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Abdominal Aortic Aneurysm What is an abdominal aortic aneurysm? An abdominal aortic aneurysm, also called AAA or triple A, is a bulging, weakened area in the wall of the abdominal aorta (the largest artery in the body) resulting in an abnormal widening or ballooning greater than 50% of the vessel's normal diameter (width). The aorta extends upward from the top of the left ventricle of the heart in the chest area (ascending thoracic aorta), then curves like a candy cane (aortic arch) downward through the chest area (descending thoracic aorta) into the abdomen (abdominal aorta). The aorta delivers oxygenated blood pumped from the heart to the rest of the body. The most common location of arterial aneurysm formation is the abdominal aorta, specifically, the segment of the abdominal aorta below the kidneys. An abdominal aneurysm located below the kidneys is called an infrarenal aneurysm. An aneurysm can be characterized by its location, shape, and cause. The shape of an aneurysm is described as being fusiform or saccular which helps to identify a true aneurysm. The more common fusiform-shaped aneurysm bulges or balloons out on all sides of the aorta. A saccular-shaped aneurysm bulges or balloons out only on one side. A pseudoaneurysm, or false aneurysm, is not an enlargement of any of the layers of the blood vessel wall. A false aneurysm may be the result of a prior surgery or trauma. Sometimes, a tear can occur on the inside layer of the vessel resulting in blood filling in between the layers of the blood vessel wall creating a dissection called a dissecting aortic aneurysm — see below. The aorta is under constant pressure as blood is ejected from the heart. With each heartbeat, the walls of the aorta distend (expand) and then recoil (spring back), exerting continual pressure or stress on the already weakened aneurysm wall. Therefore, there is a potential for rupture (bursting) or dissection (separation of the layers of the aortic wall) of the aorta, which may cause life-threatening hemorrhage (uncontrolled bleeding) and, potentially, death. The larger the aneurysm becomes, the greater the risk for rupture. Because an aneurysm may continue to increase in size, along with progressive weakening of the artery wall, surgical intervention may be needed. Preventing rupture of an aneurysm is one of the goals of therapy. What causes an abdominal aortic aneurysm to form? An abdominal aortic aneurysm may be caused by multiple factors that result in the breaking down of the well-organized structural components (proteins) of the aortic wall that provide support and stabilize the wall. The exact cause isn't fully known. Atherosclerosis (a build up of plaque, which is a deposit of fatty substances, cholesterol, cellular waste products, calcium, and fibrin in the inner lining of an artery) is thought to play an important role in aneurysmal disease, including the risk factors associated with atherosclerosis, such as: Age (older than age 60) Male (occurrence in males is four to five times greater than that of females) Family history (first degree relatives such as father or brother) Genetic factors Hyperlipidemia (elevated fats in the blood) Hypertension (high blood pressure) Smoking Diabetes Obesity Other diseases that may cause an abdominal aneurysm include: Genetic disorders of connective tissue (abnormalities that can affect tissues such as bones, cartilage, heart, and blood vessels), such as Marfan syndrome, Ehlers-Danlos syndrome, Turner's syndrome, and polycystic kidney disease Congenital (present at birth) syndromes, such as bicuspid aortic valve or coarctation of the aorta Giant cell arteritis (a disease that causes inflammation of the temporal arteries and other arteries in the head and neck, causing the arteries to narrow, reducing blood flow in the affected areas; may cause persistent headaches and vision loss) Trauma Infectious aortitis (infections of the aorta) due to infections such as syphilis, salmonella, or staphylococcus. These infectious conditions are rare. What are the symptoms of abdominal aortic aneurysms? Abdominal