TAA Incidence: – TAA is diagnosed in approximately 15,000

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Presentation transcript:

TAA Incidence: – TAA is diagnosed in approximately 15,000 to 25,000 people in the US annually ¹´² – Incidence is increasing due to : • Aging population (increased prevalence) • Increased access to sophisticated imaging Annual Incidence in Bulgaria: Ao dissection annual 13/100 000 (approx 1000 cases, 300 TAA/year) (prof. Nacheff PhD thesis) 1.Vascular Web. Available at: http://www.vascularweb.org Accessed July 31, 2006 2.Bickerstaff LK, Pairolero PC, Hollier LH, et al. Thoracic aortic aneurysms: a population-based study. Surgery 1982;92(6):1103-1108.. 3.Garrett HE. Getting started with thoracic endografting. Endovascular Today 2005;1(11):Supplement:13-14.

TAA Facts Mortality: 6,000 deaths annually due to TAA ² • 5-year Survival (untreated patients): 19 to 39% • Annual procedures volume: >18,000 thoracic aortic repair procedures 2. Bickerstaff LK, Pairolero PC, Hollier LH, et al. Thoracic aortic aneurysms: a population-based study. Surgery 1982;92(6):1103-1108. 3.Garrett HE. Getting started with thoracic endografting. Endovascular Today 2005;1(11):Supplement:13-14.

Although there are frequently no symptoms, TAA symptoms may include: Neck, chest or back pain (25%) Shortness of breath Difficulty swallowing Hoarse cough Congestion of head, neck, upper extremities (related to SVC compression)

Abdominal Aortic aneurysm Affects 4-8% of elderly males 15,000 deaths per year USA Screening and reduction of elderly male smokers reduces aneurysm related mortality by 46% USPHTF Ann Int Med Feb 2005

TREATMENT OPTIONS TAAs under 5.0 cm: medical therapy, monitor annual growth by CT TAAs over 5.0 cm in diameter: intervention/repair strongly considered Medical management (BP-lowering drugs) Open surgery Endovascular repair No proven lifestyle changes can decrease the size of TAAs.

Anatomic Criteria Proximal neck length >15mm diameter <28mm Tube graft: distal cuff length >10mm diameter <28mm Iliac artery diameter >7mm and < 15mm Minimal to moderate tortuosity No mural thrombus at attachment sites Minimal calcification No associated mesenteric occlusive disease

AAA: Assessment Landing zone >2 cm

Maintaining Branch Vessel Patency Fenestrated Endografts Branched Endografts

No landing zone Solution? Hybrid approach- surgery and endovascular or Cardiatis?

Cardiatis

Patient whit Aortic Dissection Stanford Type А Patient whit Aortic Dissection Stanford Type А. After surgical repair of Ao Asc. whit visceral and periphery ischemia implanted Cardiatis in thoracic Ao

Case presentation H.T.H.; 75 year old male; with a history of an asymptomatic abdominal aortic aneurysm Comorbidities: Coronary Artery Disease- 2vessel disease. PCI + stent x3 in the RCA. And PCI and stent in RIM. Periphery Artery Disease II st. Arterial Hypertension III gr. Operation due to Ca recti.

Aortography

CT- angio SMA

Celiac Trunk

CT- angio RR SMA

Case presentation 68 –male; V.E.F. with a history of an asymptomatic abdominal aortic aneurysm. Comorbidities- Coronary Artery Disease-1vessel disease. PCI + stent in the LCx. Periphery Artery Disease II st. Chronic thrombosis of AFS dex. and a. tibialis post sin et a. perinea sin. Arterial Hypertension III gr. Gout/ Podagra/ Diverticulosis sygmae. Steatosis hepatis. Ptosis renis sinistra. In october 2012 CT was performed with evidence for abdominal aortic aneurysm.

Aortography TAAA

Aortography Abd.A

CT- angio

CT- angio IMA LR