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Acute Aortic Syndrome PowerPoint Presentation

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Description : Check out this medical presentation on Aorta, which is titled "Acute Aortic Syndrome", to know about acute aortic syndrome, a variety of acute painful and potentially life-threatening aortic pathologies requiring immediate medical attention. It includes aortic dissection, aortic ulcer, intramural hematoma and unstable or painful thoracic aortic aneurysm.

Tags : Aorta, Acute Aortic Syndrome, aortic pathologies, aortic dissection, aortic ulcer, intramural hematoma, unstable, painful thoracic aortic aneurysm

Published on : Jun 02, 2021 | Views : 3120 | Downloads : 30

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Slide 1-

Acute Aortic Syndrome Firas F Mussa, MD, FACS Vascular Surgery Columbia University Medical Center
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Definitions Mussa FF et al, JAMA, August 16 2016
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Type B Dissection-Background Definition of COMPLICATED dissection: Rupture (free or contained) Shock Malperfusion Uncontrolled pain or hypertension
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Acute Aortic Dissection (AAD) Consider AAD in all patients presenting with chest, back or abdominal pain High risk (1) Marfan FH of aortic disease Known AVD Rec. Ao.intervention Known TAA High risk pain (2) features Abrupt onset Severe “Ripping/tearing” High risk exam (3) Pulse deficit Syst BP diff. Focal neurol deficit EDM Diagnosis is missed on initial evaluation in 38% of patients. (Spitell PC. Mayo Clinic Proc.1993;68:642-651)
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An algorithm for the identification and treatment of aortic dissection in patients presenting with chest pain Nienaber, C. A. et al. (2016) Aortic dissection Nat. Rev. Dis. Primers doi:10.1038/nrdp.2016.53
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Diagnosis
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Novel Tests (Biochemical Markers) Inflammatory  C reactive protein –  IL-6 Smooth muscle damage  Smooth muscle myosin heavy chain Calpronin Thrombosis/ Fibrinolysis  D- dimer Cardiac Stress/Damage Cardiac troponins  Creatinine kinase  Pro-brain naturetic peptide Extracellular Matrix damage  MMPs  Soluble elastin fragments Diagnose
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Treatment
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Zone 0 – proximal anastomosis If the root is torn or dilated then replace root Valve sparing aortic root replacement Aortic root surgery was not associated with increased in hospital mortality, but decreased the likelihood of re-intervention due to late aortic root intervention (Di Eusanio M et al. Ann Thorac Surg 2014;98:2078–85) Bentall Modified Cabrol Surgical Options to Manage aortic root
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Zone 1 or 2 If FET combines conventional surgical replacement of the ascending aorta and the aortic arch with endovascular repair of the descending aorta. If a tear is in Zone 1 or 2 you need to replace the Arch Elephant Trunk Frozen Elephant Trunk (FET) Elephant trunk technique for replacement of the aortic arch was advocated by Miyamoto S. et.al (Ann Thorac Cardiovasc Surg. 2006;12:412-6.) Associated with similar satisfactory early and mid-term outcomes. Leads to single-stage treatment in a significant number of patients aortic disease. Facilitates endovascular second-stage treatment in patients with residual DTA disease (Di Eusanio M.Ann Thorac Surg 2015;100: 88–94.)
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Protocol for uTBAD Courtesy of Hazim Safi, MD 14
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TEVAR for uTBAD?!!! Consecutive patients in 7 centers in Germany, France, and Italy, uncomplicated dissection 2-52 weeks 11/2003-12/2005. Patients were followed up until September 2010 (min 5 years, max 8 years) Median interval until death or latest follow up was 69 months (IQ range 62-83). No patient lost to follow up Median time between dissection and enrollment 45 days in OMT (20-252), 39 days in TEVAR (18-252) Median time between enrollment and TEVAR was 12 days (1-29) Nienaber CA, et al, Circulation. 2009;120(25):2519-2528 Trial
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16 Primary Endpoint All cause mortality at 2 years Secondary Endpoints False lumen thrombosis (FLT) Degree of aortic expansion Cardiovascular morbidity QOL Length of ICU and hospital stay Crossover INSTEAD Trial Trial
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17 KM estimates of all-cause mortality and progression with landmark analysis
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So Far… The effectiveness of the current standard medical therapy is unacceptable over the long term (aneurysmal degeneration over 5 years in >60%) The FDA approved TEVAR for all aortic dissections regardless of symptoms The role of TEVAR in reducing overall mortality or major aortic complications have never been conclusively demonstrated (P=NS-INSTEAD-XL) TEVAR induces aortic remodeling (P<0.001-INSTEAD-XL, ADSORB) 18
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Type A Type B complicated Type B uncomplicated In conclusion………. BUT regardless of the treatment path the key is early detection and identification of patients at risk is best served by Surgery TEVAR unless patients with collagenopathy Medical management followed by TEVAR in sub-acute phase
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Uncomplicated Type B Aortic Dissection Primary endpoint: Major Aortic Complications-Free Survival over median follow-up of 5 yrs Medical Therapy TEVAR/Surgery reserved for complications during follow-up INTACT-AD
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God created the aorta with ONE lumen….it should stay that way… 21