Aneurysm
Introduction
Introduction to aneurysms Divided into true, pseudo and dissection aneurysms, mostly caused by arteriosclerosis or trauma, syphilis is rare, can occur in the carotid artery, subclavian artery, radial artery, radial artery, radial artery, radial artery, femoral artery and iliac In the arteries and other parts, the femoral artery and the iliac artery are the most common sites. This disease often has a history of arteriosclerosis, hypertension or trauma. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific people Mode of infection: non-infectious Complications: cerebral infarction, intracranial aneurysm
Cause
Aneurysm etiology
Disease factor (50%)
Atherosclerosis occurs mostly in the elderly over the age of 50, often accompanied by hypertension, coronary heart disease and so on. Non-inductive aneurysms are mostly caused by immune diseases, such as multiple arteritis, Behcet's syndrome. As well as congenital arterial wall structural abnormalities such as Marfan syndrome and Ehlers-Danlos syndrome.
Infection factor (43%)
Often caused by sharp or blunt damage. In the case of tuberculosis, bacterial endocarditis or sepsis, the bacteria can invade through the wound and invade the arterial wall, resulting in weak arterial wall formation of infectious aneurysms.
Prevention
Aneurysm prevention
Switching to a diet that lowers blood pressure and atherosclerosis may help to prevent the development of an aneurysm, know if you are at risk for an aneurysm, and use appropriate measures to prevent aneurysm formation, especially if you have a stroke Or family history of heart disease, change your eating habits and lifestyle to improve your overall health, exercise regularly, pay attention to your diet, and quit if you smoke.
Complication
Aneurysm complications Complications Cerebral infarction intracranial aneurysms
Common complications after aneurysm embolization are:
1. Aneurysm ruptures again
Is a serious complication of endovascular embolization, due to rapid fluctuations in blood pressure, intraoperative mechanical stimulation, postoperative anticoagulant treatment caused by changes in blood coagulation mechanism, tumor rupture and mortality increase with age, patients can suddenly appear Mental tension, painful expression, incitement, severe headache, varying degrees of disturbance of consciousness, urinary incontinence, urgent examination of CT showed subarachnoid hemorrhage, lumbar puncture visible blood cerebrospinal fluid, nursing patients must be carefully observed at any time, timely discovery and notification to the doctor in time Treatment, postoperative neurosurgery ICU carefully observe the patient's state of consciousness, pupillary changes, physical activity, vital signs, especially blood pressure and respiratory changes, control of lower blood pressure, reduce blood pressure to about 16 / 1 lKpa, right The patient is awake and instructed to stay in bed for 48-72 hours. Do not shake the head vigorously within 48 hours to maintain emotional stability and smooth stool.
2. Cerebrovascular spasm
It is a common complication after embolization of intracranial aneurysm. If the patient has transient neurological dysfunction, such as headache, blood pressure drop, transient disturbance of consciousness and limb paralysis, it may be caused by cerebral vasospasm. Report to the doctor promptly. To expand the volume, relieve the treatment, continue to low-flow oxygen, improve the hypoxia of the brain tissue, care for patients at any time to pay special attention to changes in nervous system symptoms, and do a good job of patient psychological care, angiography, embolism 3 to 4 weeks, in order to prevent cerebral vasospasm, clinically, Nimo is commonly used with continuous micro pumping. Nemo is a calcium ion antagonist that acts highly selectively on brain tissue, which can directly expand the cerebral blood vessels. Increased cerebral blood flow can also act on neuronal cells, enhance its ability to resist ischemia and hypoxia, and accelerate the recovery of its normal physiological activities. In the application of Nemo, the heart rate should be closely monitored, blood pressure changes, such as blood pressure drop, flushing, For reactions such as palpitations, the drip rate should be slowed down or the drug should be stopped, and rehydration, expansion and supportive treatment should be given.
