Abdominal aortic aneurysm is a common arterial dilation disease, and arteriosclerosis is the most common cause of its onset. Abdominal aortic aneurysm mainly occurs in the elderly, and its existence is like a "time bomb" in people's bodies. The mortality rate of patients after rupture is as high as 80%. So, what are the common symptoms of such a serious illness?
1、 Pain is a common clinical symptom of abdominal aortic aneurysm, with about one-third of patients showing pain, which is mostly located around the navel, ribs, or waist. The nature of the pain can be dull pain, bloating pain, stabbing pain, or knife like pain. It is generally believed that pain is caused by an increase in the tension of the aneurysm wall, which leads to traction of the adventitia and retroperitoneum, compressing adjacent somatic nerves. When a huge abdominal aortic aneurysm erodes the spine, it can also cause nerve root pain. It is worth noting that sudden severe abdominal pain is often a characteristic manifestation of abdominal aortic aneurysm rupture or acute dilation. The pain caused by acute dilation of abdominal aortic aneurysm is extremely similar to its rupture and difficult to distinguish. The pain is persistent and is a severe knife cut. The pain is similar and does not alleviate due to changes in body position, However, the pain that occurs during acute dilation of abdominal aortic aneurysm is often not accompanied by hypotension or shock. Because the manifestation of pain is so important, sudden abdominal pain in abdominal aortic aneurysm is considered the most dangerous signal. Pain is closely related to surgical indications and is associated with surgical mortality. Generally, the mortality rate of elective surgery for painless non ruptured abdominal aortic aneurysm patients is 4.9%, while the mortality rate for painless non ruptured abdominal aortic aneurysm patients is as high as 26.5%, especially for patients with pain and tenderness. The surgical mortality rate can be more than twice that of patients with simple abdominal pain. Due to the diverse and non-specific pain manifestations of abdominal aortic aneurysm, it often leads to misdiagnosis and rapid deterioration of the condition in clinical practice. In rare cases, a patient with controlled aortic aneurysm rupture may have symptoms of angina pectoris due to minimal blood loss and reflex tachycardia, which must be well distinguished to prevent misdiagnosis.
2、 Compression symptoms
As the abdominal aortic aneurysm continues to expand, it can compress adjacent organs and cause corresponding symptoms, which is more common in clinical practice.
1. Symptoms of intestinal compression: This is the organ most commonly compressed by abdominal aortic aneurysm. Due to the low activity of the duodenum, early symptoms may appear when compressed, including abdominal discomfort, fullness, decreased appetite, and in severe cases, incomplete or complete intestinal obstruction such as nausea, vomiting, and cessation of bowel movements. It is often misdiagnosed as other gastrointestinal diseases, delaying the early diagnosis of abdominal aortic aneurysm.
2. Compression symptoms of urinary system: ureteral obstruction and hydronephrosis can occur when abdominal aortic aneurysm is compressed or inflammatory abdominal aortic aneurysm invades the ureter, and the incidence rate of urinary stones also increases, which can cause distention and pain in the waist, or even severe abdominal pain radiating to the groin area, and can be accompanied by hematuria. Due to the anatomical relationship, the left ureter is most vulnerable. 3. Symptoms of bile duct compression: It is relatively rare in clinical practice, and patients often present with discomfort in the liver area and aversion to oily food. In severe cases, there may be yellow staining of the skin and sclera around the body, red urine, clay colored stool, and changes in obstructive jaundice on biochemical examination.
3、 Embolism symptoms
Thrombosis of abdominal aortic aneurysm, once it falls off, becomes a clot, which embolizes the organ or limb that supplies blood to it, causing corresponding acute ischemic symptoms. If the embolic site is the mesenteric blood vessel, it manifests as intestinal ischemia, and in severe cases, it can cause intestinal necrosis. The patient presents with severe abdominal pain and bloody stools, followed by hypotension and shock, as well as symptoms of peritoneal irritation throughout the abdomen. If it is embolized into the renal artery, it can cause infarction in the corresponding part of the kidney. The patient presents with severe back pain and hematuria. When it is embolized into the main artery of the lower limb, there is pain in the corresponding limb, weakened pulse, disappearance, limb paralysis, pale color, and sensory abnormalities.
4、 Abdominal pulsatile mass
This is the most common and important sign of abdominal aortic aneurysm. Most patients feel a pulsating sensation in the heart socket or around the navel, and about 1/6 of patients report their heart falling into the abdominal cavity. This pulsating sensation is particularly prominent in supine and nighttime positions. The mass is mostly located on the left side of the abdomen, with continuous and multi-directional pulsation and swelling. If the upper boundary of the mass can accommodate two transverse fingers between the upper boundary of the mass and the rib arch, it often indicates that the lesion is below the renal artery. If there is no gap, it indicates that the aneurysm is mostly located above the renal artery. At the same time, abdominal palpation is also the simplest and most effective method for diagnosing abdominal aortic aneurysm, with an accuracy rate of 30% to 90%. Although palpating the abdominal pulsatile mass can diagnose abdominal aortic aneurysm, The size and extent of the body still require other auxiliary examinations to determine, and the surface of the mass may be tender, Systolic murmurs can be heard in some patients with obesity, ascites, and uncooperative physical examination, which can lead to the failure of palpation of abdominal aortic aneurysm. Of course, clinical differentiation from pancreatic masses, other posterior abdominal wall cystic lesions, or aortic tortuosity is still necessary.
5、 Symptoms of rupture
Abdominal aortic aneurysm rupture is an extremely dangerous surgical emergency with a mortality rate of up to 50% to 80%. The diameter of the aneurysm is the most important factor determining rupture. According to Laplace's law, the load pressure on the tube wall is proportional to the radius of the aneurysm. The larger the diameter of the aneurysm, the greater the risk of rupture. Data shows that the rupture rate of abdominal aortic aneurysm within 5 years is 10% to 15% for aneurysms with a diameter of less than 4cm, 20% for those with a diameter of less than 5cm, 33% for those with a diameter of 6cm, and 75% to 95% for those with a diameter of 7cm or more. According to the curve relationship between the rupture rate of abdominal aortic aneurysm and the diameter of the aneurysm, aneurysms with a diameter of 6cm or more are called dangerous aneurysms. However, in recent years, A large number of imaging observations have shown that when the diameter of an abdominal aortic aneurysm reaches 5cm, the risk of rupture increases significantly, and this viewpoint has gained consensus in the field of vascular surgery.