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Aortic Aneurysm

IN THE NAME OF GOD. Aortic Aneurysm. Dr.mehdi hadadzadeh Cardiovascular surgeon . Aortic Aneurysm Definition. Permanent focal dilatation of artery greater than 1.5 times its NL diameter. Classification. Location Wall shape. location.

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Aortic Aneurysm

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  1. IN THE NAME OF GOD Aortic Aneurysm Dr.mehdi hadadzadeh Cardiovascular surgeon

  2. Aortic Aneurysm Definition Permanent focal dilatation of artery greater than 1.5 times its NL diameter

  3. Classification • Location • Wall • shape

  4. location • abdominal aortic aneurysms (AAA). • thoracic aneurysms (TA). • thoracoabdominal aneurysms (TAA).

  5. Wall:false or true • blood vessel has 3 layers: the intima ,media and adventitia • The wall of a true aneurysm involves all 3 layers • The wall of a false or pseudoaneurysm only involves the outer layer

  6. shape • saccular • fusiform

  7. 29PATHOPHYSIOLOGY • Most of the elasticity and tensile strength of the aorta isderived from its medial layer • consists of approximately45 to 55 lamellar units of elastin, collagen, smooth musclecells, and ground substance • elastincontent diminishesas one proceeds distally into the descending thoracic and abdominalaorta • Most aortic aneurysms occur in the infrarenal segment (95%).

  8. The aortic wall is a biologically active environment

  9. tension = pressure x radius • Larger aneurysms have a greaterrisk of rupture. • Larger aneurysms have an increased growth rates (0/08-0/5cm/year)

  10. Frequency • prevalence : 3-4% in individuals older than 65 years. • Begin at approximately age 50years and reaches peak incidence at 80 years • Men affected 4x more • Rupture of an AAA usually is a lethal event , carrying an overall mortality rate of 80-90%

  11. Etiology • Degenerative (arteriosclerotic)(Cystic medial degeneration ) • previous aortic dissection • connective-tissue disease (marfan, Ehler- Danlos Type IV) • Imflamatory (Autoimmune) • Traumatic • Congenital:15% of first-degree relatives of patients

  12. Aortic dissection

  13. Mycotic aneurysm • fewer than 5% of cases • hematogenous origin • Sacular • Most commonly cause:S.aureus and S.epidermidis

  14. Symptoms & Sign Mass. Displacement of adjucent structure Compression of adjucent structure: esophagus,trachea,SVC,nerve,renal,…. Erosion of adjucent structure Rupture Distal embolism

  15. Physical examination • blood pressures • Cervical bruits • Abdominal palpation • Abdominal bruits and trill • peripheral pulses

  16. Diagnosis: History & PE X.ray Sonography Color duplex scanning C T MRI Angiography

  17. Diagnostic pathways • Ultrasound is an excellent screening tool to identify with an AAA in unstable patient, but is less reliable for detection of vascular rupture . sensitivity and specificity approaching 100% and 96% • CT is accurate for both detection of an AAA and identifying leak or rupture. CT is more useful in evaluation of symptomatic but stable patients • Angiography . Represent another option for evaluation of patient with symptomatic AAA. Its primary function is for consulting surgeons who may obtain anatomic information that will aid in the surgical plan. • MRI offers the advantages better than CT for defining three-dimensional views of the aorta and surrounding vascular structures, but limited to patients with metalic foreign object( I,e. pacemakers, surgical clips.

  18. Treatment: Conservative manangment - Drugs:B-Blockers / Indomethasin - Monitor growth - maintain BP - Frequent CT Scans Intervension: - Intraluminal stent - Surgery

  19. Indications for surgery • Aortic size: Patients with AAAs > 5cm • Rate of dilatation exceeds 1cm/y • Symptomatic aneurysm • Traumatic aortic rupture • Mycotic aneurysm

  20. Contraindications for surgery • severe COPD • severe cardiac disease • active infection • medical problems that preclude operative intervention: advanced cancer, end-stage lung disease ,elderly patient (>80 y) with significant comorbidities

  21. A B

  22. Thanks for your attention

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