aortic aneurysms may be asymptomatic (without symptoms) or symptomatic (with symptoms). About 3 of every 4 abdominal aortic aneurysms are asymptomatic. An aneurysm may also be discovered by X-ray, computed tomography (CT or CAT) scan, or magnetic resonance imaging (MRI) that is being done for other conditions. Since abdominal aneurysm may be present without symptoms, it's referred to as the "silent killer" because it may rupture before being diagnosed. Pain is the most common symptom of an abdominal aortic aneurysm. The pain associated with an abdominal aortic aneurysm may be located in the abdomen, chest, lower back, or groin area. The pain may be severe or dull. The occurrence of pain is often associated with the imminent (about to happen) rupture of the aneurysm. Acute, sudden onset of severe pain in the back and/or abdomen may represent rupture and is a life-threatening medical emergency. Abdominal aortic aneurysms may also cause a pulsing sensation, similar to a heartbeat, in the abdomen. The symptoms of an abdominal aortic aneurysm may resemble other medical conditions or problems. Always consult your doctor for more information. How are aneurysms diagnosed? In addition to a complete medical history and physical examination, diagnostic procedures for an aneurysm may include any, or a combination, of the following: Computed tomography (CT or CAT) scan. This diagnostic imaging procedure uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays. Magnetic resonance imaging (MRI). This is a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body. Ultrasound. An ultrasound uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. Arteriogram (angiogram). This is an X-ray image of the blood vessels used to evaluate various conditions, such as aneurysm, stenosis (narrowing of the blood vessel), or blockages. A dye (contrast) will be injected through a thin flexible tube placed in an artery. This dye makes the blood vessels visible on an X-ray. What is the treatment for abdominal aortic aneurysms? Specific treatment will be determined by your doctor based on: Your age, overall health, and medical history Extent of the disease — location, size, and rate of growth Your signs and symptoms Your tolerance of specific medications, procedures, or therapies Expectations for the course of the disease Your opinion or preference Treatment may include: Routine ultrasound procedures. These procedures will monitor the size and rate of growth of the aneurysm every 6 months to 12 months as part of a "watchful waiting" approach for smaller aneurysms less than 5 centimeters to 5.5 centimeters. Controlling or modifying risk factors. Steps such as quitting smoking, controlling blood sugar if diabetic, losing weight if overweight or obese, and controlling dietary fat intake may help to control the progression of the aneurysm. Medication. Medication can control factors such as hyperlipidemia (elevated levels of fats and cholesterol in the blood) and/or high blood pressure. Surgery: Abdominal aortic aneurysm open repair. A large incision is made in the abdomen to directly visualize the abdominal aorta and repair the aneurysm. A cylinder-like tube called a graft may be used to repair the aneurysm. Grafts are made of various materials such as Dacron (textile polyester synthetic graft) or polytetrafluoroethylene (PTFE, nontextile synthetic graft). This graft is sewn to the aorta, connecting one end of the aorta at the site of the aneurysm to the other end. The open repair is considered the surgical standard for an abdominal aortic aneurysm repair. - Abdominal aortic aneurysm open repair. A large incision is made in the abdomen to directly visualize the abdominal aorta and repair the aneurysm. A cylinder-like tube called a graft may be used to repair the aneurysm. Grafts are made of various materials such as Dacron (textile polyester synthetic graft) or polytetrafluoroethylene (PTFE, nontextile synthetic graft). This graft is sewn to the aorta, connecting one end of the aorta at the site of the aneurysm to the other end. The open repair is considered the surgical standard for an abdominal