- Thrombosis Arteri - Emboli arteri - Klaudikasio - Aterosklerosis - Penyakit Buerger’s - Subclavian steal syndrome - Aneurisma - Diseksi Penyakit Aorta O Aneurisma O Diseksi O Koarktasio O 67yrs , male presented w/abdominal pain since 3 hrs before admission. Known had HPT, not well controlled, 1 yrs ago c/o: pulsatile mass over the abdomen. O Bp 90/60, HR 110 bpm, pale, Hb 7.6, the rest WNL. ECG LVH+strain pattern. O CT scan revealed : huge AAA(7cm),contained rupture AAA O Pt sent to OT for emg aorta repaired…pt passed away during operation due to massive blood loss What we learned? O Abd pain +pulsatile mass+anemic--? O Rupture Abdominal Aortic Aneurysm O Mostly asymptomatic O Once symptom occurred rupture/impending rupture AAA Basics: What is it? O Most common between renal arteries and bifurcation O Infrarenal Aorta is between 1.4 and 3.0cm O Average Aorta size is 2.0cm Medical Therapy? O Bridge to definite TX O BP control<110/60 mmHg (BB,CCB) O HR control<60 bpm (BB, CCB) O Laxantia O Transquilizer? O Pain management O Supportive Tx/Comorbid When to Intervene? O Symptomatic AAA (mostly impending rupture) O Size>5cm (Fusiform) O Size>4cm (Saccular)
O Impending rupture/ or rupture (any size)
O SURGERY or NON SURGERY (EVAR)???? Presentation O Two clinical patterns : O patients with initially acute AD entering the chronic phase of the disease and O those in whom first diagnosis of chronic AD is made. O Patients with newly diagnosed chronic AD are often asymptomatic
O In these patients, the exact timing of dissection is often
difficult O Incidence 3/100,000 per year
O Men more likely to have aortic dissections compared to
women
O 78% have chronic hypertension
O Peak for proximal dissection 50-55, distal 60-70
O At least 20% die before arriving at the hospital
O High mortality rate: 25% during 1st 24 hours, 70% in 1st week, 80% at 2 weeks for proximal dissections, 10% in distal in 24 hours
O Acute versus chronic – present of symptoms within 2
weeks O ( now : <14 days; 14– 90days; >90days)
O 30% are chronic
O 50% start in ascending aorta
Khan et al. Chest 2002.
Penyakit Arteri Perifer O Atherosklerosis O Klaudikasio O Emboli arteri O Buerger’s O Raynaud Atherothrombosis: Can Manifest in Multiple Vascular Beds ▪ Atherothrombosis is a process that includes the following clinical consequences: – Ischemic stroke, MI, and PAD ▪ Patients with atherothrombosis have thrombus formations that can manifest in multiple vascular beds throughout the body
Munger MA et al. J Am Pharm Assoc. 2004;44(suppl 1):S5-S13.
How do patients with PAD present? Symptomatic •Intermittent claudication •Critical Limb Ischemia Pain at rest Tissue loss Gangrene
Asymptomatic ALI ALI ALI ALI ALI ALI ALI ALI BUERGER’S BUERGER’S BUERGER’S BUERGER’S BUERGER’S BUERGER’S ABI