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โรคหลอดเลือดแดงโป่งพอง คืออะไร? อันตรายแค่ไหน รู้ก่อนสาย

<p>The aorta is the main artery that branches out to supply important organs such as the heart, brain, spinal cord, arms, legs, and abdominal organs. It functions as the main conduit carrying oxygenated blood from the heart to various parts of the body. It starts from the heart&#8217;s base, ascends to the top of the chest, then curves backward alongside the spine in the chest cavity, passes through the diaphragm into the abdominal cavity, before branching into arteries that supply both legs and pelvic organs.</p>
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<p>Abdominal aortic aneurysm is the bulging or enlargement of the wall of the abdominal aorta. It mostly occurs due to the arterial wall becoming stiffer than normal because of injury to the inner lining cells of the artery (atherosclerosis), often caused by high blood pressure.<br />
Large arteries affected by moderate to severe atherosclerosis lose the strength of their walls, combined with high blood pressure, leading to aneurysm formation.</p>
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<p>Aortic aneurysm is a dangerous condition that can cause sudden death because a large aneurysm may rupture without warning. The aneurysm resembles a balloon, with the arterial wall clearly bulging out.</p>
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<h2><span style="color: #00826a;">Risk Factors for Aortic Aneurysm</span></h2>
<ol>
<li>Degeneration of elastic fibers in the middle layer of the arterial wall, commonly found in the elderly and those with high blood pressure, leading to atherosclerosis.</li>
<li>Bacterial or fungal infections of the arterial wall, such as syphilis.</li>
<li>Inflammation of the arteries due to autoimmune diseases.</li>
<li>Smoking.</li>
<li>Genetics, with a family history.</li>
<li>Associated with heart disease (ASCVD), which is related to atherosclerosis.</li>
</ol>
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<h2><span style="color: #00826a;">Symptoms and Signs of Aortic Aneurysm</span></h2>
<ol>
<li>Most patients are asymptomatic and may be diagnosed incidentally through chest X-rays or by feeling a pulsatile mass in the abdomen.</li>
<li>Patients with thoracic aortic aneurysm may experience compression symptoms on adjacent organs, such as airway compression causing difficulty breathing, esophageal compression causing difficulty swallowing, or nerve compression affecting the voice box causing hoarseness.</li>
<li>If patients experience chest tightness, back pain, dizziness, loss of consciousness, or coughing up blood, it may indicate aortic rupture. Patients with abdominal aortic aneurysm may feel a pulsatile mass in the abdomen or have abdominal or back pain.</li>
<li>If such symptoms occur, prompt medical evaluation is necessary, including history taking, physical examination, and additional tests such as chest or abdominal X-rays, ultrasound, or CT scan.</li>
</ol>
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<h2><span style="color: #00826a;">Treatment Guidelines for Aortic Aneurysm</span></h2>
<ul>
<li>Control of risk factors such as:</li>
<li>Blood pressure management</li>
<li>Smoking cessation</li>
<li>Avoiding pregnancy</li>
<li>Avoiding straining during bowel movements or heavy lifting</li>
</ul>
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<h3><span style="color: #00826a;">Indications for Surgical Treatment of Aortic Aneurysm</span></h3>
<p>The primary goal of surgery is to prevent rupture of the aorta, which carries a mortality rate of 50% to 90% and can cause disability. Surgery is appropriate in the following cases:</p>
<ol>
<li>Presence of leakage or rupture of the aorta.</li>
<li>Patients with symptomatic aortic aneurysm, such as abdominal pain, back pain, or chest tightness.</li>
<li>Asymptomatic patients with an aortic diameter larger than 5 to 5.5 cm or rapid growth of 3 to 5 mm per year.</li>
<li>Female or younger patients with smaller aneurysms (<5 cm) but with risk factors for rupture, such as a family history of sudden aortic rupture.</li>
</ol>
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<p>Traditionally, open abdominal surgery is performed, requiring a long incision from below the sternum to above the pubic bone. The surgeon opens the aneurysmal aorta and sews in a synthetic graft. This surgery takes a long time and carries risks such as bleeding, ischemia to vital organs, spinal cord ischemia causing paralysis of both legs, and a long recovery period of about 5-10 days. The surgical risk is approximately 5% if there is no rupture. In cases of rupture, patients often go into shock from massive bleeding, with a mortality rate of 50-90%.</p>
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<h2><span style="color: #00826a;">Endovascular Aortic Aneurysm Repair (EVAR)</span></h2>
<p>This procedure involves inserting a coil-covered synthetic graft through the femoral arteries in both groins to replace the aneurysmal abdominal aorta. It is a newer option requiring specialized physicians. Short- and mid-term outcomes are good, but long-term follow-up with ultrasound or CT scans is necessary. The 30-day mortality rate for asymptomatic abdominal aortic aneurysm patients undergoing EVAR is about 1-1.5%, which is three times lower than open surgery. The choice of procedure depends on the patient’s strength and the anatomical characteristics of the artery. Patients younger than 60 years with good health tend to undergo open surgery, while those over 60 are usually recommended for EVAR, with decisions made on a case-by-case basis.</p>


An abdominal aortic aneurysm is a bulge or enlargement of the wall of the aorta in the abdomen. It is most often caused by a condition where the artery wall becomes stiffer than normal due to injury to the endothelial cells (atherosclerosis).

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