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| ===Thoracic Aortic Aneurysm=== | | ===Thoracic Aortic Aneurysm=== |
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| ===Abdominal Aortic Aneurysm===< | | ===Abdominal Aortic Aneurysm=== |
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| ==Screening== | | ==Screening== |
| {{main|Abdominal aortic aneurysm#Screening}}
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| ==Medical Treatment== | | ==Medical Treatment== |
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| ===Endovascular treatment of AAA=== | | ===Endovascular treatment of AAA=== |
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| In the recent years, the endoluminal treatment of Abdominal Aortic Aneurysms has emerged as a minimally invasive alternative to open surgery repair. The first endoluminal exclusion of an aneurysm took place in Argentina by Dr. Parodi and his colleagues in 1991. The endovascular treatment of aortic aneurysms involves the placement of an endo-vascular [[stent]] via a [[percutaneous]] technique (usually through the femoral arteries) into the diseased portion of the aorta. This technique has been reported to have a lower mortality rate compared to open surgical repair, and is now being widely used in individuals with co-morbid conditions that make them high risk patients for open surgery. Some centers also report very promising results for the specific method in patients that do not constitute a high surgical risk group.
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| There have also been many reports concerning the endovascular treatment of ruptured Abdominal Aortic Aneurysms, which are usually treated with an open surgery repair due to the patient's impaired overall condition. Mid-term results have been quite promising. However, according to the latest studies, the [[EVAR]] procedure doesn't carry any overall survival benefit. <ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=16782510&query_hl=9&itool=pubmed_docsum Rutherford RB.: Randomized EVAR Trials and Advent of Level I Evidence: A Paradigm Shift in Management of Large Abdominal Aortic Aneurysms? (abstract)] Semin Vasc Surg. 2006 Jun;19(2):69-74. PMID: 16782510</ref>
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| ===Endovascular treatment of other aortic aneurysms===
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| The endoluminal exclusion of aortic aneurysms has seen a real revolution in the very recent years. It is now possible to treat thoracic aortic aneurysms, abdominal aortic aneurysms (please see above) and other aneurysms in most of the body's major arteries (such as the iliac and the femoral arteries) using endovascular stents and avoiding big incisions. Still, in most cases the technique is applied in patients at high risk for surgery as more trials are required in order to fully accept this method as the gold standard for the treatment of aneurysms.<ref>Saratzis N, Melas N, Lazaridis J, Ginis G, Antonitsis P, Lykopoulos D, Lioupis A, Gitas C, Kiskinis D. Endovascular AAA repair with the aortomonoiliac EndoFit stent-graft: two years' experience. J Endovasc Ther. 2005 Jun;12(3):280-7</ref>
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| ===Complications of Endovascular Treatment===
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| ====Endoleak====
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| *Endoleak is a complication of endovascular aneurysm repair.
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| *The endoleaks may continue to perfuse and pressurize the aneurysm sac, thereby conferring an ongoing risk of aneursym enlargement and/or rupture.
