Abdominal aortic aneurysm in the elderly
Introduction
Introduction to abdominal aortic aneurysm in the elderly Abdominal aortic aneurysm (abdominalaorticaneurysm) is one of the senile diseases, often occurs in men, and the age of onset is more than 60 years old. The vast majority of the disease occurs on the basis of arteriosclerosis. It is one of the diseases that threaten the lives of the elderly. The diagnosis and treatment should emphasize early detection, early treatment, and should be followed up for a long time. basic knowledge The proportion of the disease: the incidence rate of the elderly over 60 years old is about 0.05% - 0.07% Susceptible people: good for men over 60 years old Mode of infection: non-infectious Complications: jaundice, intestinal obstruction, renal colic
Cause
The cause of abdominal aortic aneurysm in the elderly
Disease factors (95%):
The majority of the causes of abdominal aortic aneurysm in elderly patients are from atherosclerosis, accounting for about 95%.
Other factors (5%):
Other causes are rare, including trauma, infection, degeneration of the arterial layer, congenital factors, non-infectious aortitis and syphilis.
Pathogenesis
Abdominal aortic aneurysm occurs mostly on the basis of arteriosclerosis. This is due to the degeneration of arteriosclerosis, which causes degeneration of the middle layer of the arteries, resulting in weak arterial wall and decreased tension. Under the continuous action of arterial blood pressure, the arterial wall partially expands and Inflated, when it expands and expands more than 3cm in diameter, it can be called an aneurysm. In addition, the congenital arterial wall is weak, the arterial middle muscle fibers and elastic fibers are poorly developed, and can not withstand arterial pressure; and due to inflammatory diseases such as syphilis, Tuberculosis or multiple arteritis causes vascular nodules in the arterial wall, causing degeneration of the arterial wall, which can lead to the expansion and expansion of the artery. The lesions of the aneurysm mainly occur in the intima and middle layers of the artery, which is a full-thickness expansion. Inflated, but under the action of eddy current, the intima and middle layer can also be broken into a dissection aneurysm. At this time, the aneurysm will increase rapidly, and clinical symptoms or original symptoms will increase. This is a precursor to aneurysm rupture. deal with.
The lumen of an aneurysm is larger than that of a normal artery. When blood flows from a normal arterial lumen to an enlarged aneurysm lumen, eddy currents are generated. At this time, the aneurysm can tremble and tremble and can smell. Vascular murmur, the tumor continues to be affected by arterial pressure for a long time, and it will inevitably gradually increase. Because of the uneven thickness of the tumor wall, the tumor will rupture under the constant impact of blood flow, and the tumor of the artery will rupture and bleed. The disease progresses rapidly and often leads to death.
In addition, due to the intimal roughness and eddy current formation of the aneurysm and relatively slow blood flow, it is easy to cause thrombosis. After the thrombus is mechanicalized, it is attached to the blood vessel wall, which is called a wall thrombus. It has self-protection effect. After the thrombus falls off, it can cause acute artery. Embolization can also embolize the distal end of the tumor, or secondary infection, causing the aneurysm to rupture.
Prevention
Elderly abdominal aortic aneurysm prevention
Prevention of the disease is focused on preventing the formation and discovery of arteriosclerosis, including limiting the intake of animal fats and other high-cholesterol foods, quitting smoking and alcohol, and performing appropriate physical exercise. Once abdominal aortic aneurysms are formed, alcohol should be strictly stopped. Exercise, to avoid irritability and excessive mental stress, to reduce the aneurysm rupture caused by external causes, those who have no surgical contraindications should seek early surgical treatment.
Complication
Elderly abdominal aortic aneurysm complications Complications, jaundice, intestinal obstruction, renal colic
Can be complicated by jaundice, bleeding, renal colic, intestinal obstruction and so on. Abdominal aortic aneurysm can also be complicated by lower extremity arterial embolism, ureteral compression caused by hydronephrosis and abdominal aortic aneurysm rupture and other common complications of the disease, including abdominal aortic aneurysm rupture is the main cause of sudden death, abdominal aortic intestine Ankle and abdominal aortic inferior vena cava are rare complications, and the tumor occasionally sticks to adjacent intestines.
