动脉急性主动脉综合症.pptVIP

PAU Patients with severe systemic atherosclerosis Rarely rupture, yet worse prognosis due to extensive atherosclerosis which causes organfailure (e.g. acute myocardial infarction) Cause of most saccular aneurysms Located in arch and descending aorta Often multiple (therefore surgical treatment difficult, mostly treated medically) PAU PAU Type A or Type B Single or multiple Associated IMH (if not present, be cautious to mention PAU, clinical symptoms might not be caused by PAU, which is probably stable) Possibility of endovascular treatment Complications Saccular aneurysm formation Compression of nearby structures Rupture However most patients have a poor prognosis THANKS Aortic aneurysm rupture Primary signs of Aortic Aneurysm rupture Second signs of AAA rupture retroperitoneal hematoma Signs of Pending Aneurysm Rupture High-attenuating crescent a frank AAA rupture Focal discontinuity of intimal calcification Tangential calcium sign Draped Aorta two weeks later there is a rupture Draped Aorta * 1 * * * * * the Acute Aortic Syndrome 邹瑞琪 急性主动脉综合症（AAS） 主动脉夹层：Aortic Dissection (AD) 壁间血肿：Intramural Hematoma (IMH) 穿透性粥样硬化性溃疡：Penetrating Atherosclerotic Ulcer (PAU). Imaging protocol NE-CT CE-CT 20s 60s 3ml/sec，100ml 伪影 AAS Stanford 分型 Debakey Aortic Dissection (AD) Incidence: 1-10 : 100.000 mostly men rarely 60 year (etiology = media degeneration) hypertension 70% Type A mortality 1-2% per hour after onset of symptoms, total up to 90% non-treated, 40% when treated. 1 year survival Type B up to 85% if medically treated (5 year 70%) AD Management decisions Type A or Type B Place of entry re-entry Side branches involved, originating form true / false lumen Organs at risk (1/3 of mortality is caused by organ failure) Complications (rupture, coronary occlusion, aortic insufficiency, neurological ) Diameters of true and false lumina at: proximal and distal landing zones, at entry and at minimum Iliac vessel tortuosity Imaging featur