Aortic Aneurysms Dilshan Udayasiri. Some Anatomy ascending aorta arch of the aorta descending aorta...

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Aortic Aneurysms Dilshan Udayasiri

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Transcript of Aortic Aneurysms Dilshan Udayasiri. Some Anatomy ascending aorta arch of the aorta descending aorta...

Page 1: Aortic Aneurysms Dilshan Udayasiri. Some Anatomy ascending aorta arch of the aorta descending aorta abdominal aorta.

Aortic AneurysmsDilshan Udayasiri

Page 2: Aortic Aneurysms Dilshan Udayasiri. Some Anatomy ascending aorta arch of the aorta descending aorta abdominal aorta.

Some Anatomyascending aorta

arch of the aorta

descending aorta

abdominal aorta

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Layers of the aorta

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Types of aneurysmsShape

Saccular Fusiform

Ruptured

Causes

Degenerative

Dissecting

LocationThoracic (25%)•Ascending (60%)•Aortic Arch - includes brachiocephalic arteries (10%•Descending (40%)•Thoracoabdominal (10%)Abdominal (75%)

Percentage 60% 10-15 % 25-30 %

Type DeBakey I DeBakey II DeBakey III

Stanford A Stanford B

  Proximal Distal

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Risk Factors•Hypertension

•Hypercholesterolaemia

•Smoking

•Age (rare before 60)

•Genetic (Marfans, Ehlers-Danlos syndrome)

•Bicuspid Aortic Valve

• Inflammatory/infectious - eg Giant Cell Arteritis

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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)

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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)

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Investigations

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Treatment

•Watchful Waiting + medical

•Percutaneous or open intervention

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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.

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Indications for surgery

•HD unstable

•symptomatic

•diameter ≥ 5.5cm

•rate of growth ≥ 1.0cm/year

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Endovascular repairIndications

High perioperative risk pt’s

Other Benefitsshorter ICU stayShorter Hospital StayQuicker return to normal functionIncreased surviability in the short term

ComplicationsEndoleak (Type 1-4)Device MigrationInfectionHaematomaStrokeAMIDeath

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Surgery• Incision depends on location

• Median sternotomy - arch

• left thoracomtomy - descending

• left thoracotomy extending across costal margin for retroperitoneal approach - thoracoabdominal

• Abdominal incision - AAA

ConsiderationsDistal perfusioncerebral protectionRenal DysfunctionStaged procedure


SURGERY of AORTIC ANEURYSMS ABDOMINAL AORTA or THORACO-ABDOMINAL AAORTA with RENAL ARTERY RE-IMPLANTATION RENAL ARTERY RE-IMPLANTATIONthrough LEFT THORACO-PHRENO-LAPAROTOMY.

SURGERY of AORTIC ANEURYSMS ABDOMINAL AORTA or THORACO-ABDOMINAL AAORTA with RENAL ARTERY RE-IMPLANTATION RENAL ARTERY RE-IMPLANTATIONthrough LEFT THORACO-PHRENO-LAPAROTOMY.

BOARD OF DIRECTORS · non-surgical treatment for complex aneurysms of the aorta. However, this ... Liver cancer is a fatal disease and most patients are not candidates for surgery

BOARD OF DIRECTORS · non-surgical treatment for complex aneurysms of the aorta. However, this ... Liver cancer is a fatal disease and most patients are not candidates for surgery

CASE REPORT Unusual presentation of multiple aneurysms of ... · CASE REPORT Unusual presentation of multiple aneurysms of the ascending aorta Sergio Francisco Santos Jr.,I Marcelo

CASE REPORT Unusual presentation of multiple aneurysms of ... · CASE REPORT Unusual presentation of multiple aneurysms of the ascending aorta Sergio Francisco Santos Jr.,I Marcelo

Vascular ultrasonography for follow-up of endovascular repair of … · 2015. 9. 15. · Vascular ultrasonography for aorta aneurysms and structural changes to endoprostheses visible

Vascular ultrasonography for follow-up of endovascular repair of … · 2015. 9. 15. · Vascular ultrasonography for aorta aneurysms and structural changes to endoprostheses visible

aneurismas arteriales - ucm.es Aneurismas... · aorta torácica descendente . aorta toracoabdominal . aorta suprarenal . aorta pararenal . aneurisma aorta infrarenal: AAA . clínica

aneurismas arteriales - ucm.es Aneurismas... · aorta torácica descendente . aorta toracoabdominal . aorta suprarenal . aorta pararenal . aneurisma aorta infrarenal: AAA . clínica

th, 2019 PAPER SESSION I: THE THORACIC AORTA...2018 that compared endovascular versus open repair of juxtarenal aortic aneurysms. Studies that included patients with pararenal and

th, 2019 PAPER SESSION I: THE THORACIC AORTA...2018 that compared endovascular versus open repair of juxtarenal aortic aneurysms. Studies that included patients with pararenal and

concert to produce aortic aneurysms Matrix ... · ed for zymographic analysis of MMP proteins. For his-tologic studies, the aorta was perfusion-fixed with 10% neutral-buffered formalin.

concert to produce aortic aneurysms Matrix ... · ed for zymographic analysis of MMP proteins. For his-tologic studies, the aorta was perfusion-fixed with 10% neutral-buffered formalin.

