281.2 🩺 國考版

281.2.1 高頻考點

281.2.1.1 Aneurysm Surgical Thresholds (MEMORIZE)

• AAA: ♂ ≥ 5.5, ♀ ≥ 5.0, growth ≥ 0.5 cm/y
• Ascending TAA: ≥ 5.5 (general), ≥ 5.0 (Marfan + BAV), ≥ 4.5 (FHx dissection at small), ≥ 4.0 (Loeys-Dietz, vEDS)
• Descending TAA: ≥ 5.5-6.0 cm

281.2.1.2 USPSTF Screening

• AAA: men 65-75 with smoking history (Class B)
• Women: individualized if smoking history

281.2.1.3 Dissection Pearls

• Stanford A (60%): ascending → emergency SURGERY
• Stanford B (40%): descending → medical first; TEVAR if complicated
• β-blocker FIRST before vasodilator (esmolol)
• SBP < 120, HR < 60 within 10-30 min
• BP differential > 20 mmHg between arms

281.2.1.4 Key Trials

• EVAR-1, DREAM, OVER: EVAR ↓ early mortality but ↑ re-intervention long-term vs open AAA
• INSTEAD-XL (2013): TEVAR + medical > medical alone for Type B at 5-yr
• ADSORB (2014): TEVAR for uncomplicated B reduces growth
• COMPARE, MEND, AIMS: losartan in Marfan slows aortic growth
• BBEST (2010): celiprolol ↓ events in vEDS

281.2.1.5 Genetic Aortopathy Pearls

• Marfan: FBN1, threshold 5.0 cm + losartan
• Loeys-Dietz: TGFBR1/2, threshold 4.0 cm
• vEDS: COL3A1, AVOID instrumentation
• BAV: 1-2% population, screen first-degree relatives

281.2.2 易混淆比較

Type	Pain	Murmur	BP Diff	Treatment
Type A dissection	Anterior chest	New AR	+	Emergency surgery
Type B dissection	Back/abdominal	Usually no	±	Medical first
AAA rupture	Severe back/abd + pulsatile mass	None	Often hypotension	Emergency repair
MI	Pressure	No (unless papillary)	None	Reperfusion
PE	Pleuritic	No	None	Anticoagulation

281.2.2.1 Aortic Syndrome Acronym (Pain Features Suggesting Dissection)

• Sudden, severe
• Tearing/ripping quality
• Migrating
• Maximum at onset

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