Thoracoabdominal aortic aneurysm
Introduction
Introduction to thoracic and abdominal aortic aneurysms Thoracic abdomen aortic aneurysm (TAA) refers to the aorta that affects both the thoracic and abdominal segments, as well as abdominal aortic aneurysms that invade the renal artery. They are called thoracic and abdominal aortic aneurysms, although there are many procedures. And assisted methods to reduce surgical complications, but still have 5% to 10% perioperative mortality and renal, pulmonary and spinal ischemic complications. basic knowledge The proportion of illness: the incidence rate is about 0.003%-0.008% Susceptible people: no special people Mode of infection: non-infectious Complications: bloating
Cause
Causes of thoracic and abdominal aortic aneurysms
(1) Causes of the disease
Coselli counted the causes of 1914 patients with thoracoabdominal aneurysm repair, including medial E degeneration (73.4%), aortic dissection (26.6%), equine syndrome (6.8%), infection (0.6%), and aortitis ( 0.4%), Ehlers-Danlos syndrome (0.1%).
(two) pathogenesis
1. Pathology: The gross specimen of TAA and the pathology under the microscope can not be distinguished from the typical AAA. The age of patients with aneurysm secondary to chronic dissection is significantly smaller than that caused by degenerative changes, and the extent of involvement is wider. The pathological features of Mafang syndrome It is a true cystic mesenchymal necrosis, a rare pathological change that can lead to aneurysm formation and aortic dissection. Aneurysms can be caused by arteritis (Takayasu disease) or by non-specific giant cell arteritis. Tumors can be widely distributed locally or along the chest and aorta, and are often associated with visceral aneurysms (caused by infectious arteritis) and obstructive renal artery disease. Infectious aneurysms and infective endocarditis The relationship is more closely related. The pathogenesis of infectious TAA is usually the implantation of bacteria in atherosclerotic plaque. The development of local arteritis is accompanied by the decomposition of the arterial wall, followed by the formation of pseudoaneurysms.
2. Pathological type: According to the extent of aneurysm involvement, Crawford classifies TAA into 4 types.
Type I: The aneurysm begins at the distal aorta of the left subclavian artery and extends down to the renal artery, involving the intercostal artery, the celiac artery, and the superior mesenteric artery.
Type II: the thoracic and abdominal aorta have been involved, starting from the distal aorta of the left subclavian artery, and the invasion to the aortic bifurcation, the widest range, involving the intercostal artery, the celiac artery, the superior mesenteric artery and Double renal artery.
Type III: involving the distal descending aorta and all abdominal aorta, involving the intercostal artery, celiac artery, superior mesenteric artery, and renal artery.
Type IV: Aneurysms are located only in the aorta of the abdominal cavity, involving the celiac artery, superior mesenteric artery, and renal artery.
This classification is related to the surgical treatment of aneurysms and the occurrence of surgical complications, especially to ischemic injury of the spinal cord.
Prevention
Thoracic and abdominal aortic aneurysm prevention
Pay attention to rest, work and rest, and orderly life.
Complication
Thoracic and abdominal aortic aneurysm complications Complications
Chest tightness, bloating, pain, low blood pressure.
Symptom
Symptoms of thoracic and abdominal aortic aneurysm Common symptoms Chest tightness, low blood pressure, bloating, hoarseness, murmur, murmur, renal artery stenosis, vocal cord paralysis, dyspnea, kidney area, dull pain, edema
55% to 60% of TAA patients have symptoms.
1. Pain in the kidney area is the most common, but it is difficult to distinguish whether the muscle nerve problem is caused by an augmentation or rupture of the aneurysm (whether leakage or enveloping). Usually, the pain is more serious when the aneurysm ruptures, accompanied by Hypotension, about 50% of TAA patients have significant colic or renal vascular hypertension due to the presence of renal and visceral arteriosclerosis obliterans.
2. Adjacent organ compression symptoms: TAA compression of adjacent organs can produce corresponding symptoms, compression of the recurrent laryngeal nerve or compression of the vagus nerve can cause vocal cord paralysis, hoarseness; compression of the pulmonary artery can cause pulmonary hypertension and pulmonary edema; compression of the esophagus can be swallowed Difficulties; compression of bronchial dyspnea, there have been such cases: arteriolar angiitis oppression of the stomach cavity, due to the patient's lack of hunger and weight loss.
