Abdominal aortic aneurysm

Aneurizma abdominalne aorte nastaje degeneracijom njene stijenke koja gubi potporu i izbočuje se u smjeru djelovanja tlaka krvi na istu pri čemu nastaje permanentno lokalizirano proširenje. Brojčano izraženo, aneurizmom se smatra proširenje fiziološkog dijametra aorte za 50 %. AAA je najučestaliji tip aneurizme arterija, a etiološki, nastanak povezujemo s genetskom predispozicijom i drugim čimbenicima kao što su starija dob, pušenje, hiperhomocisteinemija, hiperkolesterolemija, pretilost, nizak b6 vitamin i visok serumski rezistin. Epidemiološki, učestalost bolesti je od 1% do 5% kod muške populacije i 2% do 3% kod ženske populacije, a varijabilnost postotaka povezana je s navikom pušenja u ciljanoj populaciji, jer je to etiološki čimbenik koji je u čvrstoj korelaciji s pojavom bolesti. Klinička prezentacija AAA može biti simptomatska i asimptomatska, a o kojoj prezentaciji je riječ ovisi daljnje postupanje s pacijentom. Simptomatska aneurizma je indikacija za hitnu operaciju, dok se pacijenti s asimptomatskom aneurizmom podliježu detaljnoj obradi prema dijagnostičko-terapijskim smjernicama. Difernicjalno-dijagnostički u klinički sliku AAA se uklapaju bolesti gastrointestinalnog, muskuloskeletnog, urogenitalnog, hepatobilijarnog, kardiovaskularnog i respiratornog sustava. Dijagnoza AAA provodi se na dvije razine, osnovnim fizikalnim pregledom i slikovnim metodama, a unutar slikovnih metoda bitno je spomenuti ultrazvuk, koji je i metoda probira, te CT angiografiju. Prijeoperacijska priprema uključuje anatomsko-morfološki pregled izgleda aorte, procjenu komorbiditeta, rizika operacije, generalnu pripremu i procjenu rizika rupture. Liječenje aneurizme vrši se konzervativno nefarmakološki i farmakološki, te invazivno u vidu endoskopske ili otvorene rekonstrukcije stijenke aorte.An abdominal aortic aneurysm is caused by degeneration of its wall, which loses support and bulges in the direction of the pressure of blood on it, resulting in permanent localized expansion. Numerically, an aneurysm is considered to be an enlargement of the physiological diameter of the aorta by 50%. AAA is the most common type of arterial aneurysm, and etiologically, its occurrence is associated with genetic predisposition and other factors such as old age, smoking, hyperhomocysteinemia, hypercholesterolemia, obesity, low vitamin B6 and high serum resistance. Epidemiologically, the incidence is 1% to 5% in the male population and 2% to 3% in the female population, and the variability of percentages is related to smoking habits in the target population, as this is an etiological factor that is strongly correlated with disease onset. The clinical presentation of AAA can be symptomatic or asymptomatic, and further treatment of the patient depends on which presentation is involved. Symptomatic aneurysm is an indication for emergency surgery, while patients with asymptomatic aneurysm undergo detailed treatment according to diagnostic and therapeutic guidelines. Differential-diagnostic diseases of the gastrointestinal, musculoskeletal, urogenital, hepatobiliary, cardiovascular and respiratory systems fit into the clinical picture of AAA. Diagnosis of AAA is performed on two levels, basic physical examination and imaging methods, and within imaging methods it is important to mention ultrasound, which is also a screening method, and CT angiography. Preoperative preparation includes anatomical-morphological examination of the aortic appearance, assessment of comorbidity, risk of surgery, general preparation, and assessment of risk of rupture. Aneurysm treatment is performed conservatively, non-pharmacologically and pharmacologically, and invasively in the form of endoscopic or open reconstruction of the aortic wall