Aort Anevrizma ve Diseksiyonları
Özet
Asendan Aort Anevrizması tanımı, çıkan aort en geniş çapının 4 cm ve üzerinde olması olarak kabul edilir. Risk faktörleri arasında hipertansiyon, ateroskleroz, konjenital aort kapak anormallikleri, travma, Marfan ve Ehlers-Danlos sendromları ve sigara kullanımı bulunur.
Aort anevrizmalarının patogenezi, elastik liflerin dejenerasyonu ve ateroskleroz gibi faktörlerle ilişkilidir. Semptomlar genellikle ağrı, genellikle göğüs veya sırtta derin iç organ ağrısıdır. Tedavi, medikal tedavi ve cerrahi operasyonu içerir. Cerrahi endikasyonlar, anevrizma çapı, büyüme hızı ve hastanın klinik durumuyla belirlenir. Endovasküler müdahale, açık cerrahiye alternatif olabilir, ancak uygun hastaların seçimi ve takip önemlidir.
Aort diseksiyonları, akut aortik sendromlar içinde incelenir ve ölümcül olabilir. Tanı ve acil müdahale hayati önem taşır.Sonuç olarak, aort anevrizmaları ve diseksiyonları, tanı, tedavi ve takip süreçlerinde multidisipliner yaklaşım gerektiren ciddi vasküler durumlardır.
Ascending aortic aneurysm is defined as the widest diameter of the ascending aorta being 4 cm or greater. Risk factors include hypertension, atherosclerosis, congenital aortic valve abnormalities, trauma, Marfan and Ehlers-Danlos syndromes, and smoking.
The pathogenesis of aortic aneurysms is associated with factors such as degeneration of elastic fibers and atherosclerosis. Symptoms typically include pain, often deep visceral pain in the chest or back. Treatment involves medical management and surgical intervention. Surgical indications are determined by aneurysm diameter, growth rate, and the patient's clinical condition. Endovascular intervention may be an alternative to open surgery, but appropriate patient selection and follow-up are important.
Aortic dissections are considered among acute aortic syndromes and can be fatal. Diagnosis and urgent intervention are vital. In conclusion, aortic aneurysms and dissections are serious vascular conditions requiring a multidisciplinary approach in the diagnosis, treatment, and follow-up processes.
Referanslar
Isselbacher, E. M., Preventza, O., Black 3rd, J. H., Augoustides, J. G., Beck, A. W., Bolen, M. A., ... & Woo, Y. J. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation.
Brinster DR, Rizzo RJ, Bolman RM (2008) Ascending aortic aneurysms cardiac surgery in the adult. New York: McGraw-Hill pp: 1223-1246
Erbel R, Aboyans V, Boileau C, Bossone E, Di Bartolomeo R, et al. (2014) ESC guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J 35: 2873-2926.
Bonderman D, Gharehbaghi Schnell E, Wollenek G, Maurer G, Baumgartner H, et al. (1999) Mechanisms underlying aortic dilatation in congenital aortic valve malformation. Circulation 99: 2138-2143.
Svensson LG, Crawford ES (1997) Degenerative aortic aneurysms Cardiovascular and Vascular Disease of the Aorta. Philadelphia WB Saunders.
Zangirolami AC, Oliveira FV, Tepedino MS. Ortner's syndrome: secondary laryngeal paralysis caused by a great thoracic aorta aneurysm. Int Arch Otorhinolaryngol. 2015;19(2):180–182.
Szilagyi DE. Clinical diagnosis of intact and ruptured abdominal aortic aneurysms. In: Bergan JJ, Yao JST, eds. Aneurysms: Diagnosis and Treatment. New York, NY: Grune & Stratton;1982:205–212.
Elefteriades, John A., et al. "Indications and imaging for aortic surgery: size and other matters." The Journal of thoracic and cardiovascular surgery 149.2 (2015): S10-S13.
Schappert T, Sadony V, Schoden F et al. Diagnosis and therapeutic consequences of intramural aortic hematoma. J Card Surg, 1994;9:508.
Fiorucci, Beatrice, et al. "Thoracic aortic aneurysms-diagnosis and treatment strategies." Deutsche Medizinische Wochenschrift (1946) 144.3 (2019): 146-151.
Papakonstantinou, Nikolaos A., and Filippos-Paschalis Rorris. "Elective replacement of the ascending aorta: is the 5.5-cm threshold appropriate? The insidious, small aorta." European Journal of Cardio-Thoracic Surgery 59.3 (2021): 554-561.
KÖKSAL C,ÖZCAN V,SARIKAYA S,MEYDAN B,ZENGİN M,NUMAN F Torakal ve abdominal aort anevrizmalarının endovasküler tedavisi. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2004; 12(3): 184 - 187.
