1. Ross Milner, MDUniversity of Chicago Mark Russo, MD, MS Center for Aortic Diseases

2. THE SITUATION Over 6,000 people died last year from ruptured thoracic aortic aneurysms (TAA). 21,000 were diagnosed with this dangerous condition. Once a TAA ruptures, the survival rate is only 15%. Could your patient have an undiagnosed TAA?

3. TAA ESSENTIALS Diameter of the thoracic aorta 1.5 times greater than normal (or larger) Definition

4. TAA ESSENTIALS 21,000 new cases per year in the U.S. Men: 60%, Women: 40% –Elective repair: up to 10% mortality –Emergent repair: up to 50% mortality Scope of the challenge:

5. WHO IS AT RISK Smoking Hypertension High cholesterol Obesity Atherosclerosis Chest trauma Genetics – Marfans, Ehlers-Danlos Family history Primary Risk Factors

6. SYMPTOMS Neck, chest or back pain (25%) Shortness of breath Difficulty swallowing Hoarse cough Congestion of head, neck, upper extremities (related to SVC compression) Although there are frequently no symptoms, TAA symptoms may include:

7. DIAGNOSIS CT – the definitive exam MRI Chest x-ray Aortogram TEE Imaging 25% Ascending aorta 25% Aortic arch 50% Descending aorta Occurrence

8. TREATMENT OPTIONS TAAs under 5.0 cm: medical therapy, monitor annual growth by CT TAAs over 5.0 cm in diameter: intervention/repair strongly considered Medical management (BP-lowering drugs) Open surgery Endovascular repair No proven lifestyle changes can decrease the size of TAAs. TEVAR animation video

9. REPAIR OPTIONS Both endovascular and open surgeries are used to repair TAAs. Approximately 11,000 open surgeries are performed each year in the U.S. Approximately 8,000 endovascular repairs are performed in the U.S. annually.* *BIBA Medical Research estimated 1,960 thoracic stent grafts were implanted in the U.S. in Q2 2008.

10. REPAIR OPTIONS Requires single small incision in the groin area. An endovascular graft is inserted through the femoral artery via a catheter and deployed inside the lumen, relining the aorta. Average ICU stay: 2-3 days Average recovery time: 1-2 weeks Endovascular surgery:

11. REPAIR OPTIONS Requires thoracotomy Aorta is cross-clamped above diseased aortic segment Affected segment is replaced with fabric surgical graft Average hospital stay: 2-3 weeks Average recovery time: 3 months Open surgery:

12. THREE CLINICAL TRIALS 2005 TAG Pivotal Trial (N=139) 2008 TX2 Pivotal Trial (N=160) 2008 Talent Pivotal Trial (N=195) Controlled Endovascular Stent Graft Trials

13. ENDOVASCULAR STENT GRAFT TRIALS

14. WHAT YOU CAN DO? Remember those most at risk: –Men over 60 –Smokers –Those with a family history of TAA Image and refer as appropriate those patients with a high index of suspicion for TAA. Be aware TAAs are most often silent killers and are increasing in number.

15. University of Chicago Center for Aortic Diseases University of Chicago Medical Center 5841 S. Maryland Avenue Chicago, IL 60637 773-702-2500 ucaorta@surgery.bsd.uchicago.edu This presentation was brought to you by Cook Medical.