Symptom
Abdominal aortic aneurysm symptoms in the elderly Common symptoms varicocele abdominal discomfort jaundice urinary frequency hypertension blood pressure drop urine flow is blunt pain ureter centripetal deviation systolic murmur
Most patients with abdominal aortic aneurysm have no symptoms, and most of them are found in routine abdominal examinations. They are called quiet abdominal aortic aneurysms. With the development of regular physical examination, this type of aneurysm is gradually increasing. Among the patients, the common symptoms are abdominal pulsatile mass, followed by dull pain in the umbilical or upper abdomen, or only abdominal discomfort. When the aneurysm invades the lumbar vertebrae, there may be lumbosacral pain, and sometimes the aneurysm increases. Even can enter the duodenum or jejunum, resulting in gastrointestinal bleeding, in addition, the tumor is enlarged, can produce some compression symptoms, such as compression of the common bile duct jaundice; compression of the duodenum caused by intestinal obstruction; compression of the ureter Causes renal colic or hematuria; when the bladder is compressed, there may be frequent urination and fluctuations in urine flow.
At the time of physical examination, there may be swelling pulsation in the umbilical or mid-abdominal abdomen. The diameter of the tumor varies from 4 to 20 cm. There is no tenderness on the surface of the tumor at the early stage of the disease. When it is increased to a certain extent, it may have different degrees. Mild pain; can also smell systolic murmur, some patients may have lower limb ischemia, lower limb blood pressure, post-orbital artery and dorsal artery pulsation weakened or disappeared, etc. When the tumor compresses the iliac vein, it can cause swelling of the lower limbs. Compression of the spermatic vein causes varicocele.
Abdominal aortic aneurysm associated with hypertension may have a significant increase in blood pressure.
Examine
Examination of abdominal aortic aneurysm in the elderly
When hematuria, urine routine examination, increased red blood cells.
1. Abdominal X-ray film examination
Oval calcification of the wall of the aneurysm, that is, the "egg shell" is sometimes seen, which is helpful for diagnosis.
2. Ultrasound examination
B-mode ultrasound can understand the following issues:
1 with or without abdominal aortic aneurysm.
2 The size of the aneurysm.
3 There is no thrombosis in the aneurysm cavity, the location, size, extent of the thrombus and the size of the channel in the aneurysm.
4 The extent of aneurysm pulsation.
3. Electronic Computer Tomography (CT)
In general, CT has no superiority compared with B-ultrasound, but it has obvious superiority in diagnosis and measurement of the abdominal aorta, thoracic and abdominal aortic aneurysm and abdominal aortic aneurysm involving the common iliac artery. Sexuality, CT cross-sectional image, can more comprehensive understanding of the relationship between the tumor and the organ.
4. Magnetic resonance examination (MRI)
No need for contrast agents, the shape and structure of the aortic aneurysm can be clearly displayed. In addition to the cross-section, the sagittal image can be obtained, which is very helpful for diagnosing dissection aneurysms, but it is more expensive.
5. Ultrasound Doppler blood flow examination
Mainly check the blood flow of the extremities and carotid arteries to understand the presence or absence of peripheral arteriosclerosis obliterans, especially the examination of lower extremity blood flow is more important, the determination of surgical procedures, the choice of revascularization procedures, etc. .
Abdominal aortic angiography
It is the most reliable and accurate method to understand the extent of the lesion and the affected artery at the same time. It has guiding significance for the development of surgical procedures and preparation of suitable artificial blood vessels, but whether it is used as a routine examination has been controversial, because once the tumor cavity When there is a wall thrombus, the abdominal aorta angiography can not reflect the actual size and overall appearance of the tumor, and the high-pressure injection of the contrast agent occasionally causes the aneurysm to rupture. Therefore, the method can be selectively applied without regular use. It is good to choose the transradial approach and place the catheter on the upper end of the aneurysm to avoid damage to the aneurysm due to intubation, and to avoid arterial embolism caused by thrombus loss.
Diagnosis
Diagnosis and diagnosis of abdominal aortic aneurysm in the elderly
diagnosis
Elderly patients with atherosclerosis, if there is abdominal discomfort and pulsatile mass in the abdomen should be highly suspected abdominal aortic aneurysm, an auxiliary examination is needed to make an early diagnosis.
Differential diagnosis
Aneurysms should be distinguished from retroperitoneal masses and pancreatic tumors. The latter two have a conductive pulsation, but there is no swelling. The abdominal aortic aneurysm has a special sense of swelling. It can be distinguished by abdominal color Doppler examination. .