aortic aneurysm repair. - Fenestrated Stent Graft. The stent graft is used to repair abdominal aortic aneurysms or aneurysms that involve both the abdominal aorta and iliac arteries (the large arteries that supply blood to the pelvis and legs). The graft is delivered to the aneurysm in the aorta by way of a long, flexible delivery tube. The delivery tube containing the graft is inserted through a small incision in the groin where it is threaded through a blood vessel and advanced to the location of the aneurysm. The doctor uses a type of x-ray (fluoroscopy) to guide the graft. The graft is attached to the wall of the aorta by the self-expanding stents. Blood flow can then continue through the aorta without filling the aneurysm. This is intended to prevent further growth and possible rupture of the aneurysm. Stents may be placed through the holes in the graft to help keep the blood flowing into the arteries that supply the organs. Learn more about Treating Abdominal Aortic Aneurysm. Endovascular aneurysm repair (EVAR). EVAR is a procedure that requires only small incisions in the groin along with the use of X-ray guidance and specially-designed instruments to repair the aneurysm. With the use of special endovascular instruments and X-ray images for guidance, a stent-graft is inserted via the femoral artery and advanced up into the aorta to the site of the aneurysm. A stent-graft is a long cylinder-like tube made of thin metal mesh framework (stent), while the graft is made of various materials, such as Dacron or polytetrafluoroethylene (PTFE). The graft material may cover the stent. The stent helps to hold the graft open and in place. A small aneurysm or one that doesn't cause symptoms may not require surgical treatment until it reaches a certain size or is rapidly increasing in size over a short period of time. Your doctor may recommend "watchful waiting." This may include an ultrasound, duplex scan, or CT scan every 6 months to closely monitor the aneurysm, and blood pressure medication may be used to control high blood pressure. If the aneurysm is causing symptoms or is large, surgery may be recommended by your doctor. What is aortic dissection? An aortic dissection, although uncommon, begins with a tear in the inner layer of the aortic wall. The aortic wall is made up of three layers of tissue. When a tear occurs in the innermost layer of the aortic wall, blood is then channeled into the wall of the aorta, separating the layers of tissues. This generates a weakening in the aortic wall with a potential for rupture. Aortic dissection can be a life-threatening emergency. What causes aortic dissection? The cause of aortic dissection is still under investigation. However, several risk factors associated with aortic dissection include, but are not limited to: Hypertension (high blood pressure) Connective tissue disorders, such as Marfan's disease, Ehlers-Danlos syndrome, and Turner's syndrome Cystic medial disease (a degenerative disease of the aortic wall) Aortitis (inflammation of the aorta) Atherosclerosis Existing thoracic aneurysm Bicuspid aortic valve (presence of only 2 cusps, or leaflets, in the aortic valve, rather than the normal 3 cusps) Trauma Coarctation of the aorta (narrowing of the aorta) Hypervolemia (excess fluid or volume in the circulation) Polycystic kidney disease (a genetic disorder characterized by the growth of numerous cysts filled with fluid in the kidneys) What are the symptoms of aortic dissection? The most commonly reported symptom of an acute aortic dissection is severe, constant pain, sometimes described as "ripping" or "tearing," and located in the chest, the middle of the abdomen, the upper or lower back, or the pelvis area. The pain may be "migratory," moving from one place to another, according to the direction and extent of the dissection. The symptoms of aortic dissection may resemble other medical conditions or problems. Always consult your doctor for more information. How is aortic dissection diagnosed? In addition to a complete medical history and physical examination, diagnostic procedures for an aortic dissection may include