From the Guidelines
Aortic aneurysm and aortic stenosis are two distinct conditions affecting the aorta, though they can sometimes coexist, with the most recent evidence suggesting that careful management of hypertension is crucial in patients with aortic stenosis to reduce cardiovascular morbidity and mortality 1.
Conditions Overview
- An aortic aneurysm is an abnormal bulging or dilation of the aortic wall, typically considered significant when the diameter exceeds 1.5 times normal.
- Aortic stenosis involves narrowing of the aortic valve opening, restricting blood flow from the heart to the body.
Treatment and Management
- Treatment for aortic aneurysm depends on size and location, with surgical repair generally recommended when thoracic aneurysms reach 5.5-6.0 cm or abdominal aneurysms reach 5.0-5.5 cm, as supported by recent guidelines 1.
- For aortic stenosis, definitive treatment for severe symptomatic cases requires valve replacement, either surgically or through transcatheter aortic valve replacement (TAVR), with pre-intervention imaging being essential for procedure planning and device selection 1.
Key Considerations
- Regular monitoring with echocardiograms or CT scans, blood pressure control, and lifestyle modifications including smoking cessation and moderate exercise are crucial for optimizing cardiovascular health in patients with either condition.
- The combination of hypertension and aortic stenosis increases the rate of complications, making careful use of antihypertensive agents beneficial, with RAS blockade potentially being advantageous due to its effects on LV fibrosis and control of hypertension 1.
From the Research
Relationship Between Aortic Aneurysm and Aortic Stenosis
- The presence of an abdominal aortic aneurysm (AAA) in patients with severe aortic stenosis (SAS) increases the risk of AAA rupture if left untreated 2, 3.
- Simultaneous transcatheter aortic valve implantation (TAVI) and endovascular aneurysm repair (EVAR) is a safe and effective treatment alternative for selected patients with SAS and AAA 2, 3, 4.
- The increased systolic pressure post-TAVI can result in an increased strain within the wall of the AAA, leading to a higher risk of rupture 3.
- A detailed assessment of patients with SAS and AAA is crucial to determine the best treatment approach, taking into account the patient's overall life expectancy and risk factors 5, 6.
- Medical management of AAA, including treatment with statins, beta-blockers, and ACE inhibitors, can help reduce cardiovascular risk and slow aneurysm growth, but may not affect the risk of rupture directly 5.