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45.9 Aortic sclerosis: therapy
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Published:July 2018
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Abstract
Aortic sclerosis is a very common disease and is related to the atherosclerotic process which can start in young adulthood. The loss of compliance of the aortic ‘Windkessel’ is a major drawback of the disease, leading to enhanced blood pressure amplitude—elevated pulse pressure—due to a higher systolic and a lower diastolic blood pressure. The pressure pulse wave augmentation index and the pulse wave velocity increase. Ultrasound is able to visualize only limited aortic segments, whereas computed tomography and magnetic resonance imaging are the best tools to detect and quantify aortic atheromas. Nevertheless, transoesophageal echocardiography can image the descending thoracic aorta down to the coeliac trunk. An aortic atheroma, particularly one greater than 4 mm in size in the aortic arch, indicates an increased risk of stroke and other cardiovascular events. A grading is helpful. Plaque rupture is quite frequent and often found in multiple segments of the aorta indicating an increased risk of cholesterol emboli due to the wash-out of debris with or without thrombotic material. Free-floating structures, possible remnants of fibrous cap, are found as well as mobile thrombi. Calcification of the thoracic aorta is often found when coronary artery calcification is present, but may be present when coronary artery calcification is absent. Risk prediction of events is, however, not improved. Therapy for aortic sclerosis is based on common and recent guidelines for prevention and treatment of risk factors. Endovascular or surgical interventions are limited to rare situation in which blood flow is not preserved.
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