PVD-THORACIC AORTIC ANEURYSMS
SUMMARY
1. Thoracic aortic aneurysms tend to dissect as well as rupture causing death.
2. Causes: degenerative & developmental diseases, vasculitis, trauma.
3. Risk factors: HTN, cystic medial necrosis, bicuspid aortic valve, coarctation of the aorta, 3rd trimester of pregnancy, Marfan's syndrome.
4. Stanford classification (more commonly used): type A, dissection involving the ascending aorta; type B, involving the descending aorta.
5. Clinical: severe anterior chest pain, intrascapular pain, sudden death.
MANAGEMENT
6. Decrease elevated BP immediately with beta-blockers and nitroprusside.
7. Descending aortic dissections are treated medically unless end-organ damage develops (renal insufficiency, GI ischemia, limb compromise).
8. Surgery: 5.5 cm in the ascending aorta (5 cm if Marfan's), 6 cm in the descending aorta, rapidly enlarging (> 10 mm/yr), symptomatic, compromising surrounding structures, end-organ damage, traumatic origin.
Reference(s)
Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].
