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How To Approach Aortic PAU and IMH Edward Woo, MD Director, MedStar Vascular Program Chairman, Department of Vascular Surgery Professor of Surgery, Georgetown University

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How To Approach Aortic PAU and IMH

Edward Woo, MD

Director, MedStar Vascular Program

Chairman, Department of Vascular Surgery

Professor of Surgery, Georgetown University

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Disclosures

• none

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Definition

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Acute Aortic Syndromes

AD: Aortic Dissection

IMH: Intramural Hematoma

PAU: Penetrating Atherosclerotic Ulcer

Aneurysm

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Diagnosis

• Clinical Symptoms

– pain

• Imaging

– TEE

– ?MRA

– CTA-gold standard

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INDICATIONS FOR

INTERVENTION

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PAU and Effusion

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Rupture upon Presentation

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Delayed Ruture-3days

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Management

Medical

• Pain control

• Anti-Hypertensives

• Surveillance Imaging

Intervention

• TEVAR

– Except ascending/arch

involvement

• EVAR

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Conclusions

• PAU/IMH-Spectrum of AAS

– Not always benign

– Predictors of worse outcome

• Intervention warranted

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