SURGICAL DISEASES, TRAUMATOLOGY, ORTHOPEDICS, UROLOGY : ANEURYSM (АNEURYSМА) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Etiology. Pathological changes of the vessel wall or damage it (the wound gap).
The pathogenesis. Stretching the diseased wall under the influence of intra-arterial pressure causes the formation mesechta protrusion or fusiform expansion (true aneurysm).
When the wound in the artery, the blood is released through the hole, rasleela the surrounding tissue; the resulting hematoma communicates with the artery and pulsating (throbbing bruise). Blood in the hematoma partially folded, formed connective tissue bag. Through the wound hole in the vessel wall of the latter is connected with a bag containing liquid blood (false or traumatic aneurysm). If the artery is connected with Vienna, formed arterio-venous aneurysm.
Symptoms. Quickly (within 8 - 10 days) developing diffuse swelling in the injured area often circular or oval shape, the skin is tense, sometimes it bubbles are formed with serous-hemorrhagic content or even skin necrosis. Palpation is defined ripple, pulse on peripheral end of the artery is weakened. When listening to is determined by the noise coinciding with the kick pulse, disappearing when the compression of the Central end of the vessel. When pressing on a nerve stretchable bag aneurysm pain, paresthesias, decrease skin sensitivity, paralysis. When arterio-venous aneurysm swelling often small, the ripple is determined by labor, sometimes pulsating peripheral vein, when listening and palpation of audible continuous noise (cat purring). Circulatory disorders is expressed by the weakening of the pulse at the periphery, edema, cyanosis, impaired innervation, numbness, paresis. When pressing the leads of the trunk artery pulse rate decreases by 10 to 15 beats per minute (symptom deceleration).
Course and complications. Arterial aneurysms have a tendency to grow, sometimes slow, sometimes faster. As the growth of the aneurysm compresses the surrounding organs, causing disorders of the venous circulation (swelling), paralysis, thinning of the walls and break them bleeding outside and in the surrounding cavity. The long existence of arteriovenous aneurysm gives severe cardiac abnormalities.
Recognition is difficult. When filling the cavity hematoma clots surge to install sometimes fails. When an infected wound in the presence of swelling, redness of the skin and temperature of the pulsating hematoma can be adopted for a phlegmon. Opening it can give fatal bleeding. At the opening of the phlegmon after being wounded near large vessels should be excluded pulsating hematoma.
Prediction is always serious.
Operative treatment. As a preliminary measures apply compression leading trunk artery daily for 1 - 2 hours. Pressure is above the aneurysm in those places where the vessel is located more superficially and can be pressed against the bone. Treatment of aortic aneurysms, see Disease of the cardiovascular system.