Acute Aortic Disease.. - Index of

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Epidemiology: Incidence, Prevalence, and Trends 93 Table 1 Summary of Available Information on Incidence of Aneurysm Disease (Continued) Benefit of screening programs (all re: AAA) Cost per life saved is approximately $10,000 (10). A single negative ultrasound screening at 65 yrs suffices, as this virtually excludes future risk of AAA rupture or AAA-related death (4). Decision-making (all re: AAA) (see chapter 12 for TAA) HSTAT meta-analysis of surgical intervention criteria for AAA leads to the following conclusions: 3.0–3.9 cm AAA Very low risk of rupture Periodic surveillance 4.0–5.4 cm AAA Yearly rupture rate ∼1% Surgery or surveillance 5.5 cm or larger AAA Trends Substantial rupture risk Surgery advised The incidence of rAAA is increasing The incidence of TAA is increasing dramatically (7) dramatically (8) 1971–1986: 4.9/100,000 patient-Yr Current: 10.6/100,000 patient-Yr Increased three times over 15 yrs Abbreviations: AAA, abdominal aortic aneurysm; AAD, acute aortic dissection; CAD, coronary artery disease; HSTAT, health services/ technology assessment text; TAA, thoracic aortic aneurysm. Table 2 Leading Causes of Death Ages 65+ All ages Heart disease 563,390 Heart disease 685,089 Cancer 388,911 Cancer 556,902 Stroke 138,134 Stroke 157,689 COPD 109,139 COPD 126,382 Alzheimer’s 62,814 Trauma 106,277 Influenza 57,670 Diabetes 74,219 Diabetes 54,919 Influenza 65,183 Kidney disease 35,254 Alzheimer’s 63,457 Trauma 34,335 Kidney failure 42,453 Septicemia 26,445 Septicemia 34,069 Hypertension 18,657 Suicide 31,484 Parkinson’s 17,566 Liver disease 27,503 Pneumonia 15,850 Hypertension 21,940 Arteriosclerosis 12,336 Parkinson’s 17,997 Aortic aneurysm 12,040 Homicide 17,732 Benign neoplasm 10,838 Pneumonia 17,335 Liver disease 10,210 Aortic aneurysm 14,810 Suicide 5,248 Perinatal 14,378 Anemia 3,539 HIV 13,658 Peptic ulcer 3,110 Benign neoplasm 13,563 Abbreviation: COPD, chronic obstructive pulmonary disease. Source: From Ref. 3.
94 Elefteriades and Rizzo 70s, this rate rises to over 100 per 100,000 patient years. (This corresponds to one out of every thousand men in their 70s suffering rupture of AAA each year.) The incidence of thoracic aortic aneurysm is also about 10 per 100,000 patient years (8). Women and men have a similar incidence, but the age at diagnosis is a decade higher in women (70s) than in men (60s). RATE OF ACUTE COMPLICATIONS OF CHRONIC AORTIC CONDITIONS This book is about acute aortic diseases, so we are especially interested in the rates at which aneurysms, abdominal and thoracic, rupture or dissect. For patients with abdominal aortic aneurysms about 1% of those with moderate-sized aneurysms (4.0–5.4 cm) will suffer rupture each year. The rate rises, of course, for larger aneurysms. For abdominal aortic aneurysms larger than 5.5 cm, the rupture risk exceeds the surgical risk, and pre-emptive surgical extirpation is recommended (4). Among patients with thoracic aortic aneurysms, the rate of rupture, dissection, or death rises to 14.1% per year for aneurysms 6 cm or more in diameter (9). This is a huge number, representing a virulence beyond that of most other diseases. The behavior of thoracic aortic aneurysms is covered fully in Chapter 12. The total yearly incidence of rupture or dissection of thoracic aortic aneurysm is about 7% per year, equally divided between rupture and dissection (10,11,12). A curious and as yet unexplained finding is that 79% of thoracic aortic aneurysm ruptures occur in women (2,11,12). Benefits of Screening Programs The epidemiological implications of screening programs have been studied quite extensively for abdominal aortic aneurysms (but not for thoracic) (4,13). Screening programs based on abdominal ultrasound clearly detect aneurysms effectively and reduce the number of aneurysm-related deaths. The medical care cost per single aneurysm-related death prevented is about $10,000 USD (13). One very important benefit of screening is that a single negative ultrasound at age 65 suffices: patients without an aneurysm at this age will simply not die of aneurysm rupture (4). Efforts have been expended to define populations at risk whose routine screening would be more cost-effective than screening the general population. Family history, age, male sex, coronary artery disease, cerebrovascular disease, and hypercholesterolemia all represent incremental risk factors for aneurysm disease, and, thus, constitute potential criteria for opportunistic population screening. However, one other characteristic dwarfs the statistical significance of those other risk factors: cigarette smoking (4). AAA is five times more common in smokers, and 89% of all aneurysm ruptures occur in smokers. So, screening smokers is a cost-effective way to look for abdominal aortic aneurysm disease. In fact, one need screen only 500 smokers (compared to 1700 nonsmokers) to prevent one aneurysm-related death.