any, or a combination, of the following: Computed tomography (CT or CAT) scan. This is a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays. Transesophageal echocardiogram (TEE). This diagnostic procedure uses echocardiography to assess the heart’s function and structures. A transesophageal echocardiogram is performed by inserting a probe with a transducer down the esophagus. By inserting the transducer in the esophagus, TEE provides a clearer image of the heart because the sound waves don't have to pass through skin, muscle, or bone tissue. Ultrasound. An ultrasound uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. Arteriogram (angiogram). This is an X-ray image of the blood vessels used to evaluate various conditions, such as aneurysm, stenosis (narrowing of the blood vessel), or blockages. A dye (contrast) will be injected through a thin flexible tube placed in an artery. This dye makes the blood vessels visible on an X-ray. The doctor will determine the most appropriate examination. When a diagnosis of aortic dissection is confirmed, immediate intervention is necessary. Medical intervention or surgery will be required depending on the location of the aortic dissection.
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Aneurizma aorte - uzroci, simptomi i liječenje.MF . aneurizma aorte - produžetak dio aorte uzrokovane patološkim promjenama vezivnog struktura tkiva svojim zidovima kao posljedica ateroskleroze, upalne lezije, kongenitalne inferiornosti ili mehaničkih oštećenja. Slika 1. Shematski prikaz normalnog torakalne aorte i nju. Ovisno o mjestu aneurizme je izoliran aneurizme torakalne aorte, thoracoabdominal (thoraco-u trbuhu) aorte i trbušne aorte.S druge strane, prsne aorte aneurizme mogu se podijeliti u aorte sinusa aneurizme, aneurizma od uzlazne aorte, luk aorte aneurizme i silaznom aortalni aneurizme. Osim toga, posebno izdvojiti seciranje aneurizma aorte - abnormalno šupljina ili kanal oblikovan u debljini aorte zida zbog delaminacije svojoj krvi pumpa iz lumena aorte kroz kvara intimi (unutrašnjim stijenkama posude), koja je nastala zbog procesa bolesti ili ozljedu.aortalni zid delaminacije javlja u sredini njezinoj ljuske. uzroci aorte aneurizme najčešće razvija zbog aneurizme aorte ili aterosklerotskog procesa ima syphilitic podrijetlo.Nedavn Ostali uzroci aorte aneurizme su medionekroz i nespecifični aortoarteriit.Tu su i traumatski poremećaji (npr nakon zatvorene ozljede abdomena) i lažne aneurizme od anastomoze nakon aorte operacije.U znanstvenoj medicinskoj literaturi opisuje kao gljivičnih aneurizme (gljivične) podrijetla. Najčešći uzrok aorte seciranje aneurizme je dugo postoji hipertenzija na pozadini ateroskleroze.U ovom slučaju, unutrašnje ljuske (intima) zida aorte, obično već na raspolaganju prethodno postojećih razne male nedostatke.Rijetko kao razloge za seciranje aneurizme aorte može djelovati na pozadini hipertenzije koarktacije aorte (kongenitalni defekt manifestira segmentnim sužavanje lumena aorte);hipertenzija uzrokovana drugim čimbenicima;Marfan sindrom (genetska abnormalnost vezivnog tkiva) koje je popraćeno s velikom slabošću aorte zida.Možda stvaranje akutnog dissecting aneurizmu od uzlazne aorte zbog pucanja zbog zatvorenog traume (npr automobilsku).Ponekad seciranje aneurizma aorte može biti rezultat jatrogenički: komplikacija aorte cjevčicu arterijama i u svrhu perfuzije tijekom izvantjelesni krvotok. Simptomi aneurizma aorte Kliničke manifestacije aneurizme aorte određena kompresija (kompresija) okolnih organa, odnosno, ovisno o njihovoj lokaciji i brzini povećanja njihove veličine.U završnoj fazi aorte aneurizme bolesti često izbijaju u obližnjem šupljeg organa, pleuralni, peritonejsku šupljinu ili srčanog torbu.Ponekad postoji proboj u plućne prtljažnik sa formiranjem aorto-plućni shunta. aneurizma aorte sinusa može biti popraćena aorte insuficijencija zaliska, ili sužavanjem lumena koronarnih arterija srca.Postizanje velike, kao aneurizme može stisnuti plućni debla, desnu klijetku i desni atrij, što dovodi do stvaranja sub-akutna desnog srca karakterizira povećanje jetre, oticanje vratnih vena i pojavu edema.Brzo kompresija plućne debla aneurizmu može dovesti do iznenadne smrti pacijenta.