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Acute Aortic Disease.. - Index of

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The Key Lessons <strong>of</strong> This Book—In a Nutshell 359<br />

The benefit <strong>of</strong> β-blockers for long-term prevention <strong>of</strong> aneurysm expansion and<br />

rupture is far from proven.<br />

Potential future treatment options include:<br />

Statin medications<br />

Anti-inflammatory agents (COX-2 inhibitors)<br />

Immunosuppressants (rapamycin)<br />

Antibiotics (doxycycline)<br />

ARBs (Losartan).<br />

Suppressive therapy may have a role in treatment <strong>of</strong> patients with predisposing<br />

conditions, patients with small aneurysms, patients who are poor surgical<br />

candidates, patients with chronic aortic dissection, patients who have already<br />

undergone open or endovascular repair (to protect the remaining aorta), and<br />

patients with aneurysms undergoing nonaortic operations (to prevent aneurysm<br />

“activation” and early rupture).<br />

18 Litigation Elefteriades Consider aortic dissection.<br />

Check D-dimer (100% sensitive).<br />

Image liberally.<br />

Consider the “Triple Rule-Out CT scan” (PE, CAD, dissection).<br />

19 Future Prospects Elefteriades DNA diagnosis <strong>of</strong> aneurysm diathesis.<br />

RNA diagnosis <strong>of</strong> acute dissection.<br />

Biomarkers for clinical followup.<br />

Genetic-guided conventional drug development.<br />

Control <strong>of</strong> physical and emotional stress.<br />

20 Key Lessons Elefteriades See this Table.<br />

Abbreviatons: AAA, abdominal aortic aneurysm; ARBs, angiotensin receptor blockers; BP, blood pressure; CAD, coronary artery disease; CT, computed tomography;<br />

DHCA, deep hypothermic circulatory arrest; IMH, intramural hematoma (<strong>of</strong> aorta); IV, intravenous; MI, myocardial infarction; MMPs, matrix metalloproteinases;<br />

MRI, magnetic resonance imaging; OR, operating room; PE, pulmonary embolism; PAU, penetrating ulcer (<strong>of</strong> aorta); SMC, smooth muscle cells; TAA, thoracic<br />

aortic aneurysm; TEE, transesophageal echocardiography; VSMC, vascular smooth muscle cells.

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