3, hematoma at the puncture site
Hematoma is prone to occur within 6 hours after surgery. The reason is that the arterial vascular elasticity is poor, intraoperative heparin excess or coagulation mechanism disorder, postoperative puncture side limb activity is frequent, local compression force is different, etc., mainly manifested as local swelling, purpura, patient surgery After the safety back to the ward, the patient should be lying flat for 24 hours, and the wound sandbags should be compressed for 6 hours. At the same time, the lower limbs of the puncture site should be flexed, braked, and the local bleeding at the puncture site can be observed at any time. The hematoma is not treated with a small hematoma. Can be self-resolving, such as large amount of bleeding, blood pressure, large hematoma, in addition to compression of the femoral artery compression dressing, 24h after hot compress local, foot elevation, in order to facilitate venous return, and pay attention to observe the patient's dorsal artery pulsation .
4, cerebral infarction formation
Postoperative thrombosis or thromboembolism caused by cerebral infarction is one of the complications of surgery. In severe cases, it can be caused by cerebral artery occlusion and brain tissue ischemia. The postoperative examination of language, movement and sensory function should be closely observed. Patients communicate, in order to detect changes in the disease early, such as postoperative limb weakness, hemiplegia, aphasia and even unconsciousness, should consider the possibility of cerebral infarction, immediately notify the doctor to deal with, the patient is in a hypercoagulable state, regular Give short-term 48h heparinization, combined with long-term aspirin treatment, to prevent cerebral infarction, close observation of bleeding tendency during treatment, blood pressure every 10 ~ 30min, and detailed records, observe the gums, conjunctiva, skin with or without bleeding , color of urine and urine, as well as symptoms of intracranial hemorrhage such as headache, vomiting.
5, lower extremity thrombosis
In the embolization treatment, different degrees of vascular endothelium damage can cause the formation of lower extremity arterial thrombosis, which is characterized by different degrees of cyanosis or lower extremity pain in the lower limb skin of the operation side. The pulsation of the dorsal artery of the foot is obviously weakened compared with the contralateral side, suggesting the possibility of embolization of the lower extremity. The dorsal artery of the foot was touched once every 15 to 30 minutes after operation, and the peripheral circulation of the lower extremity was observed. For example, whether the pulsation of the dorsal artery of the foot was weakened or disappeared, whether the skin color, temperature, and pain were normal, and the patient was in a hypercoagulable state after surgery. , mental stress, lack of appropriate activities, once the lower extremity venous thrombosis, paralyzed patients absolutely bed, raise the affected limb, facilitate venous return, limit limb activity, follow the doctor's advice to give thrombolysis, anticoagulant medication.
6, delayed allergic reactions
Application of ion contrast agents is prone to allergic reactions, but some patients can still develop allergic reactions with non-ionic contrast agents. The contrast agent enters the human body for a long time. When the dose is large, similar allergy symptoms may occur. Mild allergy manifestations are: headache. Nausea, vomiting, itchy skin, urticaria, etc., severe cases of shock, difficulty breathing, limb convulsions, etc., therefore, closely observe the changes in the condition, familiar with the treatment of allergic reactions of contrast agents.
7, hydrocephalus
It is the most common complication of aneurysm surgery. Acute hydrocephalus can be solved by external drainage of the brain at the same time, and chronic hydrocephalus requires surgical shunt.
Symptom
Symptoms of aneurysm Common symptoms Venous varicose Horner syndrome Fatal upper respiratory tract bleeding Trigeminal nerve distribution area Numbness Lower limb blood pressure Low dyspnea Aortic ring dilatation Low temperature coma "E" sign Arterial oxygen saturation decreased
1. There is often a history of arteriosclerosis, hypertension or trauma.
2. Insufficient blood supply to the distal artery of the affected limb. If the tumor is large, compressing nearby nerves and veins, limb pain, numbness, varicose veins, swelling, carotid aneurysm may cause insufficient blood supply to the brain, oppressing adjacent tissues, and sound may occur. Deaf, cough, difficulty breathing and Horner's syndrome.