Čini se aneurizme od uzlazne aorte , u pravilu, bez sjaja retrosternal boli da su neki pacijenti u pratnji refleksnih napadaje daha.Ako aneurizme dosegne velikih dimenzija, može dovesti do atrofije okolnih područja prsne kosti i rebara, tako nenormalno vaskularne pulsiranje pojavljuje u drugom i trećem interkostalnog prostora s desne prsne kosti.Kompresija superior vena cava aneurizme ili proboj u njezinoj aneurizme dovodi do razvoja vrhunskog sindroma šuplju venu, što pak uzrokuje veze oteklina na vratu, licu, rukama, natečenih vratnih žila. aneurizma luka aorte često očituje kratkoća daha (to je obično teško disanje), uzrokovane kompresijom traheje i bronhija.Kompresija lijeve glavne bronha aneurizme može dovesti do atelektaza (nosi off) od lijevog pluća.Ponekad postoji hemoptiza, što može prethoditi pauzu od aneurizme.Kompresijom živca lijeve nizhnegortannogo aneurizme pojavljuje suhi kašalj, napade daha, promjene u glasu (promuklost od njegova).Možda je razvoj vrhunske sindrom šuplju venu.Kada je kompresija aneurizme brahiocefalikus lijevom subklavijsko lijeve i zajedničke karotidne arterije postupno pogoršanje simptoma oboljenja krvotoka gornjih udova i glave.Mogući proboj aneurizme aorte u jednjak ili dušnika, koji se obično razvija postupno, što se očituje u početku adventsko oskudne hemoptiza ili krvavo povraćanje, ali onda razvio golemu krvarenje. aneurizme od Silazna aorta dovodi do kompresije živčanih korijena, tijela kralješaka, jednjaka i lijevog pluća.Kompresija živčanih korijena dovodi do intenzivne boli, otporan na uvođenje najmoćnijih bolova.Pritisak na kralješcima i stražnjih rubova tijela dovodi do njihove deformacije, do te mjere da se aneurizme sac mogao stršati između unutrašnjeg ruba lijeve lopatice i kralježnice.Ovi bolesnici mogu razviti nižu paraplegijom (potpuni gubitak mogućnost dobrovoljne pokrete oba donja ekstremiteta).Kompresija aneurizme lijevog atelektaza pluća ga uzrokuje i stvara povoljne uvjete za nastanak upale pluća.Kompresija jednjaka, u nekim slučajevima može dovesti do poteškoća prolazi kroz nju hranu (disfagija).Uz uništavanje jednjaka zida dugog pritiska na nju kao mali aneurizme krvarenje iz jednjaka, a onda, kao po pravilu, postoji prodor u lumenu aneurizme s razvojem pretjeranog krvarenja.Pauze u pleuralne šupljine aneurizme u silaznu aortu razvija sve više raste anemija (anemija) i veliki hemothorax (nakupljanja krvi u pleural šupljine). thoracoabdominal aneurizme (phrenic aorta) aorta je rijetka, obično uzrokovane sifilisa.Aneurizma obloge jednjaka i želuca gornji odjel, što dovodi do drobljenja bol u epigastričan regiji, što može biti povezano s unosom hrane, ponekad - podrigivanje, povraćanje, povredu prolaz hrane kroz jednjak.Thoracoabdominal aneurizme aorte može uzrokovati suženje ili potpunu pokrivenost lumen mezenterijskoj arterije i celijakije debla, opskrba trbušne organe koji se očituje napade bolnog bolova u trbuhu (tzv crijevne angina).Zbog navedenog razloga aneurizme ta lokacija dovodi do pacijenta mršavljenja. aneurizmu abdominalne aorte vremenom manifestira kao bol uzrokovana pritiskom na živčane pleksusa aneurizme i korijena živaca, koji se nalaze neposredno uz njega.Bol može biti epigastričan ili u lumbalnoj regiji.Velika veličina aneurizme, koji se nalazi ispod točke podrijetla renalnih arterija može komprimirati mokraćovoda, uzrokujući razvoj hidronefroze i ANURIJOM.Ako je kompresija renalnih arterija, pojavljuje simptomatske hipertenzije.Kada je kompresija duodenuma aneurizme poremećen prolaz hrane mase na njemu, što se očituje povraćanjem i mršavljenje.Najčešće, aneurizme abdominalne aorte očituje prisutnošću formaciju pulsirajuće tumora u trbuhu kod pupka ili samo ispod i malo lijevo od njega.Thrombosed aneurizme ne pulsira, i stoga može biti u zabludi za tumor.Ponekad postoji porast tjelesne temperature.Proboj aneurizme u trbušnoj šupljini se odvija brzo, obično bezbolan i retroperitonealnog mast - na jake bolove u trbuhu i leđima, s razvojem šoka pojava.Nakon nekog vremena, pacijent može umrijeti zbog sve