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Aortic dilatation Aortic dissection Aortic aneurysm Aortic pathologies Hypertension KONSTANTINOS FILIS, MD

Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

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Page 1: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

Aortic dilatation

Aortic dissection

Aortic aneurysm

Aortic pathologies Hypertension

KONSTANTINOS FILIS, MD

Page 2: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated
Page 3: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated
Page 4: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

Offsprings of

hypertensive patients

Higher aortic stiffness

and lower flow-

mediated dilatation

→ Impaired endothelial

function and impaired

elastic properties of the

aorta

Page 5: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

Effect of diastolic pressure

Duration of hypertension

Page 6: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated
Page 7: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

KONSTANTINOS FILIS, MD

Aortic dilatation

Aortic dissection

Page 8: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

INTERNATIONAL REGISTRY OF ACUTE AORTIC DISSECTION

519 Hypertension initiates aortic wall stress

▪ Link between hypertension and aortic dimensions is controversial

KONSTANTINOS FILIS, MD

Page 9: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

INTERNATIONAL REGISTRY OF ACUTE AORTIC DISSECTION

Male sex predisposition

KONSTANTINOS FILIS, MD

Page 10: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

Aortic Dissection

KONSTANTINOS FILIS, MD

INTERNATIONAL REGISTRY

OF ACUTE AORTIC DISSECTION

519 patients / 71% hypertensive

Page 11: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

Aortic Dissection

KONSTANTINOS FILIS, MD

Page 12: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

AAA diameter – thrombus & lumen

KONSTANTINOS FILIS, MD

Page 13: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

Aortic Aneurysm

KONSTANTINOS FILIS, MD

Page 14: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated
Page 15: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

What is critical to do

for a hypertensive patient with

an AAA

Control hypertension

Prepare an intervention

KONSTANTINOS FILIS, MD

Page 16: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

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

Page 17: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

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

Page 18: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

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

Page 19: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

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

Page 20: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

Adam Study,

567 patients enrolled for

follow-up

Effect of diastolic pressure

Page 21: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

Expansion rate in hypertensive versus non-hypertensive patients

Page 22: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

Imaging

Surveillance

Open repair

Endovascular repair

Modification of risk factors

Cardiovascular assessment

KONSTANTINOS FILIS, MD

Page 23: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

Surveillance

after “open” or “endo” repair

Modification of risk factors

Cardiovascular assessment

KONSTANTINOS FILIS, MD

Page 24: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

JOURNAL OF VASCULAR SURGERY 2008;47(4):886-92

Page 25: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

JOURNAL OF VASCULAR SURGERY 2010;52(2):303-7

Page 26: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

Complications : Migration

Page 27: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

JOURNAL OF VASCULAR SURGERY 2007;45(5):900-5

Page 28: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

Complications : anastomotic aneurysm

Page 29: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

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

Page 30: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

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

Page 31: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

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

Page 32: Aortic pathologies Hypertension Aortic dilatation Aortic dissection Aortic … · 2019-03-30 · Offsprings of hypertensive patients Higher aortic stiffness and lower flow-mediated

Hypertension is one of many complicated pathways of aortic pathology

• Genetics• Smoking

• Age

conclusion

Aortic pathologies Hypertension