| 词条 | Thoracic aortic aneurysm | ||||||||
| 释义 |
| name = Thoracic aortic aneurysm | synonyms = | image = Thoracic Aortic Aneurysm.png | caption = | pronounce = | field = | | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }} A thoracic aortic aneurysm is an aortic aneurysm that presents primarily in the thorax. A thoracic aortic aneurysm is the "ballooning" of the upper aspect of the aorta, above the diaphragm. Untreated or unrecognized they can be fatal due to dissection or "popping" of the aneurysm leading to nearly instant death. Thoracic aneurysms are less common than an abdominal aortic aneurysm.[1] However, a syphilitic aneurysm is more likely to be a thoracic aortic aneurysm than an abdominal aortic aneurysm. PresentationComplicationsThe principal causes of death due to thoracic aneurysmal disease are dissection and rupture. Once rupture occurs, the mortality rate is 50–80%. Most deaths in patients with Marfan syndrome are the result of aortic disease. CausesThere are a number of causes, [2] Aneurysms in patients younger than 40 usually involve the ascending aorta due to a weakening of the aortic wall associated with connective tissue disorders like the Marfan and Ehler-Danlos syndromes or congenital bicuspid aortic valve. Younger patients may develop aortic aneurysms of the thoracoabdominal aorta after an aortic dissection. It can also be caused by blunt injury. Atherosclerosis is the principal cause of descending aortic aneurysms, while aneurysms of the aortic arch may be due to dissection, atherosclerosis or inflammation. AgeThe diagnosis of thoracic aortic aneurysm usually involves patients in their 60s and 70s. Risk factorsHypertension and cigarette smoking are the most important risk factors, though the importance of genetic factors has been increasingly recognized. Approximately 10% of patients may have other family members who have aortic aneurysms. It is also important to note that individuals with a history of aneurysms in other parts of the body have a higher chance of developing a thoracic aortic aneurysm.[3] DiagnosisThoracic abdominal aneurysm is defined as a diameter exceeding the following cutoff:
A diameter of 3.5 cm is generally considered dilated.[5] However, average values vary with age and size of the reference population, as well as different segments of the aorta.
ScreeningGuidelines were issued in March 2010 for early detection of thoracic aortic disease, by the American College of Cardiology, the American Heart Association, and other groups. Among the recommendations:
TreatmentThe size cut off for aortic aneurysm is crucial to its treatment. A thoracic aorta greater than 4.5 cm is generally defined as aneurysmal, while a size greater than 6 cm is the distinction for treatment, which can be either endovascular or surgical, with the former reserved for pathology at the descending aorta.[9] Indication for surgery may depend upon the size of the aneurysm. Aneurysms in the ascending aorta may require surgery at a smaller size than aneurysms in the descending aorta.