većeg gubitka krvi. aneurizma aorte pojavljuje iznenada postoji akutna bol u prsima, ne uklone protiv bolova i kolapsa.Ponekad se razvija potpuni gubitak mogućnost dobrovoljne pokrete oba donja ekstremiteta, koji mogu biti privremeni ili stalni priroda potrajati.Zbog lokalizacije i prirode kliničkih manifestacija boli koje proizlaze seciranje aneurizme aorte može se zamijeniti za akutnog infarkta miokarda. Komplikacije aorte aneurizme 1. malformacija aortalni ventil i zatajenje srca .Kada aneurizme od uzlazne aorte syphilitic podrijetla mogu razviti srčane dekompenzacije zbog kvara aorte preklapanja ventila ili ušća koronarnih arterija. 2. aneurizme raskid sa krvarenjem .Krvarenje se može pojaviti u respiratornom traktu (bronhi, dušnika), pleuralni šupljine, srce bag, jednjak, velike krvne žile koje se nalaze u prsnoj šupljini, a ponekad čak i kroz kožu tijekom uništavanja prsne kosti.U slučaju krvarenja u perikardijalna šupljine srca javlja tamponada.Krvarenje je dovelo do sve više raste krvarenje. 3. akutni i subakutni tromboza aneurizme aorte. se najčešće razvija u trbušnoj aorti i dovodi do zatvaranja svojih podružnica nalazi se ovdje. navedene komplikacije Veduga brzo do smrti pacijenta, ako se ne poduzmu odgovarajuće mjere na vrijeme. Instrumental pregled rendgenski pregled.Uz aneurizme torakalne aorte radiografiju se izvodi u tri projekcije s sine kontrasta jednjaka lumen.Karakteristično proširenje sjena vaskularni snop.Aneurizme silazne aorte u lijevu plućnu vybuhayut polju.Većina pacijenata morati suprotstaviti raseljavanje jednjaka.Ponekad određena kalcifikacija (kalcifikacije) aneurizmatskog ulici.Uz aneurizme abdominalne aorte trbušne običan radiografiju u dvije projekcije otkriva kalcifikaciju aortalni zid i uzuratsiyu lumbalnog kralješka. Slika 2. Panoramska snimka od pacijenta prsima i luk aneurizme u silaznoj torakalne aorte. Ultrazvuk (UZV) aorta i srca.Ultrazvuk otkriva prisutnost i veličinu u promjeru i aneurizme dlinniku uzlaznim, silaznim aorte, luka aorte, abdominalne aorte, stanje koje se proteže od aorte žila, kao i prisutnost kvara aortalni ventil, karakter promjena u aorte zid. Kompjuterizirana tomografija (CT) .Kada vrijednost lumen aorte 4 cm smatra se kao produžetak aneurizme.Pri obavljanju kompjutorizirana tomografija, moguće je odrediti sudjelovanje u procesu velikih arterija i prepoznati znakove snopa (seciranje) od zidova (uz seciranje aneurizma aorte). angiografski studija (aortography).Koristi se, u pravilu, prije operacije kada se planira svoju prirodu i opseg. Slika 3. angiograme aneurizmu na uzlaznu i silaznu dijelove torakalne aorte i luk. liječenje pacijenta s aorte aneurizme aneurizma prsne aorte promjera većeg od 5 cm, uz uvjet da se kirurško liječenje s obzirom na visok rizik od njegovog pucanja i razvoj tromboembolijskih komplikacija.Operacija se izvodi pod kardiopulmonalne premoštenja i hipotermija (niske temperature) i svedena na resekcija (uklanjanje) aneurizme uz istovremenu zamjenu proteze udaljenom mjestu. u asimptomatskih abdominalne aorte naznakom aneurizme za planirane operacije je promjer veći od 4 cm. U slučaju povećanja boli i opasnosti od loma prikazan hitne operacije.Operacija je smanjena na aneurizme resekcija s direktnim protetske trbušne aorte bifurkacijskih ili izvršenje aortofemoral protetici. prognoza aorte aneurizme U nedostatku pravodobno liječenje i pojave teških komplikacija aneurizme aorte lošu prognozu.Smrtnim ishodom mogu nastati kao posljedica srčane dekompenzacije zbog malformacija aortalni ventil sa Z aneurizma aorte, tamponada srca zbog proboja aneurizme u perikardijalna šupljine, masivni gubitak krvi kao rezultat napretka u šuplje organe aneurizme i pleure ili peritonealnoj šupljini. Međutim, napredak postignut u ovom trenutku u kirurškom liječenju aorte aneurizme, dopustiti u slučaju pravodobne i odgovarajuće kirurške intervencije spasiti život većine bolesnika.U izborni stopi operacija smrtnosti je 0-5%, pa čak i po hitnom kirurškom intervencijom je 50-80% u slučaju puknuća aneurizme.Stopa preživljavanja od pet godina između operirane je 80%, a među ne-operiran - 5-10%. kirurg Kletkin ME