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Aortic dilatation
Aortic dissection
Aortic aneurysm
Aortic pathologies Hypertension
KONSTANTINOS FILIS, MD
Offsprings of
hypertensive patients
Higher aortic stiffness
and lower flow-
mediated dilatation
→ Impaired endothelial
function and impaired
elastic properties of the
aorta
Effect of diastolic pressure
Duration of hypertension
KONSTANTINOS FILIS, MD
Aortic dilatation
Aortic dissection
INTERNATIONAL REGISTRY OF ACUTE AORTIC DISSECTION
519 Hypertension initiates aortic wall stress
▪ Link between hypertension and aortic dimensions is controversial
KONSTANTINOS FILIS, MD
INTERNATIONAL REGISTRY OF ACUTE AORTIC DISSECTION
Male sex predisposition
KONSTANTINOS FILIS, MD
Aortic Dissection
KONSTANTINOS FILIS, MD
INTERNATIONAL REGISTRY
OF ACUTE AORTIC DISSECTION
519 patients / 71% hypertensive
Aortic Dissection
KONSTANTINOS FILIS, MD
AAA diameter – thrombus & lumen
KONSTANTINOS FILIS, MD
Aortic Aneurysm
KONSTANTINOS FILIS, MD
What is critical to do
for a hypertensive patient with
an AAA
Control hypertension
Prepare an intervention
KONSTANTINOS FILIS, MD
Major contributing factors
▪Age
▪Male sex 3Χ
▪Smoking 4Χ
▪Family history 2Χ
▪Diabetes Mellitus (NEGATIVE ASSOCIATION)
Minor contributing factors
▪Presence of aneurysm in other location
▪Heart disease, atherosclerosis
▪Hypertension
▪Hypercholesterolemia
▪Chronic obstructive pulmonary disease
KONSTANTINOS FILIS, MD
Factors affecting enlargement
▪Smoking cessation
▪Statins;
▪Hypertension;
▪Anti-inflammatory;
▪ACE inhibitors;
▪Β-blockers;
▪Doxycycline;
▪Roxithromycine;
Evidence for effect Evidence for no effect
KONSTANTINOS FILIS, MD
Medical history
Resting ECG - cardiac symptoms (angina?)
Heart failure? (EF)
History of cerebrovascular disease
Lower extremity atherosclerosis
Pharmacological stress test
Myocardial perfusion scan
Coronary revascularization?
Cardiovascular Assessment
KONSTANTINOS FILIS, MD
Hypertension
KONSTANTINOS FILIS, MD
Blood pressure control should be
achieved from the time of diagnosis for
secondary prevention to reduce
cardiovascular morbidity
Target < 140/90 mmHg
Adam Study,
567 patients enrolled for
follow-up
Effect of diastolic pressure
Expansion rate in hypertensive versus non-hypertensive patients
Imaging
Surveillance
Open repair
Endovascular repair
Modification of risk factors
Cardiovascular assessment
KONSTANTINOS FILIS, MD
Surveillance
after “open” or “endo” repair
Modification of risk factors
Cardiovascular assessment
KONSTANTINOS FILIS, MD
JOURNAL OF VASCULAR SURGERY 2008;47(4):886-92
JOURNAL OF VASCULAR SURGERY 2010;52(2):303-7
Complications : Migration
JOURNAL OF VASCULAR SURGERY 2007;45(5):900-5
Complications : anastomotic aneurysm
Complete abdominal aortic aneurysm thrombosis and obstruction of both
common iliac arteries with intrathrombotic pressures demonstrating a
continiuing risk of rupture: a case report and review of the literature.
K. Filis, E. Lagoudianakis, H. Markogiannakis, A. Kotzadimitriou,
N. Kotronakis, K. Xiromeritis, D. Theodorou, A. Manouras.
J Med Case Reports. 2009;24(3):9292.
ICU transfer after elective abdominal aortic aneurysm repair can be
succesfully reduced…
C. Bakoyiannis, N. Tsekouras, S. Georgopoulos, C. Klonaris, E.E. Bastounis,
K. Filis, E. Papalambros, E. Bastounis.
Int Angiol. 2011; 30(1):43-51.
KONSTANTINOS FILIS, MD
Published Data – Ippokrateion Hospital
Osteopontin and osteoprotegerin as potential biomarkers in abdominal aortic
aneurysm before and after treatment.
K. Filis, V. Martinakis, G. Galyfos, F. Sigala, D. Theodorou, I. Andreadou,
G. Zografos.
Int Sch Res Notices. 2014 Jul 2014;2014:461239. doi: 10.1155/2014/461239.
Published Data – Ippokrateion Hospital
Endovascular repair of blunt thoracic aortic trauma: Is post-implant
hypertension an incidental finding?
K. Tigkiropoulos, F. Sigala, D. Tsilimigras, D. Moris, K. Filis, N. Melas,
D. Karamanos, C. Kontogiannis, I Lazaridis, N. Saratzis.
Ann Vasc Surg. 2018 Mar 7
220 ΑΚΑ
Open Surgery
2 ΘΑΝΑΤΟΙ < 1%
1 ΑΣΘΕΝΗΣ ΜΕ ΣΟΒΑΡΗ ΝΟΣΗΡΟΤΗΤΑ
Endo Surgery
0 ΘΑΝΑΤΟΙ
KOSTAS FILIS, MD - IPPOKRATEIO HOSPITAL OF ATHENS
ΑΠΟΤΕΛΕΣΜΑΤΑ ΘΕΡΑΠΕΙΑΣ ΑΚΑ 14 ΕΤΩΝ
Hypertension is one of many complicated pathways of aortic pathology
• Genetics• Smoking
• Age
conclusion
Aortic pathologies Hypertension