the aorta and aneurysm, located in various places of the body with the help of modern medical techniques:

• Ultrasound. Informative non-invasive method to accurately determine the size of the aneurysm, localization and size of para-aortic hematoma.
• CT. Carried out directly before a surgical intervention allows to accurately determine the size and localization of the aneurysm, rupture of vessel, size of the stent (a special design that allows to expand the lumen of the aorta).
• The aortography. Is carried out with contrast agent filling the cavity of the aorta (with catheter) with subsequent multiple x-rays. Next, the doctor examines the pictures and identify the pathology of the aorta, including protrusions and gaps. In the process of medical manipulations carried out perforation of a large vessel, which can cause complications (bleeding, thrombosis, embolism, and others), the study of the abdominal aorta introduction of catheter is near the spine, which can also threaten with complications.
• Laparoscopy. Surgical intervention to determine the presence of blood in the abdominal cavity, the retroperitoneal fat. Also, it is an invasive examination with possible complications.

During the survey, it is also necessary to control blood pressure andto study the ECG of the patient in dynamics, because the symptoms can resemble a myocardial infarction, heart stroke or other heart disease.

Treatment of aortic rupture

In the first instance, the rupture of the aorta symptomatic therapy:

• Analgesia (intramuscular injection morphine).
• If collaptoid reactions intravenously or subcutaneously may be administered dopamine or mezaton with subsequent blood pressure control.
• At elevated pressure introduced antihypertensive drugs (sodium nitroprusside, magnesium sulfate) intravenously.

The patient urgently hospitalitynet in the Department of vascular surgery. In a hospital carried out a further examination and, subject to the confirmation of the diagnosis (symptoms similar to heart disease), surgery is carried out.

Conservative treatment of rupture of the aorta does not exist. The emergency order is the replacement of the damaged portion of the vessel with a synthetic graft. Material "substitute" of the aorta has a high biocompatibility and can be installed for a long time.

There are 2 possible explanations:

• Abdominal surgery.
• The endoprosthesis.

Abdominal surgery

The disadvantages of this intervention include:

• Heavy General anesthesia, which is not to move the elderly.
• Significant blood loss (completion of blood transfusion is performed).
• A significant area of surgical intervention.
• Long period of rehabilitation (up to 3 months).
• The need for bypass surgery and stenting for ischemic heart disease.

The benefits include:

• Prostheses used for abdominal surgery, are more durable than the prostheses for joint replacement.
• For patients requires routine care that do not require frequent and careful monitoring.

Arthroplasty

Endovascular method has its advantages and disadvantages.

Disadvantages:

• Arthroplasty cannot be performed with high tortuosity of the vascular and the substantial stretching of the portion of the aorta.
• The patient required almost constant monitoring for timely adoption of measures to further strengthen the vascular wall.
• In the case of non-compliance of medical prescriptions may re-expansion of the vascular wall (you must carefully monitor pressure and make antiatherosclerotic drugs).

Advantages:

• Low invasivenesssurgical intervention and the possibility of hosting the elderly.
• Not require General anesthesia (only local anesthesia).
• There is no need to artificially ventilate the lungs.
• Small blood loss not requiring blood transfusion.
• The discharge of a patient is performed in 3-4 days.
• After this intervention the intestine retains its normal function.

The choice of treatment by a medical doctor on an individual basis, after examine the symptoms of the disease, the studies and accurately diagnosed.

What if the examination revealed an aneurysm?

In the case of the detection of aneurysms depending on the readings can be conducted in 3 treatment regimens:

• Is stenting - the installation of a special frame made of metal or plastic. This gives additional strength to the vascular wall and prevents rupture of the aorta.
• Surgery is performed to replace the damaged portion of the vessel prosthesis (similar to the treatment of rupture of the aorta during abdominal surgery.
• Is the endoprosthesis of the prosthesis are introduced separately through large vascular, and assembled directly in the area of pathology. Operation is possible with the prosthesis of the abdominal aorta.

Prevention of aortic rupture

To preventive measures include early treatment of the disease that can cause an aneurysm (atherosclerosis, diabetes mellitus and others), careful monitoring of blood pressure and timely adoption of antihypertensive drugs. It is also necessary to exclude trauma, heavy physical activity after 50 years periodically ultrasound to detect aneurysms and their treatment.