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Acute Aortic Disease
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15. Heart Failure: Basic Science an
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52. Clinical, Interventional, and I
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Informa Healthcare USA, Inc. 270 Ma
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Introduction Informa Healthcare has
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Foreword There is no disease more c
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Preface Over 100 years ago, the gre
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Preface xi Some distinguishing feat
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xiv Acknowledgments Above all, than
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xvi Contents 6. Genetic Basis of Th
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Contributors Nili Avidan Division o
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Contributors xxi Arun Raghupathy Di
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2 Nienaber and Ince Table 1 Risk Co
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4 Nienaber and Ince In addition to
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6 Nienaber and Ince CLASSIFICATION
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8 Nienaber and Ince Lansman’s Cla
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10 Nienaber and Ince Figure 4 Curve
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12 Nienaber and Ince Figure 6 Evolu
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14 Nienaber and Ince dissection, su
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16 Nienaber and Ince (A) (B) Probab
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18 Nienaber and Ince Table 5 Risk P
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20 Nienaber and Ince of the predila
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22 Nienaber and Ince 34. Pieters FA
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24 Nienaber and Ince 75. Mehta RH,
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26 Nienaber and Ince hematoma (IMH)
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28 Nienaber and Ince One good featu
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30 Isselbacher SYMPTOMS Pain Experi
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32 Isselbacher and wane in severity
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34 Isselbacher The mechanisms are u
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36 Isselbacher deficits are most co
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38 Isselbacher 3. Nallamothu BK, Me
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40 Danias spinal arteries) and the
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Page 73 and 74: 44 Danias However, due to the dista
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Page 77 and 78: 48 Danias faster, with higher resol
Page 79 and 80: 50 Danias Figure 6 Transverse slice
Page 81 and 82: 52 Danias hematoma, CT was reported
Page 83 and 84: 54 Danias Figure 9 Transverse black
Page 85 and 86: 56 Danias Figure 12 Single phase-co
Page 87 and 88: 58 Danias restricted to the absolut
Page 89 and 90: 60 Danias In conclusion, in the rig
Page 91 and 92: 62 Danias DISCUSSION AND COMMENTARY
Page 93 and 94: 64 Danias tomography, among others.
