Aortic aneurysm in the elderly
Introduction
Introduction to aortic aneurysm in the elderly Aortic aneurysm (aorticaneurysm) refers to a disease caused by local or diffuse abnormal expansion of the aortic intima and medial smooth muscle and elastic tissue, which oppresses surrounding organs. This disease is more common in the elderly. basic knowledge The proportion of sickness: 0.0052% Susceptible people: the elderly Mode of infection: non-infectious Complications: shock, sudden death
Cause
The cause of aortic aneurysm in the elderly
Atherosclerosis (30%):
For the most common reason, atherosclerotic plaque erodes the aortic wall, destroys the middle layer, degeneration of the elastic fiber, thickening of the wall due to atherosclerosis, pressure on the nourishing blood vessels, nutritional disorders, or nourishment of blood vessels It ruptures and accumulates blood in the middle layer, which is more common in older men.
Cystic necrosis (20%):
Mainly seen in ascending aortic aneurysm, more common in men, hereditary diseases such as Ma Fang syndrome, Turner syndrome, Ehlers Danlos syndrome. Infection is marked by syphilis, often invading the thoracic aorta.
Other (25%):
Including giant cell aortitis, Behcet's disease, multiple arteritis and so on.
1. Traumatic penetrating injury directly affects the aorta caused by the damaged aorta.
2. Congenital findings in aortic sinus tumors.
(two) pathogenesis
Aortic aneurysm can be divided into thoracic aortic aneurysm and abdominal aortic aneurysm according to its location. Thoracic aortic aneurysm can be divided into:
1 liter of aortic aneurysm: from the aortic root to the beginning of the innominate artery, can be complicated by aortic regurgitation.
2 arch aortic aneurysm: from the innominate artery to the left subclavian artery.
3 thoracic aortic aneurysm: from the left subclavian artery to the diaphragm of the aorta.
4 Thoracic and abdominal aortic aneurysm: From the lower end of the thoracic aorta to the upper end of the abdominal aorta, the predilection sites of the thoracic aortic aneurysm are: descending aorta, ascending aorta, aortic arch and thoracic and aorta, completely located in the abdominal aorta. Abdominal aortic aneurysm is more common in the level of renal artery. According to its morphology, aortic aneurysm can be divided into: saccular aneurysm, fusiform aneurysm. The saccular aneurysm is more likely to rupture due to the pressure concentration of the vessel wall than the fusiform aneurysm. Unless there is thrombosis or scar tissue formation to prevent further development of the tumor, the tumor gradually increases with age, eventually to rupture, because atherosclerotic lesions in the abdominal aorta are far more severe than the thoracic aorta, so atherosclerosis Aneurysms are more common in the abdominal aorta.
Prevention
Elderly aortic aneurysm prevention
1. For asymptomatic old age, avoid extreme cold, warm clothes in winter, do not bathe with cold water, avoid strong sun exposure on feet and calves, often walk to promote blood circulation, soak your feet with warm water and dry thoroughly, especially toes. To avoid skin rupture and infection, shoes and socks need to be loose and comfortable. Do not wear socks with elastic bands.
2. Intermittent claudication for the elderly, the effect of medical treatment is limited, but some cases have a certain effect, during the treatment period, to advise to quit smoking, obese people encourage weight loss, and as much activity as possible, walk to a certain time after the limp, should rest immediately, Then continue to walk, such as drug treatment is not satisfactory, the only method is surgical treatment, for arterial bypass grafting, or percutaneous transluminal angioplasty.
Complication
Elderly aortic aneurysm complications Complications
Common tumor rupture, hemorrhagic shock and sudden death. Aneurysm re-rupture is a serious complication of endovascular embolization, caused by rapid fluctuations in blood pressure, intraoperative mechanical stimulation, and changes in blood coagulation mechanisms after anticoagulation. The rupture and mortality of the tumors increase with age. The patient may suddenly have nervousness, painful expression, irritability, severe headache, varying degrees of disturbance of consciousness, and urinary incontinence. Acute CT examination showed subarachnoid hemorrhage, and bloody cerebrospinal fluid was seen in the lumbar puncture. Care patients must be carefully observed at any time, timely found and notified to the doctor to deal with. Postoperative neurosurgery ICU carefully observed the patient's state of consciousness, pupillary changes, physical activity, vital signs, especially blood pressure and respiratory changes.
Symptom
Symptoms of aortic aneurysm in the elderly Common symptoms Dysphagia, pain, dyspnea, hoarseness, calcification, hemoptysis, tremor, post-sternal pain, abdominal mass, spinal cord compression
Most patients with aortic aneurysm are asymptomatic in the early stage, and are often found occasionally during physical examination or chest radiography. The following symptoms and signs appear as the aneurysm increases in volume and the different parts of the aneurysm involve the surrounding tissue and even rupture.
Pain
For common symptoms, the pain is mostly painful and beating. It may be caused by dilatation of the nerve in the artery wall or compression of the surrounding tissue by the aneurysm. The pain caused by the thoracic aortic aneurysm is mostly located behind the sternum or back, such as compression erosion. Pain in the sternum, ribs or spine and nerves can be aggravated. The pain in the abdominal aortic aneurysm is mostly located in the umbilicus and mid-upper abdomen. It can be radiated to the waist or thigh. The pain can be changed with the body position. The aneurysm can be sustained when the lumbar vertebrae are invaded. Pain, when the aneurysm volume gradually increases, the general pain is not severe. If the pain suddenly increases, it often indicates that the tumor is on the verge of rupture.
