Honěk Kardiologická klinika 2LF UK a FN Motol Anatomy and physiology Abdominal aortic aneurysm AAA Aneurysm of thoracic aorta Aortic dissection Overview Anatomy ID: 1031971
Download Presentation The PPT/PDF document "Diseases of aorta Jakub" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
1. Diseases of aortaJakub HoněkKardiologická klinika2.LF UK a FN Motol
2. Anatomy and physiologyAbdominal aortic aneurysm (AAA)Aneurysm of thoracic aortaAortic dissectionOverview
3. AnatomyAscending aortaAortic rootST junctionTubular partAortic archAortic isthmusDescending aortaAbdominal aortaSuprarenal segmentInfrarenal segmentBifurcation
4. Physiology Elasticity, pulse wave
5. PhysiologyArterial stiffnessZieman SJ. Arterioscler Thromb Vasc Biol 2005;25:932-943.
6. Localized distension of aortic diameter >50% (>3.0cm in women, >3.4 cm in men)90 % subrenalProgresses over time5x more frequent in menPrevalence ↑ with ageMultifactorial etiologyRisk factors simillar to atherosclerosis, pathophysiology is different - aortic wall remodellingAAA
7. Mostly asymptomatic!Rarely patient palpates pulsatile mass, or feels pulsationsMostly first smyptoms occur due to complicationsPeripheral thromboembolismAAA rupture (first sign in 40%!)AAAClinical features
8. Emergent, life threatening situationMortality 80–90 % when optimally treated90% retroperitoneal rupture Clinical triadPAIN (amdominal/lumbar, radiation to groins)PULSATILE MASSHYPOTENSION (circulatory shock)AAA rupture
9. Duplex ultrasoundFast, cheap, screening of pts. in risk, follow-upCTA/MRAOptimal resolution, anatomyDSAInvasive treatment, luminographyScreeningEffective in risk groups (pts. With family history, CAD, PAD, male smokers >65 yrs…)Prevention of fatal complications, elective operation/ineterventionAAA diagnostic imaging
10. Lifestyle changes, follow-up, blood pressure control (beta-blockers)Preventive operation/intervention Indication based on AAA diameter: > 55 mm > 10 mm increase/year Modified by BSA, sex, comorbiditiesTreatment – stable AAA
11. SurgeryResection of aneurysmal sac, implantation of vascular prosthesisEndovascular treatmentImplantation of stentgraftFemoral approchSimila longterm results to surgeryConservativeFollow-up, risk of ruptureTreatment – stable AAA
12.
13. Emergent surgery/endovascular tretamentPatient stabilization, fast imagingUp to 50% pts. die before reaching hospital30-40% die die before reaching op. Theatre40-50% of the operated dieOverall mortality 80-90%Treatment – ruptured AAA
14. Less frequent than AAA (10/100 000)Same definition60% ascending, 5-10% arch, 30-35% descendningAnuloaortic ectasiaAneurysm of thoracic aorta
15.
16. Multiple etiologies – genetic, degenerative, infectious, inflammatoryBicuspid aortopathyCystic medial degenerationMostly assymptomaticSymptoms of complications: Ao regurgitation, embolization, compression sy., dissection, ruptureIamging: TTE, TEE, CTA, MRA, DSAAneurysm of thoracic aorta
17. BP controlFollow-upElective surgeryAneurysm of thoracic aortaTreatmentBonow et al. Braunwalds heart disease.
18. Incidence: 3/100 000 per yearHigh mortality Untreated: 25%/24h, 50%/weekOptimal treatment: 20%/30 daysIntimal tear – entryIntimal flap, false lumenReentryAortic dissection
19. Arterial hypertensionGenetically triggered thoracic aortic diseaseMarfan syndromeBicuspid aortic valve (bicuspid aortopathy)Ehlers-Danlos syndromeCongenital diseasesCoarctation of aortaTetralogy of FallotAtherosclerosis of aortaIatrogenic or blunt traumaCatheterisation or stentingSurgery (CABG, valve replacement, operation of aorta)Intraaortic balloon contrapulsationTrauma (road traffic accidents)GravidityCocaine abuseInflammatory and infectious diseasesTakayasu arteritis, giant cell arteritis, syphilisAortic dissection risk factors
20. StanfordDe BakeyAortic Dissection - classificationEntry: 65% root, 20% isthmus, 15% other
21. Pain severe, sudden, sharp – stabbing, tearing („stabbed in the chestwhit a knife“)Retrosternal (+radiation to neck, jaw), between scapulae, abdominal, backAcute heart failure, MI, syncope, stroke, paraplegia…Aortic dissectionClinical manifestation
22. Urgent situation – fast diagnosisRare disease vs. Common diseasesPhysical exam, ECG, lab (D dimers)Ideal imaging test – fast, available, good resolution – CTATrasthoracic echo - bedisideAortic dissectionDiagnostic approach
23.
24. Urgent situation, high mortality in first hoursMultidisciplinary approachInitial management:BP control (beta blockers)Pain controlHemodynamic stabilizationIn type A – plan urgent surgeryIn type B – conservative/ surgery/endovascularAortic dissectionTherapy
25. Aortic dissectionTherapy