Description
Aortic aneurysms can occur in different parts of the aorta, including the ascending aorta, the aortic arch, and the descending aorta. It can be caused by a number of factors, including high blood pressure, smoking, atherosclerosis (a build-up of fatty deposits in the arteries), connective tissue disorders (such as Marfan syndrome), and family history. They are diagnosed using imaging tests such as CT scans, MRI scans, or ultrasound. Treatment for aortic aneurysms depends on their size, location, and other factors. Small aneurysms may be monitored with regular imaging tests, while larger aneurysms may require surgery or other interventions.Some people may be at higher risk of developing aortic aneurysms, including those with a family history of the condition, smokers, and people with high blood pressure or cholesterol.
Résumé
- Aortic aneurysms are localized abnormal dilatations of blood vessels, most commonly found in the abdominal aorta. They are defined as a diameter exceeding 1.5 times the expected size for the region, except for the aortic root and ascending aorta, where a threshold of 4.5 cm or more is used. Risk factors include family history, genetic conditions like Marfan syndrome, smoking, male gender, hypertension, and older age. Diabetics, conversely, have a lower risk due to thicker aortic walls.
- Causes of aortic aneurysms can be primary (congenital), mechanical/iatrogenic, post-stenotic, traumatic, or infectious (mycotic aneurysms). Patients may present asymptomatically, or with pain (indicating rapid expansion or rupture), or symptoms due to erosion/compression of surrounding structures. Rupture carries a high mortality rate, increasing with aneurysm size.
- Thoracoabdominal aortic aneurysms are classified using the Crawford classification, based on location and extent. Imaging is critical for diagnosis, assessing rupture risk, and surgical planning. Aortic diameters should be measured at reproducible landmarks, perpendicular to the direction of blood flow. CT and MRI are used, measuring inner to inner diameter, unless there is an exhaustion process. Modality selection depends on availability and required information.
- Surveillance is crucial for asymptomatic aneurysms. Those less than 4 cm are re-imaged every three years, while those nearing intervention thresholds (5 cm for men, 4.5 cm for women) require six-month follow-up imaging.
- Medical management, although not a primary treatment, focuses on cardiovascular risk reduction through smoking cessation, statins, and antiplatelet therapy. ACE inhibitors are beneficial for hypertension management, while beta-blockers can be considered.
- Operative management is indicated for symptomatic aneurysms or those exceeding specific size thresholds. Surgical repair is strongly advised for symptomatic patients or those with aneurysm sizes exceeding 5.5 cm. Rapid growth (more than 0.5 cm per year) also necessitates surgical intervention.
- Surgical approach (open vs. endovascular) depends on the location, patient's condition, and the expertise of the surgical team. Endovascular repair is considered for stable, ruptured aneurysms or those not amenable to open surgery.
Exemple de certificat
À propos des intervenants
Dr Munish Chauhan
Consultant principal, médecine de soins intensifs, Fortis Memorial Research Institute, Gurgaon
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