Descending thoracic aortic aneurysm
Introduction
Introduction to thoracic descending aortic aneurysm A descending aortic aneurysm is the most common aneurysm in thoracic aortic aneurysms. In the past, the cause of descending aortic aneurysms was mostly syphilis, and most of them are currently caused by atherosclerotic lesions. Factors such as advanced age and hypertension increase the incidence of atherosclerotic lesions. Other causes include trauma, bacterial infection, and necrosis of the middle layer of the artery. Most descending aortic aneurysms occur in the proximal descending aorta, located distal to the left subclavian artery. The diseased aorta is fusiform, varying in length, sometimes involving the full length of the descending aorta or even extending into the abdomen. Near artery. The aneurysm grows slowly and eventually breaks through the bleeding. After a clear diagnosis by chest X-ray, the average survival time is about 3 years. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: hemoptysis
Cause
Causes of thoracic descending aortic aneurysm
In the past, the cause of descending aortic aneurysms was mostly syphilis. At present, most of them are caused by atherosclerotic lesions. Older age, high blood pressure and other factors increase the incidence of atherosclerotic lesions. Other causes are still traumatic, bacteria. Sexual infections and necrosis of the middle layer of the artery.
Prevention
Thoracic descending aortic aneurysm prevention
There is no effective preventive measure for this disease. Early diagnosis and early treatment is the key to the prevention and treatment of this disease. However, in patients with giant aortic aneurysm, large aneurysms can be combined with larger wall thrombosis, so it is also possible to cause embolism due to thrombus shedding. And antiplatelet therapy may help prevent thrombosis.
Complication
Chest drop aortic aneurysm complications Complications hemoptysis
Aneurysm compression of the left main bronchus can cause dyspnea, rupture into the lungs or bronchus produces hemoptysis, oppression of the left recurrent laryngeal nerve is hoarse, the aneurysm grows slowly, and finally wears through the bleeding, and the disease is the most serious Complications are complicated by thrombosis, because once the formation mechanism of the aneurysm is initiated, the aneurysm will continue to increase under the impact of high-speed and high-pressure blood flow of the aorta. If a large aneurysm is formed without timely treatment, the aneurysm Local turbulence can form in the surrounding area, thus providing a pathological basis for thrombosis, and local tearing after force may be a triggering factor. If the thrombus falls off, it may cause embolism and bring life to the patient.
Major bleeding is a common and dangerous complication of aortic aneurysm surgery. It is also the main cause of surgical death in early years. The prevention and treatment of hemorrhage is the key to the success of aortic aneurysm surgery:
1 should choose the appropriate surgical method, in order to have a good field and sufficient operating time.
2 surgical operation should be soft, precise, and true.
3 bleeding should not rely on artificial hemostatic material filling, due to poor filling effect, easy to infection, easy to form a pseudoaneurysm locally, proximal anastomotic bleeding can be used right atrial shunt.
4 strict control of blood pressure after surgery to prevent hypertension from anastomotic bleeding.
Symptom
Chest drop aortic aneurysm symptoms Common symptoms Chest pain, hoarseness, dyspnea, hemoptysis, high blood pressure, dull pain
Thoracic descending aortic aneurysms may not present any symptoms at an early stage. When an aneurysm grows up, it often complains of chest pain between the back shoulders. Sometimes the pain is in the lower back, shoulders, upper limbs or neck. The pain is often persistent dull pain. Aneurysm compression of the left main bronchus can cause dyspnea, rupture into the lungs or bronchus produces hemoptysis, and oppression of the left recurrent laryngeal nerve is hoarse.
The risk of aneurysm is high. Although some patients have no clinical manifestations, once the formation mechanism of aneurysm is initiated, under the impact of high-speed and high-pressure blood flow of the aorta, the aneurysm will continue to increase, and then the surrounding organs will be pressed. The clinical manifestations, even the tumor rupture, caused the patient to die. According to the literature, if the aneurysm has an inner diameter greater than 5.4 cm or combined with hypertension, it is more likely to rupture.
Examine
Examination of thoracic descending aortic aneurysm
1, chest X-ray examination and computed tomography examination can show aneurysm block and may see pulsation or thrombosis.
2, aortic angiography can clearly diagnose and show the location, shape and extent of the aneurysm, but because of its trauma, it may cause complications such as peripheral arterial embolization and the application is limited.
Diagnosis
Diagnosis and diagnosis of thoracic descending aortic aneurysm
The disease can be diagnosed according to clinical and examination, no need to identify, but the most important thing in clinical is to distinguish the cause of aneurysm. The most need to identify is atheromatous plaque and thrombus. Aortic angiography can not identify atheromatous plaque. With thrombus, transesophageal echocardiography (TEE) technology provides a high-quality real-time image of the thoracic descending aorta, which can accurately measure the size and extent of the tumor, showing that the blood flow is stagnant due to slow blood flow in the tumor. Echo, detected thrombus and atheromatous plaque, found that the compression of adjacent organs, because the formation of thrombus, new and old, and multi-layered changes, the newly formed thrombus is hypoechoic, and there is a sense of drift The echo center of the thrombus is weak, and the echo around it is strong. It seems to have a capsule-like structure. The pathological changes of the atheromatous plaque are mainly in the intima of the artery. The lesion protrudes into the lumen. The inside of the plaque can be hemorrhagic due to necrosis. In the echo zone, when the atheromatous plaque ruptures itself or collapses due to external force, the endometrium is interrupted to form a complex plaque. Therefore, the free surface of the plaque is irregular, with intimal rupture and ulcer formation, and multiple layers of thrombus. Change and surrounding The echo appears to have a sharp contrast to the envelope-like structure.