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| *Endoleaks are classified by the source of blood flow, and organized into five categories.<ref>Baum, Richard A., Stavropoulos, S. William, Fairman, Ronald M., Carpenter, Jeffrey P. [http://www.jvir.org/cgi/content/abstract/14/9/1111 Endoleaks after Endovascular Repair of Abdominal Aortic Aneurysms.] J Vasc Interv Radiol 2003 14: 1111-1117.</ref> <ref>Stavropoulos, S. William, Clark, Timothy W.I., Carpenter, Jeffrey P., Fairman, Ronald M., Litt, Harold, Velazquez, Omaida C., Insko, Erik, Farner, Michael, Baum, Richard A. [http://www.jvir.org/cgi/content/abstract/16/5/663 Use of CT Angiography to Classify Endoleaks after Endovascular Repair of Abdominal Aortic Aneurysms.] J Vasc Interv Radiol 2005 16: 663-667.</ref>
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| :*I: Attachment site leaks
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| :*II: Collateral vessel leaks
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| :*III: Graft failure (i.e. midgraft hole, junctional leak or disconnect)
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| :*IV: Graft wall porosity
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| :*V: Endotension (with or without endoleak)
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| Images shown below are courtesy of RadsWiki and copylefted
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Endoleak-001.jpg|Endoleak after Abdominal aortic aneurysm repair
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| Image:Endoleak-002.jpg|Endoleak after Abdominal aortic aneurysm repair
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| Image:Endoleak-003.jpg|Endoleak after Abdominal aortic aneurysm repair
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Endoleak-004.jpg|Endoleak after Abdominal aortic aneurysm repair
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| Image:Endoleak-005.jpg|Endoleak after Abdominal aortic aneurysm repair
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| </gallery>
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| </div>
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| ==Prevention== | | ==Prevention== |
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| Attention to patient's general blood pressure, smoking and [[cholesterol]] risks helps reduce the risk on an individual basis. There have been proposals to introduce [[ultrasound scan]]s as a screening tool for those most at risk: men over the age of 65.<ref>Routine screening in the management of AAA, UK Department of Health study [http://www.dh.gov.uk/PolicyAndGuidance/ResearchAndDevelopment/ResearchAndDevelopmentAZ/CardiovascularDiseaseAndStroke/CardiovascularDiseaseAndStrokeArticle/fs/en?CONTENT_ID=4002152&chk=/9i9J2 Report]</ref> <ref>Abdominal Aortic Aneurysm screening, a review by Bandolier, a UK independent source of evidence-based healthcare information for both healthcare professionals and consumers. Bandolier 27-3 [http://www.jr2.ox.ac.uk/bandolier/band27/b27-3.html Article]</ref>. The tetracycline antibiotic [[Doxycycline]] is currently being investigated for use as a potential drug in the prevention of aortic aneurysm due to its metalloproteinase inhibitor and collagen stabilizing properties.
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| ===Research===
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| Stanford University is conducting research to gather information on AAA risk factors, and to evaluate the effectiveness of an exercise program at preventing the growth of small AAAs in older individuals. [http://aaastop.stanford.edu/]
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| ==See Also== | | ==See Also== |
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| ==Pathological Findings== | | ==Pathological Findings== |
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| [http://www.peir.net Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Aortic aneurysm 1.jpg|Dissecting Aneurysm: Gross very good example dissected channel has been opened
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| Image:Aortic aneurysm 2.jpg|Dissecting Aneurysm: Gross external view good appearance from adventitia
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| Image:Aortic aneurysm 3.jpg|Dissecting Aneurysm: Gross opened false channel
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Aortic aneurysm 4.jpg|Dissecting Aneurysm: Gross good example dissection beginning at third portion aortic arch
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| Image:Aortic aneurysm 5.jpg|Dissecting Aneurysm: Gross cross sections showing thrombus in false lumen true lumen has been opened longitudinally
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| Image:Aortic aneurysm 6.jpg|Dissecting Aneurysm: Gross shows origin just above aortic valve false channel shown in descending thoracic aorta (very good example)
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Aortic aneurysm 7.jpg|Atherosclerotic Aneurysm: Gross, a good example of typical abdominal aorta aneurysm with mural thrombus
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| Image:Aortic aneurysm 8.jpg|Dissecting Aneurysm: Gross, a very good example of dissection beginning just above aortic ring
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| Image:Aortic aneurysm 9.jpg|Atherosclerotic Aneurysm: Gross, (rather) good example of abdominal aortic aneurysm
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Aortic aneurysm 10.jpg|Dissecting Aneurysm: Gross, an excellent example, starting just above the aortic valve with reflection of aorta to show the dissection tract and some thrombus
