4. A AORTA

5. A AORTA

6. A AORTA

11. A AORTA A AORTA

25. Imagem tridimensional por RM de aneurisma aórtico torácico Fonte: Tratado de cirurgia – Sabiston, 17º edição DIAGNÓSTICO

37. LOCALIZAÇÃO

40. Sabiston, Textbook of Surgery DIAGNÓSTICO

46. ANEURISMAS DISSECANTES DISSECÇÃO AÓRTICA

50. Robbins & Cotran, Patologia FISIOPATOLOGIA

55. Computed tomography scan, type A aortic dissection with intimal flap in the ascending (A) and descending (B) segments of the aorta. Sabiston, Textbook of Surgery DIAGNÓSTICO

56. Tipo B Sem Complicações Ruptura, Isquemia em Membro. Má-Perfusão, Dor Persistentes Terapia Medicamentosa “Anti-Impulso” Dissecção Crônica Toracoabdominal ou Ao. Descendente Sem mudança no diâmetro aórtico Acompanhamento contínuo com imagem seriada DTAA/TAAA >5 cm Intervenção Cirúrgica ou Endoluminal AVALIAÇÃO PARA SUBSTITUIÇÃO CIRÚRGICA POR ENXERTO Dissecção Aórtica Aguda Tipo A Reparo urgente da Ao. Asc. +- Reparo Valvar TRATAMENTO

57. Robbins & Cotran, Patologia DISSECÇÃO AÓRTICA

60. Townsend: Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practices. 18th. Ed. 2007. Saunders. EPIDEMIOLOGIA

61. Risk Factors for Rupture of Abdominal Aortic Aneurysm Townsend: Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practices. 18th. Ed. 2007. Saunders. RISK FACTOR LOW RISK AVERAGE RISK HIGH RISK Diameter <5 cm 5-6 cm >6 cm Expansion <0.3 cm/yr 0.3-0.6 cm/yr >0.6 cm/yr Smoking, COPD None, mild Moderate Severe/steroids Family history No relatives One relative Numerous relatives Hypertension Normal blood pressure Controlled Poorly controlled Shape Fusiform Saccular Very eccentric Gender Male Female

64. Townsend: Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practices. 18th. Ed. 2007. Saunders.

69. Townsend: Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practices. 18th. Ed. 2007. Saunders. A B Risks of Open Surgical Repair of Abdominal Aortic Aneurysm AAA, abdominal aortic aneurysm; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; EF, ejection fraction; FEV1, forced expiratory volume in 1 second; MI, myocardial infarction. AVALIAÇÃO PRÉ-OPERATÓRIA RISK FACTOR LOW RISK INTERMEDIATE RISK HIGH RISK Age <70 yr 70-80 yr >80 yr Functional status Active regular physical exercise Sedentary, but otherwise independent Minimally able to accomplish daily activities Cardiac No clinically overt cardiac disease Stable coronary disease; remote MI; EF >35% Significant coronary disease; recent MI; frequent angina; CHF; EF <25% Pulmonary No clinical disease Mild COPD, FEV 1 >1 L/sec O 2 dependent; dyspnea at rest; FEV 1 <1 L/sec Renal Normal renal function Creatinine 2.0-3.0 Creatinine >3.0 Other Noninflammatory infrarenal AAA Juxtarenal; suprarenal or inflammatory AAA Child's class B or C liver failure; albumin <2 Anticipated operative mortality 1%-3% 3%-7% At least 5%-10%. Each comorbid condition adding 3%-5% to overall risk

70. Townsend: Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practices. 18th. Ed. 2007. Saunders. TRATAMENTO

71. Townsend: Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practices. 18th. Ed. 2007. Saunders. TRATAMENTO