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