Thoracic aortic aneurysm medical therapy: Difference between revisions
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|bgcolor="LightGreen" | '''1.''' Stringent control of hypertension, lipid profile optimization, smoking cessation, and other atherosclerosis risk-reduction measures should be instituted for patients with small aneurysms not requiring surgery, as well as for patients who are not considered surgical or stent graft candidates ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' | |bgcolor="LightGreen" | '''1.''' Stringent control of hypertension, lipid profile optimization, smoking cessation, and other atherosclerosis risk-reduction measures should be instituted for patients with small aneurysms not requiring surgery, as well as for patients who are not considered surgical or stent graft candidates ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' | ||
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==ACC/ AHA Guidelines - Recommendations for Blood pressure control in Thoracic aortic disease (DO NOT EDIT)== | |||
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |||
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|bgcolor="LightGreen" | '''1.'''Antihypertensive therapy should be administered to hypertensive patients with thoracic aortic diseases to achieve a goal of less than 140/90 mm Hg (patients without diabetes) or less than 130/80 mm Hg (patients with diabetes or chronic renal disease) to reduce the risk of stroke, myocardial infarction, heart failure, and cardiovascular death. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | |||
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|bgcolor="LightGreen" | '''2.'''Beta adrenergic–blocking drugs should be administered to all patients with Marfan syndrome and aortic aneurysm to reduce the rate of aortic dilatation unless contraindicated. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' | |||
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Revision as of 01:15, 9 October 2012
Thoracic aortic aneurysm Microchapters |
Differentiating Thoracic Aortic Aneurysm from other Diseases |
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Diagnosis |
Treatment |
Special Scenarios |
Case Studies |
Thoracic aortic aneurysm medical therapy On the Web |
Directions to Hospitals Treating Thoracic aortic aneurysm medical therapy |
Risk calculators and risk factors for Thoracic aortic aneurysm medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Amjad AlMahameed, MD, MPH, RPVI, FACP. Beth Israel Deaconess Medical Center and Harvard Medical School. Boston, USA
Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]
Overview
Medical Therapy
The goals of medical therapy include:
- Lowering BP to the lowest level tolerated
- Cessation of smoking
- Treat associated coronary and carotid artery disease
- Follow up:
- Using clinical and non-invasive imaging tests
- Initial at 3 months and then 6 monthly or yearly
TAA size is the primary indication for repair. Once a TAA reaches a pre-specified size (>5 cm in the ascending aorta, >6 cm in the descending segment) referral for surgical or endovascular repair sholuld be initiated. Most patients undergo repair once they reach >5.5 for ascending and >6.5 cm for descending TAA, respectively.
In certain populations, such as those with Marfan's syndrome, patients with bicuspid aortic valve (especially when AVR is being considered), personal or family history of prior aortic dissection, or those who have been documented on serial imaging studies to have rapidly expanding aneurysms, clinicians would perform repair sooner (size >4-5 cm for ascending and >5.5-6 cm for descending TAAs).
ACC/ AHA Guidelines - Recommendations for Medical treatment of patients with Thoracic aortic diseases (DO NOT EDIT)
Class I |
1. Stringent control of hypertension, lipid profile optimization, smoking cessation, and other atherosclerosis risk-reduction measures should be instituted for patients with small aneurysms not requiring surgery, as well as for patients who are not considered surgical or stent graft candidates (Level of Evidence: A) |
ACC/ AHA Guidelines - Recommendations for Blood pressure control in Thoracic aortic disease (DO NOT EDIT)
Class I |
1.Antihypertensive therapy should be administered to hypertensive patients with thoracic aortic diseases to achieve a goal of less than 140/90 mm Hg (patients without diabetes) or less than 130/80 mm Hg (patients with diabetes or chronic renal disease) to reduce the risk of stroke, myocardial infarction, heart failure, and cardiovascular death. (Level of Evidence: B) |
2.Beta adrenergic–blocking drugs should be administered to all patients with Marfan syndrome and aortic aneurysm to reduce the rate of aortic dilatation unless contraindicated. (Level of Evidence: B) |