2. Compression symptoms
Aortic arch aneurysm can stimulate, compress the trachea or block the bronchus, causing cough and dyspnea. Compression of the superior vena cava can manifest as superior vena cava obstruction syndrome. Compression of the recurrent laryngeal nerve appears hoarseness or aphasia. Lower aortic aneurysm can compress the esophagus. Dysphagia, abdominal aortic aneurysm compression pyloric or duodenal can occur nausea and vomiting, mesenteric artery compression can appear paralytic ileus symptoms, if compression of the spinal cord can appear different segments of spinal cord compression signs.
3. Heart dysfunction
Mainly seen in the ascending aortic root aneurysm, due to aortic valve insufficiency and reflux, can gradually appear left ventricular enlargement of cardiac dysfunction, aortic valve auscultation area can be heard diastolic and systolic murmur, once it appears Cardiac function can rapidly deteriorate after heart failure.
4. rupture
Tumor rupture is seen in 30% to 50% of patients, which may be a fatal symptom of initial onset. When the thoracic aortic aneurysm ruptures, the patient may have a sudden increase in chest pain, which is a severe tearing pain and cannot be relieved by analgesics. Trachea, bronchial bronchial blood may occur, rupture to the esophagus may cause a large amount of hematemesis, rupture to the pericardium can cause pericardial tamponade, abdominal aortic aneurysm rupture often breaks into the retroperitoneum or peritoneal cavity, the patient has abdominal and back tear pain and hemorrhagic shock Abdominal mass tenderness, abdominal muscle rigidity and jumping pain, bowel sounds weakened, and if the aortic aneurysm ruptured without emergency surgery, the vast majority of patients died.
5. Abdominal mass
Abdominal pulsatile mass is the most obvious sign of abdominal aortic aneurysm, usually in the upper abdomen or umbilicus. Palpation has the characteristics of dilatation and pulsation, and sometimes vascular murmur or tremor can be heard in the tumor. Diagnosis can often be established, but it needs to be differentiated from the pulsation of the normal aorta, especially in women with thinner body shape, such as obvious tenderness in the abdominal mass, suggesting that the tumor is close to rupture.
Examine
Examination of aortic aneurysm in the elderly
Diagnosis of aortic aneurysm In addition to the above symptoms and signs, the following examinations are helpful in diagnosis:
X-ray inspection
Thoracic aortic aneurysm can be found from the posterior anterior chest radiograph. The aortic abnormal enlargement shadow can be observed. The pulsatile mass can be observed under fluoroscopy. The abdominal aorta plain film can often show the diameter of the abdominal aorta widened, the wall calcification, and the tumor outside the tumor. Zhou's eggshell-like calcification shadow is characteristic, and the lumbar muscle shadow can disappear when the tumor is broken.
2. Aortic angiography
For accurate diagnostic techniques, the exact location and extent of the tumor and the relationship between the tumor cavity and the visceral artery can be clarified. It is meaningful to decide whether or not surgery can be performed, but there are certain risks and complications. The possibility of flaky thrombosis in the tumor cavity may not show arterial angiography. In recent years, digital subtraction angiography is used, which can be administered intravenously. The dosage is small, the method is simple and safe, and the abdominal aortic aneurysm can be obtained. The same effect of common aortic angiography.
3. Computerized tomography (CT)
Can clearly show the location, extent of the aorta, calcification of the tumor wall, thrombus and peritumoral conditions in the tumor cavity, such as posterior peritoneal hematoma, perirenal interstitial fluid accumulation, increased lumbar muscle shadow, blurred CT findings It is a poor display of the aorta and aortic aneurysm, and the involvement of the aortic branch is limited. It is necessary to understand the relationship between the abdominal aortic aneurysm and the renal artery opening. A thin-layer enhanced scan of the renal artery level can be added to determine the surgical plan. Significance.
4. Two-dimensional echocardiography
It can clearly show the length, diameter and wall thrombus of abdominal aortic aneurysm, and determine the thickness of the tumor wall. It has become an important non-invasive examination method commonly used at present. In recent years, transesophageal ultrasound technology has been used to overcome transthoracic wall ultrasound. The limitations of cardiogram can clearly show the location and extent of thoracic aortic aneurysm, which has great diagnostic value.
5. Magnetic resonance imaging (MRI)
It can show the location, length and expansion of the thoracic aortic aneurysm, determine the outer diameter of the aneurysm, MRI diagnosis of abdominal aortic aneurysm is very accurate, can clearly show the size, shape, extent, thickness of the tumor wall and the renal artery and The relationship between the common iliac artery.
The white blood cell count is increased, the hemoglobin is decreased, and red blood cells are present in the urine.
X-ray examination, CT scan and MRI can be found abnormal.
Diagnosis
Diagnosis and diagnosis of aortic aneurysm in the elderly
Diagnosis should be noted that the identified diseases are mediastinal mass, renal colic, pancreatic cyst, peptic ulcer, cholecystitis, intestinal obstruction, myocardial infarction and so on.