3. Multiple aneurysms: About 20% of patients have multiple sites of aneurysms, the most extensive being the giant aorta (maga-aorta). Aneurysms can occur in ascending, descending aorta and thoracic and aorta.
4. Other symptoms: Among the 1914 cases of Cosselli statistics, there are other symptoms of complications such as hypertension (75.8%), obstructive pulmonary disease (36.9%), coronary heart disease (35.5%), and renal failure (13.4%). , aneurysm rupture (11.1%), diabetes (5.7%), preoperative dialysis (1.4%) and paraplegia (0.6%).
5. Signs: 90.4% of patients in the abdomen can be swollen and exploding pulsatile mass, unlike abdominal aortic aneurysm can be clearly defined in the abdomen and its upper edge, the tumor is mild tenderness and in the corresponding visceral vascular opening area such as kidney Arterial and celiac artery openings, systolic murmurs in the bifurcations.
Examine
Examination of thoracic and abdominal aortic aneurysms
X-ray inspection
(1) Chest flat: chest and abdomen aortic aneurysm can often show mediastinal widening on the chest radiograph, and even calcification of the edge of the aneurysm, abdominal plain film: sometimes visible calcification of the aneurysm wall.
(2) Arteriography: Although it is an invasive examination, it is still the best examination currently recognized. According to the angiography, the size and extent of the aneurysm can be judged, the vascular condition of the organ is involved, the collateral circulation is established, and the thoracic and abdominal aorta is achieved. According to the classification, Debakey is classified according to the extent of aneurysm: type I, the lesion is above the renal artery; type II, the lesion involves the whole process of the thoracic and abdominal aorta, including: intercostal artery, celiac artery, superior mesenteric artery and double renal artery; Type III, aneurysm is located in the abdominal aorta, involving the superior mesenteric artery and the double renal artery of the celiac artery.
2. B-ultrasound: Doppler non-invasive examination can show the size of abdominal aortic aneurysm, presence or absence of wall thrombosis and involvement of intra-abdominal vascular disease and involvement of the lower extremity radial artery.
3. CT and MRI examination: non-invasive examination shows the contour, size and affected blood vessels of the aneurysm, especially when the artery is stratified, the anatomy and extent of the aneurysm can be clearly distinguished.
4. Esophageal ultrasonography (TEE) can show the condition of thoracic aortic aneurysm, true and false two-chamber aneurysm (Fig. 5).
The above tests can be complementary. It is not the above-mentioned examination that each patient must do all, but an optional examination to achieve the purpose of diagnosis.
Diagnosis
Diagnosis and diagnosis of thoracic and abdominal aortic aneurysms
1. Usually chest and aortic aortic aneurysm and abdominal aortic aneurysm can be complained of abdominal pulsatile mass, with few symptoms, symptoms can occur in the following cases.
(1) Symptoms of compression: Aneurysm enlargement and compression cause chest tightness and bloating.
(2) Aorta and its branches are obstructed. If the visceral artery branches are obstructed, celiac artery syndrome may occur, and the symptoms of insufficiency of the superior mesenteric artery and renal hypertension may be caused by renal artery stenosis.
(3) Aneurysm breaks into the adjacent organs or free abdominal cavity, which can cause massive hemorrhage such as duodenal fistula to cause acute upper gastrointestinal bleeding.
(4) Aneurysm stratification can cause tearing pain in the lower back, paraplegia and shock.
2. Symptoms of accompanying disease: There are many symptoms of aneurysm associated with disease, which is directly related to the cause of arteriosclerosis. In the aneurysm patients, the incidence of hypertension is as high as 44.8%, and coronary heart disease accounts for 26.5%. Lung and cerebral arteriosclerosis accounted for 18.3%, and a large number of long-term smoking history in aneurysms accounted for 57.1%.
3. Diagnostic steps: According to the symptoms and accompanying symptoms of the patient's aneurysm, the first feasible non-invasive examination, and then select 2 to 3 auxiliary examinations, angiography is still the best means of examination, when suspected aneurysm stratification or rupture At the time, you can choose to use MRI, CT and other tests instead of arteriography.