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| Image:Aortic aneurysm 11.jpg|Dissecting Aneurysm: Gross shows dilated aorta with extensive atherosclerosis dissection is seen, a small abdominal aorta atherosclerotic aneurysm is present good for association of dilation with dissection
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| Image:Aortic aneurysm 12.jpg|Dissecting Aneurysm: Gross arrow points to start of dissection in first portion aortic arch good but not the best example shows dilation
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Aortic aneurysm 13.jpg|Dissecting Aneurysm: Gross, very good to show start of dissection above aortic valve and blood in false channel
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| Image:Aortic aneurysm 14.jpg|Dissecting Aneurysm: Gross, heart with root of aorta to show hemorrhage into pericardium (a very good example)
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| Image:Aortic aneurysm 15.jpg|Dissecting Aneurysm: Gross, of heart and aorta with dissection and large false channel (a good example)
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Aortic aneurysm 16.jpg|Dissecting Aneurysm: Gross cross section of aorta with two channels (a good example)
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| Image:Aortic aneurysm 17.jpg|Atherosclerotic Aneurysm: Gross, a nice view of cross section of abdominal aorta aneurysm
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| Image:Aortic aneurysm 18.jpg|Dissecting Aneurysm: Gross good example of typical angular tear above aortic valve
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Aortic aneurysm 19.jpg|Dissecting Aneurysm: Gross good example angular tear above aortic valve
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| Image:Aortic aneurysm 20.jpg|Atherosclerotic Aneurysm: Gross, external natural color very good example of an atherosclerotic thoracic aorta aneurysm with focal rupture
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| Image:Aortic aneurysm 21.jpg|Atherosclerotic Aneurysm: Gross, excellent color, opened thoracic segment of aorta with two saccular atherosclerotic ruptured aneurysms
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Aortic aneurysm 22.jpg|Atherosclerotic Aneurysm: Gross, an excellent example, natural color, external view of typical thoracic aortic aneurysms
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| Image:Aortic aneurysm 23.jpg|Atherosclerotic Aneurysm: Gross unopened lesion natural color
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| Image:Aortic aneurysm 24.jpg|Dissecting Aneurysm: Gross dissection first portion of arch fixed specimen (a good example)
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Aortic aneurysm 25.jpg|Dissecting Aneurysm: Gross, rather well shown dissection in first portion of the aortic arch
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| Image:Aortic aneurysm 26.jpg|Dissecting Aneurysm: Gross, rather well shown dissection in first portion of the aortic arch
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| Image:Aortic aneurysm 27.jpg|Dissecting Aneurysm: Gross, an excellent example of type I lesion
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Aortic aneurysm 28.jpg|Dissecting Aneurysm: Gross, external view, an excellent example
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| Image:Aortic aneurysm 29.jpg|Dissecting Aneurysm: Gross, Type I shows false channel
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| Image:Aortic aneurysm 30.jpg|Dissecting Aneurysm: Gross, opened to show false channel (good example)
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Aortic aneurysm 31.jpg|Atherosclerotic Aneurysm: Gross, very good example of ruptured thoracic segment
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| Image:Aortic aneurysm 32.jpg|Dissecting Aneurysm: Gross, coagulum of blood in false channel
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| Image:Aortic aneurysm 33.jpg|Dissecting Aneurysm: Gross, aortic valve area dissection (well shown, typical lesion)
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Aortic aneurysm 34.jpg|Abdominal Aneurysm Ruptured: Gross (good example) opened kidneys in marked place, atherosclerosis in lower thoracic aorta
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| Image:Aortic aneurysm 35.jpg|Abdominal Aneurysm: Gross, (very good example) opened lesion with mural thrombus
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| Image:Aortic aneurysm 36.jpg|Dissecting Aneurysm: Gross, large tear in first portion of aortic arch, annuloaortic ectasis
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Aortic aneurysm 37.jpg|Dissecting Aneurysm: Gross, external view of heart and first portion of aortic arch, annuloaortic ectasia, hemorrhage beneath adventitia is evidence of dissection
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| Image:Aortic aneurysm 38.jpg|Atherosclerotic Aneurysm Infected: Gross, infected abdominal aneurysm at superior suture line with rupture into duodenum
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| Image:Aortic aneurysm 39.jpg|Atherosclerotic Aneurysm: Gross, cross sections of repaired aneurysm showing Dacron graft and old mural thrombus. A nice example of fibrin layer in graft
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Aortic aneurysm 40.jpg|Ruptured Syphilitic Aneurysm
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| Image:Aortic aneurysm 41.jpg|Dissecting Aneurysm in a patient with [[Marfan's syndrome]]
