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Ross Milner, MD University of Chicago

Ross Milner, MD University of Chicago Mark Russo, MD, MS Center for Aortic Diseases. THE SITUATION. Over 6,000 people died last year from ruptured thoracic aortic aneurysms (TAA). 21,000 were diagnosed with this dangerous condition.

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Ross Milner, MD University of Chicago

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  1. Ross Milner, MD University of Chicago Mark Russo, MD, MS Center for Aortic Diseases

  2. THE SITUATION • Over 6,000 people died last year from ruptured thoracic aortic aneurysms (TAA). • 21,000 were diagnosed with this dangerous condition. • Once a TAA ruptures, the survival rate is only 15%. Could your patient have an undiagnosed TAA?

  3. TAA ESSENTIALS Definition • Diameter of the thoracic aorta 1.5 times greater than normal (or larger)

  4. TAA ESSENTIALS Scope of the challenge: • 21,000 new cases per year in the U.S. • Men: 60%, Women: 40% • Elective repair: up to 10% mortality • Emergent repair: up to 50% mortality

  5. WHO IS AT RISK Primary Risk Factors • Smoking • Hypertension • High cholesterol • Obesity • Atherosclerosis • Chest trauma • Genetics – Marfans, Ehlers-Danlos • Family history

  6. SYMPTOMS Although there are frequently no symptoms, TAA symptoms may include: • Neck, chest or back pain (25%) • Shortness of breath • Difficulty swallowing • Hoarse cough • Congestion of head, neck, upper extremities (related to SVC compression)

  7. DIAGNOSIS Imaging Occurrence • CT – the definitive exam • MRI • Chest x-ray • Aortogram • TEE • 25% Ascending aorta • 25% Aortic arch • 50% Descending aorta

  8. TREATMENT OPTIONS • TAAs under 5.0 cm: medical therapy, monitor annual growth by CT • TAAs over 5.0 cm in diameter: intervention/repair strongly considered • Medical management (BP-lowering drugs) • Open surgery • Endovascular repair No proven lifestyle changes can decrease the size of TAAs. TEVAR animation video

  9. REPAIR OPTIONS • Both endovascular and open surgeries are used to repair TAAs. • Approximately 11,000 open surgeries are performed each year in the U.S. • Approximately 8,000 endovascular repairs are performed in the U.S. annually.* *BIBA Medical Research estimated 1,960 thoracic stent grafts were implanted in the U.S. in Q2 2008.

  10. REPAIR OPTIONS Endovascular surgery: • Requires single small incision in the groin area. • An endovascular graft is inserted through the femoral artery via a catheter and deployed inside the lumen, relining the aorta. Average ICU stay: 2-3 days Average recovery time: 1-2 weeks

  11. REPAIR OPTIONS Open surgery: • Requires thoracotomy • Aorta is cross-clamped above diseased aortic segment • Affected segment is replaced with fabric surgical graft Average hospital stay: 2-3 weeks Average recovery time: 3 months

  12. THREE CLINICAL TRIALS Controlled Endovascular Stent Graft Trials • 2005 TAG Pivotal Trial (N=139) • 2008 TX2 Pivotal Trial (N=160) • 2008 Talent Pivotal Trial (N=195)

  13. ENDOVASCULAR STENT GRAFT TRIALS

  14. WHAT YOU CAN DO? Be aware TAAs are most often silent killers and are increasing in number. • Remember those most at risk: • Men over 60 • Smokers • Those with a family history of TAA • Image and refer as appropriate those patients with a high index of suspicion for TAA.

  15. University of Chicago Center for Aortic Diseases University of Chicago Medical Center 5841 S. Maryland Avenue Chicago, IL 60637 773-702-2500 ucaorta@surgery.bsd.uchicago.edu This presentation was brought to you by Cook Medical.

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