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Aortic Aneurysm PowerPoint Presentation

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Published on : Mar 14, 2014
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Slide 1 - Aortic Aneurysm Victor Politi, M.D., FACP Medical Director, SVCMC, School of Allied Health Professions, Physician Assistant Program
Slide 2 - The Aorta The aorta is the largest human artery It is the primary artery that carries blood from the heart to the head and extremities During an average lifetime it transports 200 million liters of blood and withstands the force of up to 3 billion heartbeats
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Slide 4 - The Aorta The aorta is one inch in diameter It divides at the hip into the two iliac arteries that supply blood to the legs The arteries that feed all of the body’s organs branch off from the aorta
Slide 5 - The Aorta The aorta emerges from the heart and runs the length of the torso thoracic aorta - as it leaves the heart, ascends, arches, and descends through the chest until it reaches the diaphragm abdominal aorta - after passing the diaphragm - continues down abdomen- ends where it splits at two iliac arteries
Slide 6 - Where do they develop Can develop anywhere along the aorta In the chest - called thoracic aneurysm More than 3/4 of aortic aneurysms occur in the abdomen - most often below the renal arteries About 2/3 of abdominal aneurysms extend from the aorta into one or both of the iliac arteries
Slide 7 - What is an aortic aneurysm An aneurysm can be caused by pressure on a weakened section of the arterial wall or by dissection - a split in the three layers of tissue comprising the aortic wall - blood seeps between them, the wall stretches, increasing the risk of rupture
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Slide 9 - Three common types of aortic aneurysms Saccular involves only the muscular middle layer of aorta with a localized out-pocketing (balloon-like swelling) Fusiform most common form, spindle shaped, widens all around circumference of aorta (balloon-like swelling) Dissecting longitudinal, blood-filled split in the lining of the artery, usually in the aortic arch near the heart
Slide 10 - Incidence On average 15,000 Americans die suddenly each year from rupture of an aortic aneurysm It is the 9th leading cause of death from men over age 55
Slide 11 - Incidence Increases with age > 60 at greater risk Males more common than females (5:1) 5% of men over age 60 develop an abdominal aortic aneurysm
Slide 12 - Incidence Most common cause - arteriosclerosis (80% of cases) post physical trauma to aorta Other Risk factors connective tissue disease, arteritis, congenital malformation, Marfan syndrome, atherosclerotic risk factors (smoking, HTN, hyperlipidemia, diabetes)family hx of aneurysm
Slide 13 - Symptoms Aneurysms can be small or grow to the size of a grapefruit Most are symptomless, especially when small Symptoms tend to increase as aneurysms enlarge and press on nerves, organs, or other blood vessels Symptoms occur in only 25% of patients
Slide 14 - Symptoms Most common symptom is a throbbing, or pulsation in the abdomen May cause lower back pain
Slide 15 - Symptoms In thoracic aneurysm symptoms may include: pain in the shoulders, lower back, neck or abdomen a dry cough hoarseness from pressure of aneurysm on nerves controlling vocal cords many of these are frequently misdiagnosed!
Slide 16 - Symptoms Other symptoms throbbing lump in abdominal area severe backache leg pain/coldness in leg (due to embolus from clot formed in abdominal aneurysm) severe abdominal pain (rupture)
Slide 17 - Diagnosis Abdominal palpitation may reveal abnormally wide pulsation of the abdominal aorta characteristically felt on both sides of the aorta which is midline Even large aneurysms can be difficult to detect on exam in overweight people Aneurysms that are rapidly enlarging and on the verge of rupture are often tender
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Slide 19 - Diagnosis Abdominal aortic aneurysm x-ray (shows calcium deposits in 90% of cases) CT Scan w/contrast MRI abdominal Ultrasound -(98% accuracy in size measurement) abdominal aortography
Slide 20 - Aortic Aneurysm The aorta (short arrow) looks like a white "candy-cane" in the middle of this image. The aneurysm (long arrow) is the thin line running through the candy cane.
Slide 21 - Diagnosis thoracic aortic aneurysm chest x-ray TEE MRI CT scan
Slide 22 - Complications - 1/2 of all persons with untreated abdominal aortic aneurysms die of rupture within 5 years Abdominal aortic aneurysms - 13th leading cause of death - overall - in the US
Slide 23 - Complications Rupture highly lethal - causes profuse bleeding, leads to shock- death uncommon < 5cm wide More common > 6cm wide Peripheral embolization of clot within the aneurysm Infection of aneurysm Spontaneous blockage of the aorta
Slide 24 - Treatment Symptomatic aneurysms require early or urgent treatment Surgical treatment involves replacing the part of the aorta affected by the aneurysm with a synthetic graft - risk of death from rupture 50%- even during surgery Surgery only treatment
Slide 25 - Treatment Treatment of dissecting aneurysm lowering of BP to reduce force on the tear-prior to surgery if left untreated- most people die within a few weeks
Slide 26 - Treatment Repair can be done surgically or by installation of a stent graft Surgical repair recommended for all aneurysms over 6cm wide usually recommended for aneurysms 4-6cm in good surgical risk cases Stent graft - minimally invasive -may be option in some cases
Slide 27 - Questions??