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| Image:Aortic aneurysm 42.jpg|Traumatic Aneurysm
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Aortic aneurysm 43.jpg|Kidney: Arteriosclerosis: Gross aorta with well shown renal artery containing large plaque and kidney with multiple cortical scars and atrophy also abdominal aorta aneurysm with mural thrombus (excellent example for renovascular hypertension)
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| Image:Aortic aneurysm 44.jpg|Dissecting Aneurysm: Gross, fixed tissue, descending thoracic segment dissection opened to show the false channel. The true surface is also visible
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| Image:Aortic aneurysm 45.jpg|Aneurysm: Gross, ruptured thoracic aorta aneurysm, in situ lower thoracic portion (probably due to atherosclerosis)
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Aortic aneurysm 46.jpg|Abdominal Aneurysm Graft Repair: Gross, natural color, close-up view, an excellent example of Dacron graft that has been in place for years with pseudointima and atherosclerosis
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| Image:Aortic aneurysm 47.jpg|Dacron Graft: Gross, close-up Dacron graft to repair aneurysm. Aorta completely covered with a calcified and ulcerated plaque with small mural thrombi (an excellent depiction of proximal suture line)
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| Image:Aortic aneurysm 48.jpg|Dissecting Aneurysm: Gross natural color descending aorta opened into false channel
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Aortic aneurysm 49.jpg|Abdominal Aneurysm: Gross, natural color, unopened specimen with about a six centimeter aneurysm between renals and bifurcation (a very good example of opened aneurysm)
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| Image:Aortic aneurysm 50.jpg|Abdominal Aneurysm: Gross, natural color, an opened aneurysm showing quite well laminated thrombus
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| Image:Aortic aneurysm 51.jpg|Atherosclerosis with Mural Thrombi: Gross, natural color, a nice photo of descending thoracic aorta with extensive ulcerated plaques and mural thrombi in distal portion. The case also has an abdominal aneurysm
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Aortic aneurysm 52.jpg|Pseudoaneurysm Ruptured Into Duodenum: Gross natural color aorta and duodenum with arrow pointing to rupture point of aortobifemoral bypass pseudoaneurysm rupture and another in duodenum a very good demonstration of this very well known complication of aortic prostheses
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| Image:Aortic aneurysm 53.jpg|Abdominal Aneurysm: Gross, natural color, large aneurysm opened showing sessile calcified plaques with no mural thrombus. Lesion extends from renal arteries to the bifurcation (the same lesion seen externally with focus of rupture)
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| Image:Aortic aneurysm 54.jpg|Abdominal Aneurysm Ruptured: Gross, natural color, external view with large area of apparent rupture. Aorta is opened to show this aneurysm)
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Aortic aneurysm 55.jpg|Abdominal Aneurysm: Gross, natural color, unopened large and quite typical aneurysm extending from below renal arteries to bifurcation
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| Image:Aortic aneurysm 56.jpg|Abdominal Aneurysm: Gross, natural color, opened aneurysm with well shown and typical laminated thrombus (external view)
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| Image:Aortic aneurysm 57.jpg|Aortobifemoral Prosthesis: Gross, natural color, nice dissection showing Dacron prosthesis replacing abdominal segment of aorta with portion of atherosclerotic aneurysm with renal arteries and kidneys
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Aortic aneurysm 58.jpg|Aortobifemoral Prosthesis: Gross natural color close-up view of nicely dissected prosthesis extending from below renals to common iliac arteries portion of atherosclerotic aneurysm behind prosthesis
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| Image:Aortic aneurysm 59.jpg|Dissecting Aneurysm: Gross natural color close-up view of aortic valve and proximal aortic arch with ruptured intima rather good illustration of this lesion
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| Image:Aortic aneurysm 60.jpg|Syphilitic Aneurysm: Gross natural color rather a close-up view and outstanding photo of aneurysm ruptured into the left main stem bronchus
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Aortic aneurysm 61.jpg|Syphilitic Aneurysm: Gross natural color typical tree barking in aorta aneurysm opening is seen in which is a thrombus aneurysm ruptured into left main stem bronchus (shown very well)
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| Image:Aortic aneurysm 62.jpg|Dissecting Aneurysm Chronic: Gross natural color first portion of aortic arch with intimal rent well shown with healed margins and view into false channel that shows a surface looking like atherosclerosis which is known to develop in a chronic dissection
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| Image:Aortic aneurysm 63.jpg|Dissecting Aneurysm Chronic: Gross, natural color, closer view of the previous one (a very good example)
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| </gallery>
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| </div>
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| ==References== | | ==References== |
