Aortic dilatation

Aortic dissection

Aortic aneurysm

Aortic pathologies Hypertension

KONSTANTINOS FILIS, MD

Offsprings of

hypertensive patients

Higher aortic stiffness

and lower flow-

mediated dilatation

→ Impaired endothelial

function and impaired

elastic properties of the

aorta

Effect of diastolic pressure

Duration of hypertension

KONSTANTINOS FILIS, MD

Aortic dilatation

Aortic dissection

INTERNATIONAL REGISTRY OF ACUTE AORTIC DISSECTION

519 Hypertension initiates aortic wall stress

▪ Link between hypertension and aortic dimensions is controversial

KONSTANTINOS FILIS, MD

INTERNATIONAL REGISTRY OF ACUTE AORTIC DISSECTION

Male sex predisposition

KONSTANTINOS FILIS, MD

Aortic Dissection

KONSTANTINOS FILIS, MD

INTERNATIONAL REGISTRY

OF ACUTE AORTIC DISSECTION

519 patients / 71% hypertensive

Aortic Dissection

KONSTANTINOS FILIS, MD

AAA diameter – thrombus & lumen

KONSTANTINOS FILIS, MD

Aortic Aneurysm

KONSTANTINOS FILIS, MD

What is critical to do

for a hypertensive patient with

an AAA

Control hypertension

Prepare an intervention

KONSTANTINOS FILIS, MD

Major contributing factors

▪Age

▪Male sex 3Χ

▪Smoking 4Χ

▪Family history 2Χ

▪Diabetes Mellitus (NEGATIVE ASSOCIATION)

Minor contributing factors

▪Presence of aneurysm in other location

▪Heart disease, atherosclerosis

▪Hypertension

▪Hypercholesterolemia

▪Chronic obstructive pulmonary disease

KONSTANTINOS FILIS, MD

Factors affecting enlargement

▪Smoking cessation

▪Statins;

▪Hypertension;

▪Anti-inflammatory;

▪ACE inhibitors;

▪Β-blockers;

▪Doxycycline;

▪Roxithromycine;

Evidence for effect Evidence for no effect

KONSTANTINOS FILIS, MD

Medical history

Resting ECG - cardiac symptoms (angina?)

Heart failure? (EF)

History of cerebrovascular disease

Lower extremity atherosclerosis

Pharmacological stress test

Myocardial perfusion scan

Coronary revascularization?

Cardiovascular Assessment

KONSTANTINOS FILIS, MD

Hypertension

KONSTANTINOS FILIS, MD

Blood pressure control should be

achieved from the time of diagnosis for

secondary prevention to reduce

cardiovascular morbidity

Target < 140/90 mmHg

Adam Study,

567 patients enrolled for

follow-up

Effect of diastolic pressure

Expansion rate in hypertensive versus non-hypertensive patients

Imaging

Surveillance

Open repair

Endovascular repair

Modification of risk factors

Cardiovascular assessment

KONSTANTINOS FILIS, MD

Surveillance

after “open” or “endo” repair

Modification of risk factors

Cardiovascular assessment

KONSTANTINOS FILIS, MD

JOURNAL OF VASCULAR SURGERY 2008;47(4):886-92

JOURNAL OF VASCULAR SURGERY 2010;52(2):303-7

Complications : Migration

JOURNAL OF VASCULAR SURGERY 2007;45(5):900-5

Complications : anastomotic aneurysm

Complete abdominal aortic aneurysm thrombosis and obstruction of both

common iliac arteries with intrathrombotic pressures demonstrating a

continiuing risk of rupture: a case report and review of the literature.

K. Filis, E. Lagoudianakis, H. Markogiannakis, A. Kotzadimitriou,

N. Kotronakis, K. Xiromeritis, D. Theodorou, A. Manouras.

J Med Case Reports. 2009;24(3):9292.

ICU transfer after elective abdominal aortic aneurysm repair can be

succesfully reduced…

C. Bakoyiannis, N. Tsekouras, S. Georgopoulos, C. Klonaris, E.E. Bastounis,

K. Filis, E. Papalambros, E. Bastounis.

Int Angiol. 2011; 30(1):43-51.

KONSTANTINOS FILIS, MD

Published Data – Ippokrateion Hospital

Osteopontin and osteoprotegerin as potential biomarkers in abdominal aortic

aneurysm before and after treatment.

K. Filis, V. Martinakis, G. Galyfos, F. Sigala, D. Theodorou, I. Andreadou,

G. Zografos.

Int Sch Res Notices. 2014 Jul 2014;2014:461239. doi: 10.1155/2014/461239.

Published Data – Ippokrateion Hospital

Endovascular repair of blunt thoracic aortic trauma: Is post-implant

hypertension an incidental finding?

K. Tigkiropoulos, F. Sigala, D. Tsilimigras, D. Moris, K. Filis, N. Melas,

D. Karamanos, C. Kontogiannis, I Lazaridis, N. Saratzis.

Ann Vasc Surg. 2018 Mar 7

220 ΑΚΑ

Open Surgery

2 ΘΑΝΑΤΟΙ < 1%

1 ΑΣΘΕΝΗΣ ΜΕ ΣΟΒΑΡΗ ΝΟΣΗΡΟΤΗΤΑ

Endo Surgery

0 ΘΑΝΑΤΟΙ

KOSTAS FILIS, MD - IPPOKRATEIO HOSPITAL OF ATHENS

ΑΠΟΤΕΛΕΣΜΑΤΑ ΘΕΡΑΠΕΙΑΣ ΑΚΑ 14 ΕΤΩΝ

Hypertension is one of many complicated pathways of aortic pathology

• Genetics• Smoking

• Age

conclusion

Aortic pathologies Hypertension