1 / 28

CASE PRESENTATION 54 Y/OLD MAN /IHD(-) CC: asymptomatic RF: HTN /HLP/ SMOKER P/E: captopril 25 bd

jrice
Download Presentation

CASE PRESENTATION 54 Y/OLD MAN /IHD(-) CC: asymptomatic RF: HTN /HLP/ SMOKER P/E: captopril 25 bd

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Aortic AneurysmsPresented by:Dr.Marzieh BalaghiResident of cardiology,Modarres Hospital,Shahid Beheshti University of Medical Sciences, Tehran, IranRevision and supervision:Dr.Habibollah Saadat Dr.Isa KhaheshiCardiovascular Research Center, Modarres Hospital,Shahid Beheshti University of Medical Sciences, Tehran, Iran

  2. CASE PRESENTATION 54 Y/OLD MAN /IHD(-) CC: asymptomatic RF: HTN /HLP/ SMOKER P/E: captopril 25 bd ECHO: EF=55%/MILD LVH ECG: NSR/NAX/ NO ST- T CHANGES LAB TEST:CR=1,HB=13,LDL:100, FBS=105 ;

  3. SONOGRAPHY: AAA (SIZE=4.5 cm in infrarenal) Dx: AAA

  4. WHAT IS YOUR MANAGMENT

  5. Aortic AneurysmsIncidence • 30-60/1000 • Increasing incidence over past 3 decades

  6. Definitions • Aneurysm : Increase in diameter of 50% (1.5x) its normal diameter – Focal region

  7. AAA is more common • Increase diameter to >3 cm • 3-9% men >50 y/old • Is more common in inferarenal(>80%) • Pararenal and suprarenal( 10%) • M/F=5/1 • Age depended • Usually is common in age>60 • Smoker/no smoker=5/1 • RF:male ,age ,smoking,HTN/HLP/emphysema • POSITIVE FH:20%

  8. TAA is less common • Incidence:10/100000 • Ascending Aorta:60% • Descending aorta:35% • Aortic arch<10%

  9. Aortic AneurysmsAssociated Aneurysms • Iliac - 41% • Femoro-popliteal - 15% • Pts with unilateral popliteal aneurysms-->8% AAA • Pts with bilateral popliteal aneurysms--> 30%-50% AAA

  10. Aortic AneurysmsAssociated Medical Conditions • Carotid Artery Stenosis - 10% have AAA • Smoker:Nonsmoker - 8:1 • Male:Female - 4:1 • HTN - 40% of pts with AAA have HTN

  11. Aortic AneurysmsEtiology • Atherosclerosis • Cystic Medial Necrosis • Dissection • Ehlers-Danlos Syndrome • Syphilis • Familial Associated • Lysyl Oxidase deficiency

  12. Aortic AneurysmsClinical Presentation • Asymptomatic - 70-75% • Symptoms: • Early satiety, N,V • Abd., Flank, or Back pain (1/3 of pts experience abd. And flank pain) -Abrupt onset of pain -->Rupture or expansion of aneurysm

  13. Ruptured Aneurysm • 60-70 y/o who presents with abd pain, hypotension and a pulsatile abdominal mass

  14. Aortic AneurysmsRuptured Aneurysms • rupturUsually occurs postero-laterally • Can rupture in Vena Cava creating Aorto-Caval Fistula • Occasionally can rupture anterior - usually fatal

  15. Aortic AneurysmsDiagnosis • Physical Exam: • If <5cm in diameter, then cannot be detected by routine physical exam • Radiographs: • Calcified wall. Can determine size in 2/3

  16. Aortic AneurysmsDiagnosis • Arteriography: • Cannot determine aneurysm size because of mural thrombus

  17. echocardiography • Proximal AoD- • TEE sensitivity 88-98%,specificity 90-95% • TTE 77-80% and 93-96% • Distal AoD-TEE better

  18. Aortic AneurysmsDiagnosis • Ultrasound • Establishes diagnosis easily • Accurately measures infrarenal diameter • Difficult to visualize thoracic or suprarenal aneurysms • Difficult to establish relationship to renal arteries • Technician dependent • Widely available, quick, no risk, cheap

  19. Aortic AneurysmsCT Scan • Very reliable and reproducible • Can image entire aorta • Can visualize relation ship to visceral vessels • Longer to obtain and is more costly than U/S • Most useful • Requires contrast agent - renal toxicity

  20. Aortic AneurysmsMRA • Now widely available • More expensive than CT • No contrast agent required • Spacial resolution less than CT

  21. Aortic Aneurysmscomplication • Complications of AAA • Thrombosis • Distal embolization • Rupture 23.4% of aneurysms 4-5 cm will rupture

  22. Aortic AneurysmsRupture Risks • Patients with COPD and HTN have increased risk of rupture -Survival • 50% die prior to reaching hospital, and an additional 24% prior to repair.

  23. TREATMENT • MEDICAL • SURGICAL

  24. MEDICAL TREATMENT • STOP SMOKING( more important) • RF MODIFICATION • STATINS( in all of paitent) ACEI( pt with ateroschelerosis)

  25. Aortic AneurysmsIndications for repair • Presence of an infrarenal aneurysm > 5cm without associated co-morbid medical conditions • Repair smaller aneurysms if rate of enlargement is greater than expected(>1 cm per year) • Repair all symptomatic aneurysms • If co-morbid conditions exist wait until risk of repair and rupture are equal (approx. 6 cm)

  26. Aortic AneurysmsTreatment-Surgical • Standard Surgical Repair • Replace diseased aorta with artificial artery • Requires 7 day hospital stay • Recovery time 3-6 months

  27. Aortic AneurysmsTreatment - Endovascular • Repair through an incision in the groin with expandable prosthesis under fluoroscopic guidance • Requires both surgical and radiological assistance • Significantly reduced diametr • Long tern result unknown • Hospital stay 2 days, Recovery time 1-2 weeks

  28. What is your management? • Stop smoking • Risk factor modification -Statin -ACEI -SONOGRAPHY(EVERY 6 MONTH)-

More Related