Gangguan Aorta dan Arteri

- Penyakit Raynaud - Koarktasio aorta

- 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
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BUERGER’S
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