Page 95 and 96: 66 Danias cardiac silhouette. The a
Page 97 and 98: 68 Raghupathy and Eagle the inciden
Page 99 and 100: 70 Raghupathy and Eagle Figure 1 Sp
Page 101 and 102: 72 Raghupathy and Eagle SIGNS A tho
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Page 113 and 114: 84 Raghupathy and Eagle EDITOR’S
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Page 129 and 130: 100 Milewicz et al. KNOWN GENETIC S
Page 131 and 132: 102 Milewicz et al. Table 2 Quick G
Page 133 and 134: 104 Milewicz et al. ascending aorti
Page 135 and 136: 106 Milewicz et al. Turner syndrome
Page 137 and 138: 108 Milewicz et al. dissection in t
Page 139 and 140: 110 Milewicz et al. Figure 5 Haplot
Page 141 and 142: 112 Milewicz et al. A genome wide s
Page 143 and 144: 114 Milewicz et al. Structural anal
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Page 151 and 152: 122 Milewicz et al. DISCUSSION AND
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Matrix Metalloproteinases in Aortic
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Matrix Metalloproteinases in Aortic
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INTRODUCTION 9 Inflammation and Rem
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Inflammation and Remodeling in the
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10 Weight Lifting and Aortic Dissec
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Weight Lifting and Aortic Dissectio
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11 Timing of Acute Aortic Events: H
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Timing of Acute Aortic Events 171 F
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SECTION IV: TREATMENT OF ACUTE AORT
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Natural History of Thoracic Aortic
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206 Shahriari and Farkas properties
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208 Shahriari and Farkas Figure 2 E
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210 Shahriari and Farkas Less than
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212 Shahriari and Farkas helpful if
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214 Shahriari and Farkas Figure 6 A
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216 Shahriari and Farkas (68). Many
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218 Shahriari and Farkas Figure 9 H
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220 Shahriari and Farkas fistula is
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222 Shahriari and Farkas MEGS is de
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224 Shahriari and Farkas 26. Svenss
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226 Shahriari and Farkas 63. Fehren
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14 Acute Aortic Dissection: Anti-im
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Acute Aortic Dissection 231 lamella
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Acute Aortic Dissection 233 P t is
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Acute Aortic Dissection 235 From th
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Acute Aortic Dissection 237 Figure
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Acute Aortic Dissection 239 concern
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Acute Aortic Dissection 241 Table 2
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Acute Aortic Dissection 243 dissect
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Acute Aortic Dissection 245 22. Bax
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Acute Aortic Dissection 247 62. Lin
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Acute Aortic Dissection 249 DISSCUS
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252 Elefteriades and Griepp ACUTE A
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254 Elefteriades and Griepp Figure
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256 Elefteriades and Griepp sometim
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262 Elefteriades and Griepp to a se
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264 Elefteriades and Griepp Natural
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266 Elefteriades and Griepp CONCLUS
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268 Elefteriades and Griepp DISCUSS
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270 Brinster et al. thoracic aneury
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272 Brinster et al. Figure 1 Retrop
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274 Brinster et al. artery. Z3 land
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276 Brinster et al. or ischemia of
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278 Brinster et al. registry arm (2
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280 Brinster et al. Table 3 Early P
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282 Brinster et al. According to th
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284 Brinster et al. ranged from 1 t
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Table 4 Meta-Analysis of Tevar for
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288 Brinster et al. conventional op
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290 Brinster et al. using no (or lo
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292 Brinster et al. Table 5 Risk Fa
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294 Brinster et al. wire manipulati
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296 Brinster et al. Thoracoabdomina
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298 Brinster et al. 25. Hagan PG, N
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300 Brinster et al. 60. Elefteriade
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302 Brinster et al. 98. Liu ZG, Sun
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304 Brinster et al. 131. Szeto WY,
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306 Brinster et al. 100% 90% 80% 70
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308 Brinster et al. ● “Long-ter
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310 Hackmann et al. treatment. New
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312 Hackmann et al. tissue than in
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314 Hackmann et al. Table 1 Pharmac
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316 Hackmann et al. Some anti-hyper
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318 Hackmann et al. inhibits NF-κB
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320 Hackmann et al. Patients with C
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322 Hackmann et al. ACKNOWLEDGMENTS
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324 Hackmann et al. 34. Thompson RW
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326 Hackmann et al. 70. LeMaire SA,
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328 Hackmann et al. 105. Marra DE,
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330 Hackmann et al. DISCUSSION AND
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332 Elefteriades Diseases of the th
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334 Elefteriades Table 1 Individual
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336 Elefteriades Table 1 Individual
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338 Elefteriades Failure to Diagnos
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340 Elefteriades of physicians on t
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342 Elefteriades Figure 3 Computed
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344 Elefteriades reviewed over the
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346 Elefteriades DISCUSSION AND COM
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348 Elefteriades Figure 1 (See colo
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350 Elefteriades that are the subje
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SECTION VII: SYNTHESIS 20 The Key L
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The Key Lessons of This Book—In a
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362 Index Aging, aortic aneurysms a
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364 Index Cytokines, aortic aneurys
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366 Index Pathoanatomy classificati
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368 Index [Thoracic aortic aneurysm
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Figure 1.C Note from schematic depi
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Figure 8.1 Dramatic clinical exampl
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Figure 11.2 Proposed schema for the
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Figure 19.1 Future prospects in car
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