Thoracic aortic aneurysm medical therapy

Thoracic aortic aneurysm Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Thoracic Aortic Aneurysm from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
General Approach to Imaging in Thoracic Aortic Aneurysm
Chest X Ray
MRI
CT
Echocardiography
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Endovascular Stent Grafting
Lifestyle Changes
Special Scenarios
Management during Pregnancy
Case Studies
Case #1
Thoracic aortic aneurysm medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Thoracic aortic aneurysm medical therapy
CDC on Thoracic aortic aneurysm medical therapy
Thoracic aortic aneurysm medical therapy in the news
Blogs on Thoracic aortic aneurysm medical therapy
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]

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)