Diseases of the Aorta

Prof. Mohamed Ayman M. Saleh

 Diseases of the Aorta
Anatomic-Histologic considerations:
– Course of the aorta.
– Branches.
– Relations.
– Histology.
Physiologic & pathophysiologic considerations:
– Function of the aorta.
– Aging of the aorta.
Any disease involving the aorta results in:
– Weakening of the wall:
Aneurysm  mass effect, impending rupture, stagnation  thrombosis.
+/or dissection  pain +/or ischemia.
+/or rupture  pain & shock.
– +/or narrowing of lumen  ischemia  5 P’s
 Aneurysm
Mass effect.
Stagnation:
– Thrombosis  distal embolization  see
narrowing.
Expansion  impending rupture.

Clinically  symptoms & signs

– Thoracic aorta:
Ascending aorta.
Arch of aorta.
Descending aorta.
– Abdominal aorta.
 Dissection
Pain.
Rupture  shock  death.
Ischemia at different sites  see
narrowing.
Natural cure  rare.
Clinically  symptoms & signs
– Thoracic aorta:
Ascending aorta.
Arch of aorta.
Descending aorta.
– Abdominal aorta.
Narrowing  acute or chronic
Coroanry.
Innominate.
Left common carotid artery.
Left subclavian artery.
Renal.
Mesenteric.
Iliac.
Aorta itself.
 Etiologies of dissection
Atherosclerotic.
Congenital:
– PDA.
– Coarctation.
– Defect of media as Marfan $, Annular ectasia, Ehler Danlos $.
Traumatic.
Inflammatory:
– Infective: mycotic, abscess, infected thromb.
– Non infective: Behcet $, Takayasu, Ankylosing spondylitis, Non takayasu
non spondylotic aortitis
 Diagnostic tools for aortic
disease
To define patho-anatomy:
– X-ray:
chest & abdomen.
– Ultrasound:
TTE.
TEE.
Abdominal U/S.
– CT:
Chest.
Abdomen.
– MRI & MRA.
– Angiography.
 Diagnostic tools for aortic
disease
To define aetiology:
– Laboratory:
As ESR, CBC, CRP, blood culture.
– X-ray spine ……. etc.
 Treatment
Of pathology:
– Aneurysm:
Surgery or PCI.
– Dissection:
Medical, surgical or PCI.
– Rupture:
Surgery.
– Narrowing:
Medical, surgical or PCI.
 Treatment
Of aetiology:
– Acute non specific aortitis or Takayasu  steroids.
– Corctation:
Surgery or PCI.
– Syphilitic  antibiotics.
– I.E.  antibiotics.
– Atherosclerosis:
Aspirin hypocholesterolemic drugs & anticoagulants.
– Hypertension:
Antihypertensives.
– Associated CVD / CAD:
Anti-ischemic, antiplatelets, anticoagulants.
CABG or PCI.