Aorta/ascending aorta/aortic arch?

Aorta/ascending aorta/aortic arch?

Abdominal aortic aneurysm (AAA) screening · 2020. 8. 25. · Abdominal aortic aneurysms The aorta is a big blood vessel that takes blood from your heart round your body. When some

Abdominal aortic aneurysm (AAA) screening · 2020. 8. 25. · Abdominal aortic aneurysms The aorta is a big blood vessel that takes blood from your heart round your body. When some

Management of Abdominal Aortic Aneurysms Clinical Practice ... · aorta: an abdominal aortic diameter of 3.0 cm or more, which usually is more than 2 standard deviations above the

Management of Abdominal Aortic Aneurysms Clinical Practice ... · aorta: an abdominal aortic diameter of 3.0 cm or more, which usually is more than 2 standard deviations above the

101 Aneurysms

101 Aneurysms

Endovascular Stent Grafts for Abdominal Aortic Aneurysms · Endovascular Stent Grafts for Abdominal Aortic Aneurysms 34704 Endovascular repair of infrarenal aorta and/or iliac artery(ies)

Endovascular Stent Grafts for Abdominal Aortic Aneurysms · Endovascular Stent Grafts for Abdominal Aortic Aneurysms 34704 Endovascular repair of infrarenal aorta and/or iliac artery(ies)

Subclavian and Axillary Artery Aneurysms · AXILLARY AND SUBCLAVIAN ARTERY ANEURYSMS • Very rare peripheral artery aneurysms –Make up 0.13-1% of all peripheral aneurysms •Subclavian

Subclavian and Axillary Artery Aneurysms · AXILLARY AND SUBCLAVIAN ARTERY ANEURYSMS • Very rare peripheral artery aneurysms –Make up 0.13-1% of all peripheral aneurysms •Subclavian

Dissecting Aneurysms

Dissecting Aneurysms

Abdominal Aortic Aneurysm Model of Care · arteries and the aorta (thoracic and abdominal). Aneurysms most commonly occur in the abdominal aorta and as such, a large proportion of

Abdominal Aortic Aneurysm Model of Care · arteries and the aorta (thoracic and abdominal). Aneurysms most commonly occur in the abdominal aorta and as such, a large proportion of

Abdominal Aortic Aneurysms - American Society of ... · 146 RADIOLOGIC TECHNOLOGY, November/December 2016, Volume 88, Number 2 CE Directed Reading Abdominal Aortic Aneurysms The aorta

Abdominal Aortic Aneurysms - American Society of ... · 146 RADIOLOGIC TECHNOLOGY, November/December 2016, Volume 88, Number 2 CE Directed Reading Abdominal Aortic Aneurysms The aorta

SPIRITUAL HEALER Palm Reader - Pandit Balaji Solve Any ... · ve centimetres (normal diameter of the aorta in the abdomen is about two centimeters). Also, patients with aneurysms

SPIRITUAL HEALER Palm Reader - Pandit Balaji Solve Any ... · ve centimetres (normal diameter of the aorta in the abdomen is about two centimeters). Also, patients with aneurysms

TECHNOLOGIES€¦ · of the native aorta and endografts Chairmen: A. Freyrie, F. Speziale Endovascular Treatment of Mycotic Aortic Aneurysms A. Wanhainen Inflammatory abdominal aortic

TECHNOLOGIES€¦ · of the native aorta and endografts Chairmen: A. Freyrie, F. Speziale Endovascular Treatment of Mycotic Aortic Aneurysms A. Wanhainen Inflammatory abdominal aortic

Postdissection Aneurysms Supp_sec 9.pdfaneurysm usually involves the thoracoabdominal aorta, the repair involves taking care of the visceral branches of the aorta in most cases. Open

Postdissection Aneurysms Supp_sec 9.pdfaneurysm usually involves the thoracoabdominal aorta, the repair involves taking care of the visceral branches of the aorta in most cases. Open

Carotid-ophthalmic aneurysms · aneurysms. Bull (1962) in a study of 1769 intra-cranial aneurysms did not analyse carotid-ophthalmic aneurysms separately but grouped them with other

Carotid-ophthalmic aneurysms · aneurysms. Bull (1962) in a study of 1769 intra-cranial aneurysms did not analyse carotid-ophthalmic aneurysms separately but grouped them with other