3. There are round or fusiform masses along the arterial line, the surface is smooth, tight and elastic, expansive pulsation, touch with fine tremor, squeaking and squeaking during the systolic period, compressing the proximal end of the artery, shrinking the mass, pulsating, tremor and murmur disappear.
4. X-ray film, the tumor wall may have calcification, angiography can determine the location, size, extent and collateral circulation of the tumor.
Examine
Aneurysm examination
(1) X-ray plain film examination: can display calcified tumor wall.
(2) Arteriography: To determine the location, extent, size, etc. of the aneurysm, it is helpful to confirm the diagnosis and formulate the surgical plan.
(3) Ultrasound examination: the size, pulsation and noise of an aneurysm can be measured.
(4) Reactive hyperemia test: Observe whether the collateral circulation of the affected limb has been fully established.
Method: first raise the affected limb, and wrap it from the distal end to the underside of the aneurysm with an elastic bandage to drive out the blood in the limb, and then press the artery with the finger above the aneurysm until the beat of the aneurysm disappears; After 5 minutes, the elastic bandage is released, but the finger continues to press the artery. If the skin of the affected limb is red in 2 to 3 minutes and reaches the finger (toe) end, the collateral circulation is fully established, such as not being issued within the above time. Red, indicating that the collateral circulation is not fully established, such as carotid aneurysm, can compress the carotid artery, after 30 minutes of compression, the patient still does not have dizziness, ocular ocular and other ischemic symptoms, indicating that the brain has sufficient collateral circulation form.
Diagnosis
Diagnosis of aneurysm
The identification of different types of aneurysms is a prerequisite for the clinical diagnosis and treatment of aneurysms.
First, the morphological type of aneurysm
1. Cystic aneurysm: The wall of the affected vascular segment is spherically expanded, and the larger one can reach 15 to 20 cm in diameter. Because of the vortex formed when the blood flows, the aneurysm often forms a thrombus.
2. Fusiform aneurysm: the wall of the blood vessel is evenly expanded, and gradually shrinks toward the end until it reaches the original diameter of the blood vessel, so it is fusiform, and this artery has less thrombus.
3. Cylindrical aneurysm: The initial blood vessel suddenly expands in a roller shape, and also suddenly transitions to normal blood vessels, and a wall thrombus can occur.
4. Sick aneurysm: the vessel wall is dilated one-sided, while the contralateral vessel wall is unchanged; common in dissecting aneurysms.
5. Sickle aneurysm: The adjacent vascular segments are asymmetrically dilated. Therefore, the affected vessels are bulging and bulging, and most of them are seen in blood vessels whose blood flow direction is changed again (such as the pelvic artery).
Second, according to the structure classification of aneurysm wall
1. Aneurysm verum The wall is composed of all three layers of vascular wall tissue, and most aneurysms belong to this type.
2. Pseudoaneurysm (aneurysma spurium) Mostly due to vascular trauma, blood enters the surrounding tissue through the rupture to form a hematoma, and then the hematoma is mechanized and its inner surface is covered by the endothelium. Therefore, pseudoaneurysm is a kind of Endothelium-covered hematoma.
3. Dissected aneurysm (aneurysma dissecans) is more common in the elderly (except for patients with marfan syndrome), more men than women, more from the blood vessels of the vascular tree shear stress and the most obvious changes in blood pressure (ascending aorta, Starting from the aortic arch), blood flow from the rupture of the intima into the pathologically loose middle membrane (a few are from the nourishment of blood vessels), and the medial collaterals are split in the direction of blood flow to form a pseudovascular lumen. The vascular lumen can be broken into the lumen of the true blood vessel again. The blood flow is like a bypass. The etiology and pathogenesis of this aneurysm is quite complicated. It can be seen in congenital vascular malformations and metabolic connective tissue diseases (such as marfan syndrome). , the elastic fibers of the aorta in the aorta are broken, missing, collagen and proteoglycan increase), the vascular wall proteoglycan increases when the thyroid function is too low, syphilitic aortitis and atherosclerosis.