Gürbüz, Ali, et al. "Torakal ve torakoabdominal aort anevrizmalarının tedavisinde cerrahi ve endovasküler cerrahi tekniklerin birlikte kullanımı." Turk Gogus Kalp Dama 16 (2008): 146-9.
paç taa
Fort ACP, Rubin LA, Meltzer AJ, Schneider DB, Lichtman AD. Perioperative Management of Endovascular Thoracoabdominal Aortic Aneurysm Repair. J Cardiothorac Vasc Anesth. 2017 Aug;31(4):1440-1459. doi: 10.1053/j.jvca.2017.03.022. Epub 2017 Mar 18. PMID: 28800994.
Girardi, Leonard N., Christopher Lau, Monica Munjal, Mohamed Elsayed, Ivancarmine Gambardella, Lucas B. Ohmes, and Mario Gaudino. "Impact of preoperative pulmonary function on outcomes after open repair of descending and thoracoabdominal aortic aneurysms." The Journal of thoracic and cardiovascular surgery 153, no. 2 (2017): S22-S29.
Frederick, John R., and Y. Joseph Woo. "Thoracoabdominal aortic aneurysm." Annals of cardiothoracic surgery 1.3 (2012): 277.
Zafar, Mohammad A., et al. "Natural history of descending thoracic and thoracoabdominal aortic aneurysms." The Journal of Thoracic and Cardiovascular Surgery 161.2 (2021): 498-511.
Danyi P, Elefteriades JA, Jovin IS. Medical therapy of thoracic aortic aneurysms: are we there yet? Circulation. 2011;124:1469–1476.
Sultan S, Kavanagh EP, Diethrich E, et al. A clinical review of early outcomes from contemporary flow modulation versus open, fenestrated and branch technologies in the management of thoracoabdominal aortic aneurysm. Vascular. 2018;26:209-215.
Schanzer A, Greenberg RK, Hevelone N, et al. Predictors of abdominal aortic aneurysm sac enlargement after endovascular repair. Circulation. 2011;123:2848-2855.
Evangelista A, Isselbacher EM, Bossone E, et al. Insights from the International Registry of Acute Aortic Dissection: a 20-year experience of collaborative clinical research. Circulation. 2018;137:1846–1860.
Bossone E, LaBounty TM, Eagle KA. Acute aortic syndromes: diagnosis and management, an update. Eur Heart J. 2018;39:739d–749d.
Kicska GA, Hurwitz Koweek LM, et al. Expert Panel on Cardiac Imaging, ACR Appropriateness Criteria® Suspected Acute Aortic Syndrome. J Am Coll Radiol. 2021;18:S474–S481.
Diercks DB, Promes SB, Schuur JD, et al. Clinical policy: critical issues in the evaluation and management of adult patients with suspected acute nontraumatic thoracic aortic dissection. Ann Emerg Med. 2015;65:32–42.e12.
Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010;121:e266–e369.
Chen SW, Chan YH, Lin CP, et al. Association of long-term use of antihypertensive medications with late outcomes among patients with aortic dissection. JAMA Netw Open. 2021;4:e210469.
Goldstone AB, Chiu P, Baiocchi M, et al. Interfacility transfer of Medicare beneficiaries with acute type A aortic dissection and regionalization of care in the United States. Circulation. 2019;140:1239–1250.
Hsieh WC, Kan CD, Yu HC, et al. Ascending aorta replacement vs. total aortic arch replacement in the treatment of acute type A dissection: a metaanalysis. Eur Rev Med Pharmacol Sci. 2019;23:9590–9611.
Cambria RP, Crawford RS, Cho JS, et al. A multicenter clinical trial of endovascular stent graft repair of acute catastrophes of the descending thoracic aorta. J Vasc Surg. 2009;50:1255–1264.e1-4.
Referanslar
Isselbacher, E. M., Preventza, O., Black 3rd, J. H., Augoustides, J. G., Beck, A. W., Bolen, M. A., ... & Woo, Y. J. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation.
Brinster DR, Rizzo RJ, Bolman RM (2008) Ascending aortic aneurysms cardiac surgery in the adult. New York: McGraw-Hill pp: 1223-1246
Erbel R, Aboyans V, Boileau C, Bossone E, Di Bartolomeo R, et al. (2014) ESC guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J 35: 2873-2926.
Bonderman D, Gharehbaghi Schnell E, Wollenek G, Maurer G, Baumgartner H, et al. (1999) Mechanisms underlying aortic dilatation in congenital aortic valve malformation. Circulation 99: 2138-2143.
Svensson LG, Crawford ES (1997) Degenerative aortic aneurysms Cardiovascular and Vascular Disease of the Aorta. Philadelphia WB Saunders.
Zangirolami AC, Oliveira FV, Tepedino MS. Ortner's syndrome: secondary laryngeal paralysis caused by a great thoracic aorta aneurysm. Int Arch Otorhinolaryngol. 2015;19(2):180–182.
Szilagyi DE. Clinical diagnosis of intact and ruptured abdominal aortic aneurysms. In: Bergan JJ, Yao JST, eds. Aneurysms: Diagnosis and Treatment. New York, NY: Grune & Stratton;1982:205–212.
