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Aortic Aneurysms

Aortic Aneurysms. Dilshan Udayasiri. Some Anatomy. ascending aorta arch of the aorta descending aorta abdominal aorta. Layers of the aorta. Types of aneurysms. Shape. Location Thoracic (25%) Ascending (60%) Aortic Arch - includes brachiocephalic arteries (10% Descending (40%)

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Aortic Aneurysms

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  1. Aortic Aneurysms Dilshan Udayasiri

  2. Some Anatomy ascending aorta arch of the aorta descending aorta abdominal aorta

  3. Layers of the aorta

  4. Types of aneurysms Shape • Location • Thoracic (25%) • Ascending (60%) • Aortic Arch - includes brachiocephalic arteries (10% • Descending (40%) • Thoracoabdominal (10%) • Abdominal (75%) Causes Degenerative Dissecting Saccular Fusiform Ruptured

  5. Risk Factors • Hypertension • Hypercholesterolaemia • Smoking • Age (rare before 60) • Genetic (Marfans, Ehlers-Danlos syndrome) • Bicuspid Aortic Valve • Inflammatory/infectious - eg Giant Cell Arteritis

  6. Symptoms • Incidental • Pain - tearing, radiating to back • Heart failure - due to AR • Thromboembolic (stroke, painful/parathesia of limbs) • Hoarseness of voice (compression of recurrent laryngeal nerve ) • Can mimic other acute disorders (AMI, renal colic, pancreatitis)

  7. Signs • obs • lack of peripheral pulses • Pulsatile mass and tender abdomen • Murmur • Decreased BS and dullness to percussion • Signs of heart failure • Neurologic signs (Horner’s Syndrome - compression of cervical sympathetic ganglion)

  8. Investigations

  9. Treatment • Watchful Waiting + medical • Percutaneous or open intervention

  10. Watchful Waiting • Tight blood pressure control (MAP between 60 - 75) • beta blocker favourable unless contraindicated • persistent hypertension, check kidneys • cease smoking • treat hypercholesterolaemia • Screening • 6 months after initial scan then every 12 months unless symptomatic or increased rate of expansion or if size is 4.5cm - 5.5cm.

  11. Indications for surgery • HD unstable • symptomatic • diameter ≥ 5.5cm • rate of growth ≥ 1.0cm/year

  12. Endovascular repair Indications High perioperative risk pt’s Other Benefits shorter ICU stay Shorter Hospital Stay Quicker return to normal function Increased surviability in the short term Complications Endoleak (Type 1-4) Device Migration Infection Haematoma Stroke AMI Death

  13. Surgery • Incision depends on location • Median sternotomy - arch • left thoracomtomy - descending • left thoracotomy extending across costal margin for retroperitoneal approach - thoracoabdominal • Abdominal incision - AAA Considerations Distal perfusion cerebral protection Renal Dysfunction Staged procedure

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