Aortic dissection: clinical picture, types, diagnosis and treatment
An aortic dissection is one of the most serious damage of the vessel, represents a lethal threat to life. According to statistics, 65-70% of victims do not seek help, dying of severe internal bleeding. Of undergoing surgery about 30% of patients do not survive. The forecasts in this disease is far from rosy.
Is crucial for the survival when aortic dissection is timely diagnosis. Despite the relatively simple methodology for determining the damage cases do not recognize is frequent.
The clinical picture
The aorta comprises three layers - inner, middle and outer. The stratification is due to deficiency of the middle layer for any particular site. Because of this damage and possible tear of the inner layer (intima) and the formation of a false lumen between intimal and the outer shell. Tear can capture a portion of the aorta or distributed throughout the internal volume.
- The development of dissecting aneurysm may be suspended at the site where the tissue of the aorta has not undergone changes. The resulting cavity is called the "blind bag". In the future, it may be completely filled with thrombi, which leads to self-destruction crack.
- Penetration of blood between the layers contributes to the spread of damage: because the blood moves in the aorta under high pressure. An aortic dissection can extend into the artery that leads to global disturbances in the circulation. When you break the outer layer of the vessel is massive blood loss. To save a patient in this situation is almost impossible.
Dissection or dissecting aneurysm can form in any part of the aorta and ends with the rupture of a vessel within a few hours or days.
- 1 type - a aortic dissection begins in the ascending part of and moves at least along the arc. According to statistics, this form is observed in 50% of victims.
- Type 2 is the stratification of aneurysms localized to the ascending phase. This disease affects around 35%.
- 3 type - the formation of the false lumen begins in the descending part of and develops in distal, or up in an arc that is less common. Patients with type 3 dissecting aneurysms accounted for 15%.
A simplified classification divides diseases by type A, which corresponds to lesions of the ascending arc, and type B dissection descending.
Causes of disease
An aortic dissection is formed on the background of already existing degenerative changes in the tunica. Mechanical cause of violations of acts of excessive physical effort, emotion, or caused bysome other factor in the jump in blood pressure.
The real reason are disorders and diseases that cause degeneration of the tissue of the vascular.
- Atherosclerosis, in particular the form that affects the blood vascular vascular - arterioles and capillaries that serve the very aorta.
- Hypertension or any other disease, is fraught with a sharp drop in blood pressure. Provocateur aneurysms are sharp differences, not just high value.
- Excessive exercise, too much painful experience to the weakening of blood vascular and a tendency to hypertension.
- Congenital - hypoplasia, for example, and related diseases - spondylitis.
The cause may be direct mechanical damage when injected into the vessel of a foreign body, but such cases are quite rare. Treatment, however, almost always involves surgery.
Very rarely, the aortic dissection is not accompanied by pain. However, this exception to put it mildly, not happy: if in the ascending phase is already formed aneurysm, the dissection is painless.
In all other cases, the symptoms of aortic dissection are the strongest of unbearable pain. Moreover, the treatment includes taking pain, but not always, the symptoms manage to suppress. The pain is localized in accordance with the damaged area, and the promotion of dissecting aneurysms can move to different areas of the body.
- With the defeat of upward - thoracic aorta, the pain is concentrated in the front of the sternum. Usually this is a sign of proximal bundle.
- In the distal stratification characterized by pain in salopettes region.
- Disease type 1 is accompanied by pain in the front, and salopettes region. If the dissection extends distal, there is an overflow of pain in the neck and jaw, and then on the back, lower back and even the groin.
- The defeat of the abdominal aorta causes severe pain in the abdomen. Also a symptom of aortic dissection is numbness and pain in the legs. Damage to the abdominal aorta may be accompanied by failure of internal organs - intestines, for example. And in the blockade of blood circulation in the spinal cord, dissection of the abdominal aorta provokes disturbances in mobility and partial paralysis.
Many patients describe the pain as tearing apart the bundle. However, the same kind of symptoms occur in acute infarction, acute violation of brain blood circulation, and even "acute abdomen". Characteristic of stratification and the abdominal and thoracic aorta is sharp, sudden and persistent pain.
The patient is very restless, constantly trying to change the position of the body toto ease the pain. This is the second characteristic feature, as, for example, angina pain with limited activity weakens.
Diagnosis and treatment
For diseases of the heart and vascular is characterized by the similarity of symptoms with completely different causes, which is extremely complicates the definition of the disease and its treatment. Sometimes this leads to fatal errors.
So, the symptoms of an aneurysm of the proximal aorta is very similar to coronary artery ischemia, treatment of which requires the input of thrombolytics - drugs that dissolve blood clots that when stratification is death, as the triggers active development of the disease.
The correct diagnosis
The stratification of the thoracic or abdominal aorta should be suspected in any patient with acute, tearing apart the pain in the sternum or salopettes region, with fainting for unknown reasons, especially in cases where a fixed difference between the pulse and blood pressure.
To establish or refute the presumptive diagnosis is possible using these methods:
- The primary diagnostic tool is a traditional radiography. The method allows to detect the shape changes of the aorta, displacement of the chest and even fluid in the lungs. In this picture, the x-ray are assigned to more detailed studies.
- Echocardiography (transesophageal) - this method gives the most accurate picture, because the sensor is behind the heart in the vicinity of the aorta. When you bundle it fixes the double silhouette.
- With the defeat of the abdominal aorta is an abdominal ultrasound. Here, the method is usually duplicated by Doppler, allowing to obtain a more detailed picture of circulatory disorders.
- MRI is a highly informative method, but its use is justified only in non-critical cases, which happens infrequently. As a rule, this diagnosis is a reason for urgent surgery, and the patient simply do not have time to research, occupying more than 10-20 minutes.
- Angiography - informative value is a benchmark study. Its essence boils down to the introduction through the arteries of the catheter and advancing it in the direction of the aorta. However, there is a risk of the catheter into a false move, which can completely distort the picture. In addition, the movement of the foreign object may cause further delamination. The result of echocardiography, despite some errors, is used more often.
The treatment of the patient with aortic aneurysm
The rate depends on the duration of separation and localization. However, in any case, the treatment involves immediate transportation to the hospital and complete physical rest, as any kind of activity provokes further damage to the shells of the vessel and maylead to irreversible consequences.
To suppress such effects to patients intravenously administered drugs that reduce blood pressure.
The dissection of the thoracic aorta is an indication for immediate surgical intervention, regardless of the timing of the formation. Treatment, that is, the operation involves excision of the damaged site and its prosthetics with synthetic vessel.
If the damage is a rising arc of one surgery is enough to completely eliminate stratification. If the lesion was exposed and the descending part, the prosthesis and the abdominal aorta, is carried out in the second turn.
- Patients with dissection of the abdominal aorta is not so critical, and the operation in this case is planned. However, if there is a threat of rupture of the aorta, and there is a progressive disruption of the abdominal cavity, the patient is emergency care.
- No operation is conducted in cases where studies clearly show that about section successfully trombicula.
An aortic dissection is a disease that threatens life. Misplaced doubt need surgery or not. Even thorough preparation and perfect execution are not a 100% guarantee of survival of the patient. But if treatment is not carried out, the chances of further life reduced to 20-30%.