[10] Treatment may be via open or via endovascular means.Expandable ends prosthesis greatly simplify, quicken and improve the graft-aorta anastomosis EpidemiologyEach year in the United States, some 45,000 people die from diseases of the aorta and its branches. Acute aortic dissection, a life-threatening event due to a tear in the aortic wall, affects 5 to 10 patients per million population each year, most often men between the ages of 50 and 70; of those that occur in women younger than 40, nearly half arise during pregnancy. The majority of these deaths occur as a result of complications of thoracic aneurysmal disease. References1. ^{{EMedicine|article|424904|Thoracic Aortic Aneurysm}} 2. ^{{MerckHome|03|035|b||Aneurysms: Aneurysms and Aortic Dissection}} 3. ^Thoracic Aortic Disease - Northwestern Memorial Hospital. Thoracic Aortic Aneurysm {{Webarchive|url=https://web.archive.org/web/20120502195840/http://www.nmh.org/nm/vascular-disease-thoracic-aortic-disease |date=2012-05-02 }} 4. ^{{cite journal|last1=Cho|first1=In-Jeong|last2=Jang|first2=Sung-Yeol|last3=Chang|first3=Hyuk-Jae|last4=Shin|first4=Sanghoon|last5=Shim|first5=Chi Young|last6=Hong|first6=Geu-Ru|last7=Chung|first7=Namsik|title=Aortic Aneurysm Screening in a High-Risk Population: A Non-Contrast Computed Tomography Study in Korean Males with Hypertension|journal=Korean Circulation Journal|volume=44|issue=3|year=2014|pages=162|issn=1738-5520|doi=10.4070/kcj.2014.44.3.162}} 5. ^1 {{cite web|url=http://emedicine.medscape.com/article/761627-overview|title=Thoracic Aneurysm|author=Bret P Nelson|date=2015-10-01|website=Medscape|accessdate=2017-04-16}} 6. ^{{cite journal|last1=Wolak|first1=Arik|last2=Gransar|first2=Heidi|last3=Thomson|first3=Louise E.J.|last4=Friedman|first4=John D.|last5=Hachamovitch|first5=Rory|last6=Gutstein|first6=Ariel|last7=Shaw|first7=Leslee J.|last8=Polk|first8=Donna|last9=Wong|first9=Nathan D.|last10=Saouaf|first10=Rola|last11=Hayes|first11=Sean W.|last12=Rozanski|first12=Alan|last13=Slomka|first13=Piotr J.|last14=Germano|first14=Guido|last15=Berman|first15=Daniel S.|title=Aortic Size Assessment by Noncontrast Cardiac Computed Tomography: Normal Limits by Age, Gender, and Body Surface Area|journal=JACC: Cardiovascular Imaging|volume=1|issue=2|year=2008|pages=200–209|issn=1936878X|doi=10.1016/j.jcmg.2007.11.005}} 7. ^{{cite web|title=UOTW #64 - Ultrasound of the Week|url=https://www.ultrasoundoftheweek.com/uotw-64/|website=Ultrasound of the Week|accessdate=27 May 2017|date=25 November 2015}} 8. ^{{cite journal |vauthors=Hiratzka LF, Bakris GL, Beckman JA, etal |title=2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine |journal=J. Am. Coll. Cardiol. |volume=55 |issue=14 |pages=e27–e129 |date=April 2010 |pmid=20359588 |doi=10.1016/j.jacc.2010.02.015 |url=http://content.onlinejacc.org/cgi/content/full/j.jacc.2010.02.010v1 |deadurl=yes |archiveurl=https://web.archive.org/web/20101023075854/http://content.onlinejacc.org/cgi/content/full/j.jacc.2010.02.010v1 |archivedate=2010-10-23 |df= }} 9. ^{{cite journal |vauthors=Makaroun MS, Dillavou ED, Kee ST, etal |title=Endovascular treatment of thoracic aortic aneurysms: results of the phase II multicenter trial of the GORE TAG thoracic endoprosthesis |journal=J. Vasc. Surg. |volume=41 |issue=1 |pages=1–9 |date=January 2005 |pmid=15696036 |doi=10.1016/j.jvs.2004.10.046 |url=http://linkinghub.elsevier.com/retrieve/pii/S0741521404014855}} 10. ^{{cite web |url=http://www.mayoclinic.org/aortic-aneurysm/thoracictreatment.html |title=Treatment Considerations related to Thoracic Aortic Aneurysm |work= |accessdate=2010-10-23}} External links{{Medical resources| DiseasesDB = | ICD10 = {{ICD10|I|71|1|i|70}}, {{ICD10|I|71|2|i|70}} | ICD9 = {{ICD9|441.1}}, {{ICD9|441.2}} | ICDO = | OMIM = | MedlinePlus = 001119 | eMedicineSubj = article | eMedicineTopic = 761627 | eMedicine_mult = {{eMedicine2|article|424904}} {{eMedicine2|article|418480}} | MeshID = D017545 }}{{Vascular diseases}} 3 : Diseases of the aorta|Diseases of arteries, arterioles and capillaries|Vascular diseases |
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