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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
Disclosures
• none
Definition
Acute Aortic Syndromes
AD: Aortic Dissection
IMH: Intramural Hematoma
PAU: Penetrating Atherosclerotic Ulcer
Aneurysm
Diagnosis
• Clinical Symptoms
– pain
• Imaging
– TEE
– ?MRA
– CTA-gold standard
INDICATIONS FOR
INTERVENTION
PAU and Effusion
Rupture upon Presentation
Delayed Ruture-3days
Management
Medical
• Pain control
• Anti-Hypertensives
• Surveillance Imaging
Intervention
• TEVAR
– Except ascending/arch
involvement
• EVAR
Conclusions
• PAU/IMH-Spectrum of AAS
– Not always benign
– Predictors of worse outcome
• Intervention warranted