Ross Milner, MDUniversity of Chicago
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Ross Milner, MDUniversity of Chicago Mark Russo, MD, MS Center for Aortic Diseases. THE SITUATION. Over 6,000 people died last year from ruptured thoracic aortic aneurysms (TAA). 21,000 were diagnosed with this dangerous condition.

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Ross milner md university of chicago

Ross Milner, MDUniversity of Chicago

Mark Russo, MD, MS Center for Aortic Diseases


The situation

THE SITUATION

  • Over 6,000 people died last year from ruptured thoracic aortic aneurysms (TAA).

  • 21,000 were diagnosed with this dangerous condition.

  • Once a TAA ruptures, the survival rate is only 15%.

    Could your patient have an undiagnosed TAA?


Taa essentials

TAA ESSENTIALS

Definition

  • Diameter of the thoracic aorta 1.5 times greater than normal (or larger)


Taa essentials1

TAA ESSENTIALS

Scope of the challenge:

  • 21,000 new cases per year in the U.S.

  • Men: 60%, Women: 40%

    • Elective repair: up to 10% mortality

    • Emergent repair: up to 50% mortality


Who is at risk

WHO IS AT RISK

Primary Risk Factors

  • Smoking

  • Hypertension

  • High cholesterol

  • Obesity

  • Atherosclerosis

  • Chest trauma

  • Genetics – Marfans, Ehlers-Danlos

  • Family history


Symptoms

SYMPTOMS

Although there are frequently no symptoms, TAA symptoms may include:

  • Neck, chest or back pain (25%)

  • Shortness of breath

  • Difficulty swallowing

  • Hoarse cough

  • Congestion of head, neck, upper extremities (related to SVC compression)


Diagnosis

DIAGNOSIS

Imaging

Occurrence

  • CT – the definitive exam

  • MRI

  • Chest x-ray

  • Aortogram

  • TEE

  • 25% Ascending aorta

  • 25% Aortic arch

  • 50% Descending aorta


Treatment options

TREATMENT OPTIONS

  • TAAs under 5.0 cm: medical therapy, monitor annual growth by CT

  • TAAs over 5.0 cm in diameter: intervention/repair strongly considered

  • Medical management (BP-lowering drugs)

  • Open surgery

  • Endovascular repair

    No proven lifestyle changes can decrease the size of TAAs.

    TEVAR animation video


Repair options

REPAIR OPTIONS

  • Both endovascular and open surgeries are used to repair TAAs.

  • Approximately 11,000 open surgeries are performed each year in the U.S.

  • Approximately 8,000 endovascular repairs are performed in the U.S. annually.*

    *BIBA Medical Research estimated 1,960 thoracic stent grafts were implanted in the U.S. in Q2 2008.


Repair options1

REPAIR OPTIONS

Endovascular surgery:

  • Requires single small incision in the groin area.

  • An endovascular graft is inserted through the femoral artery via a catheter and deployed inside the lumen, relining the aorta.

    Average ICU stay: 2-3 days

    Average recovery time: 1-2 weeks


Repair options2

REPAIR OPTIONS

Open surgery:

  • Requires thoracotomy

  • Aorta is cross-clamped above diseased aortic segment

  • Affected segment is replaced with fabric surgical graft

    Average hospital stay: 2-3 weeks

    Average recovery time: 3 months


Three clinical trials

THREE CLINICAL TRIALS

Controlled Endovascular Stent Graft Trials

  • 2005 TAG Pivotal Trial (N=139)

  • 2008 TX2 Pivotal Trial (N=160)

  • 2008 Talent Pivotal Trial (N=195)


Endovascular stent graft trials

ENDOVASCULAR STENT GRAFT TRIALS


What you can do

WHAT YOU CAN DO?

Be aware TAAs are most often silent killers and are increasing in number.

  • Remember those most at risk:

    • Men over 60

    • Smokers

    • Those with a family history of TAA

  • Image and refer as appropriate those patients with a high index of suspicion for TAA.


  • University of chicago center for aortic diseases

    University of Chicago Center for Aortic Diseases

    University of Chicago Medical Center

    5841 S. Maryland Avenue

    Chicago, IL 60637

    773-702-2500

    [email protected]

    This presentation was brought to you by Cook Medical.


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