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July 2007

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Section 1 Cardiovascular Medicine

XII Diseases of the Aorta
Kim A. Eagle, M.D., F.A.C.P.
Albion Walter Hewlett Professor of Internal Medicine, University of Michigan Medical School, and Chief of Clinical Cardiology, University of Michigan Health System

William  F. Armstrong, M.D.
Professor of Internal Medicine, University of Michigan Medical School, and Associate Clinical Chief of Cardiology and Director of the Echocardiography Laboratory, University of Michigan Health System

This chapter covers the major presentations affecting the aorta€”aortic aneurysms (abdominal aortic aneurysms and thoracic aortic aneurysms), aortic dissection, aortic atheromatous emboli, Takayasu arteritis, giant cell aortitis, and trauma. The sections on aortic aneurysm cover screening; clinical presentation; diagnostic evaluation; management to reduce risk of aneurysm rupture; surgical treatment (including preoperative evaluation and management); postoperative modification of risk factors; and management of postoperative complications. Aortic dissections affect either the ascending aorta (type A) or the descending aorta (type B) and may be classified as acute or chronic. The discussion of aortic dissection describes the clinical presentation, diagnostic workup, and treatment for both type A and type B dissections. Atypical dissections (i.e., aortic dissections that do not involve an intimal tear or in which there is no penetrating atherosclerotic ulcer) are also discussed. The figures include two algorithms: a stepwise approach to cardiac assessment and a logical procedure for the evaluation and treatment of a suspected aortic dissection. Figures provide a stepwise approach to cardiac assessment in patients suspected of having an aortic aneurysm, a decision algorithm for evaluation and treatment of a suspected aortic aneurysm, and imaging studies of various aneurysm presentations. The chapter includes 104 references.

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