Elefteriades, John A., et al. "Indications and imaging for aortic surgery: size and other matters." The Journal of thoracic and cardiovascular surgery 149.2 (2015): S10-S13.
Schappert T, Sadony V, Schoden F et al. Diagnosis and therapeutic consequences of intramural aortic hematoma. J Card Surg, 1994;9:508.
Fiorucci, Beatrice, et al. "Thoracic aortic aneurysms-diagnosis and treatment strategies." Deutsche Medizinische Wochenschrift (1946) 144.3 (2019): 146-151.
Papakonstantinou, Nikolaos A., and Filippos-Paschalis Rorris. "Elective replacement of the ascending aorta: is the 5.5-cm threshold appropriate? The insidious, small aorta." European Journal of Cardio-Thoracic Surgery 59.3 (2021): 554-561.
KÖKSAL C,ÖZCAN V,SARIKAYA S,MEYDAN B,ZENGİN M,NUMAN F Torakal ve abdominal aort anevrizmalarının endovasküler tedavisi. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2004; 12(3): 184 - 187.
Gürbüz, Ali, et al. "Torakal ve torakoabdominal aort anevrizmalarının tedavisinde cerrahi ve endovasküler cerrahi tekniklerin birlikte kullanımı." Turk Gogus Kalp Dama 16 (2008): 146-9.
paç taa
Fort ACP, Rubin LA, Meltzer AJ, Schneider DB, Lichtman AD. Perioperative Management of Endovascular Thoracoabdominal Aortic Aneurysm Repair. J Cardiothorac Vasc Anesth. 2017 Aug;31(4):1440-1459. doi: 10.1053/j.jvca.2017.03.022. Epub 2017 Mar 18. PMID: 28800994.
Girardi, Leonard N., Christopher Lau, Monica Munjal, Mohamed Elsayed, Ivancarmine Gambardella, Lucas B. Ohmes, and Mario Gaudino. "Impact of preoperative pulmonary function on outcomes after open repair of descending and thoracoabdominal aortic aneurysms." The Journal of thoracic and cardiovascular surgery 153, no. 2 (2017): S22-S29.
Frederick, John R., and Y. Joseph Woo. "Thoracoabdominal aortic aneurysm." Annals of cardiothoracic surgery 1.3 (2012): 277.
Zafar, Mohammad A., et al. "Natural history of descending thoracic and thoracoabdominal aortic aneurysms." The Journal of Thoracic and Cardiovascular Surgery 161.2 (2021): 498-511.
Danyi P, Elefteriades JA, Jovin IS. Medical therapy of thoracic aortic aneurysms: are we there yet? Circulation. 2011;124:1469–1476.
Sultan S, Kavanagh EP, Diethrich E, et al. A clinical review of early outcomes from contemporary flow modulation versus open, fenestrated and branch technologies in the management of thoracoabdominal aortic aneurysm. Vascular. 2018;26:209-215.
Schanzer A, Greenberg RK, Hevelone N, et al. Predictors of abdominal aortic aneurysm sac enlargement after endovascular repair. Circulation. 2011;123:2848-2855.
Evangelista A, Isselbacher EM, Bossone E, et al. Insights from the International Registry of Acute Aortic Dissection: a 20-year experience of collaborative clinical research. Circulation. 2018;137:1846–1860.
Bossone E, LaBounty TM, Eagle KA. Acute aortic syndromes: diagnosis and management, an update. Eur Heart J. 2018;39:739d–749d.
Kicska GA, Hurwitz Koweek LM, et al. Expert Panel on Cardiac Imaging, ACR Appropriateness Criteria® Suspected Acute Aortic Syndrome. J Am Coll Radiol. 2021;18:S474–S481.
Diercks DB, Promes SB, Schuur JD, et al. Clinical policy: critical issues in the evaluation and management of adult patients with suspected acute nontraumatic thoracic aortic dissection. Ann Emerg Med. 2015;65:32–42.e12.
Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010;121:e266–e369.
Chen SW, Chan YH, Lin CP, et al. Association of long-term use of antihypertensive medications with late outcomes among patients with aortic dissection. JAMA Netw Open. 2021;4:e210469.
Goldstone AB, Chiu P, Baiocchi M, et al. Interfacility transfer of Medicare beneficiaries with acute type A aortic dissection and regionalization of care in the United States. Circulation. 2019;140:1239–1250.
Hsieh WC, Kan CD, Yu HC, et al. Ascending aorta replacement vs. total aortic arch replacement in the treatment of acute type A dissection: a metaanalysis. Eur Rev Med Pharmacol Sci. 2019;23:9590–9611.
Cambria RP, Crawford RS, Cho JS, et al. A multicenter clinical trial of endovascular stent graft repair of acute catastrophes of the descending thoracic aorta. J Vasc Surg. 2009;50:1255–1264.e1-4.
