-
Revue Medicale de Liege May 2018Aortic dissection is a life-threatening condition due to a tear in the intimal layer of the aorta or bleeding within the aortic wall, resulting in the separation of the... (Review)
Review
Aortic dissection is a life-threatening condition due to a tear in the intimal layer of the aorta or bleeding within the aortic wall, resulting in the separation of the different layers of the aortic wall. Among the risk factors, age, hypertension, dyslipidemia and genetic disorders of the connective tissue have been identified. A prompt diagnosis and an adequate treatment are important in the management of affected patients. The type of treatment depends on the location and extension of the dissection. Open surgical repair is most commonly used for dissections involving the ascending aorta and the aortic arch, whereas endovascular intervention is indicated for descending aorta dissections that are complicated. In this paper, we will review the epidemiology, and physiopathology of aortic dissection and describe the appropriate management for each type of dissection (open surgery, endovascular or medical treatment).
Topics: Aortic Dissection; Cardiac Surgical Procedures; Endovascular Procedures; Humans; Risk Factors
PubMed: 29926568
DOI: No ID Found -
Journal of the American College of... Oct 2020The Stanford classification of aortic dissection was described in 1970. The classification proposed that type A aortic dissection should be surgically repaired... (Review)
Review
The Stanford classification of aortic dissection was described in 1970. The classification proposed that type A aortic dissection should be surgically repaired immediately, whereas type B aortic dissection can be treated medically. Since then, diagnostic tools and management of acute type A aortic dissection (ATAAD) have undergone substantial evolution. This paper evaluated historical changes of ATAAD repair at Stanford University since the establishment of the aortic dissection classification 50 years ago. The surgical approaches to the proximal and distal extent of the aorta, cerebral perfusion methods, and cannulation strategies were reviewed. Additional analyses using patients who underwent ATAAD repair at Stanford University from 1967 through December 2019 were performed to further illustrate the Stanford experience in the management of ATAAD. While technical complexity increased over time, post-operative survival continued to improve. Further investigation is warranted to delineate factors associated with the improved outcomes observed in this study.
Topics: Academic Medical Centers; Aged; Aortic Dissection; Female; Humans; Length of Stay; Male; Middle Aged; Time Factors; Treatment Outcome
PubMed: 33004136
DOI: 10.1016/j.jacc.2020.07.061 -
Techniques in Vascular and... Jun 2021
Topics: Aortic Dissection; Blood Vessel Prosthesis Implantation; Humans
PubMed: 34602274
DOI: 10.1016/j.tvir.2021.100745 -
Cardiology Clinics Aug 2017Type A aortic dissection is a surgical emergency occurring when an intimal tear in the aorta creates a false lumen in the ascending aorta. Prompt diagnosis and surgical... (Review)
Review
Type A aortic dissection is a surgical emergency occurring when an intimal tear in the aorta creates a false lumen in the ascending aorta. Prompt diagnosis and surgical treatment are imperative to optimize outcomes. Surgical repair requires replacement of the ascending aorta with or without aortic root or aortic arch replacement. Surgical outcomes for this highly lethal diagnosis have improved, with contemporary survival to discharge at Centers of Excellence of 85% to 90%. Survival is related to prompt treatment, preexisting medical comorbidities, presence or absence of end organ malperfusion, extent of aortic repair required, and the development of postoperative complications.
Topics: Acute Disease; Aortic Dissection; Aorta; Aortic Aneurysm, Thoracic; Humans
PubMed: 28683905
DOI: 10.1016/j.ccl.2017.03.004 -
Heart (British Cardiac Society) Jan 2017
-
The American Journal of the Medical... Nov 2017Painless aortic dissection (PAoD) has been previously linked to poor outcomes. We recently encountered a case of a patient with PAoD presenting with dyspnea; the clue to... (Review)
Review
Painless aortic dissection (PAoD) has been previously linked to poor outcomes. We recently encountered a case of a patient with PAoD presenting with dyspnea; the clue to diagnosis was the presence of a loud aortic diastolic murmur. A systematic review of the literature revealed 86 other cases, 62% of which occurred in men with a mean age of 65 years. Left-sided neurologic deficits were the most common presentation, followed by dyspnea and bilateral lower extremity deficits. Pulse asymmetry was found in 53% of patients, as 29% had right-left asymmetry and 24% had upper-lower asymmetry. Cumulatively, 88% of the cases were type A dissection and 51% of the patients died. Erroneous application of fibrinolysis and anticoagulation occurred in multiple instances. PAoD is rare but potentially fatal; a high index of suspicion and a thorough cardiovascular examination are needed to establish the diagnosis before applying possible harmful interventions such as fibrinolysis, vasodilation or anticoagulation.
Topics: Aged; Aortic Dissection; Female; Humans; Male; Middle Aged
PubMed: 29173364
DOI: 10.1016/j.amjms.2016.11.005 -
Journal of the American College of... Sep 2019Historically, the gold standard for treating acute uncomplicated type B aortic dissection (TBAD) has been aggressive medical therapy to achieve optimal heart rate and... (Review)
Review
Historically, the gold standard for treating acute uncomplicated type B aortic dissection (TBAD) has been aggressive medical therapy to achieve optimal heart rate and blood pressure control. However, recent data have demonstrated that a significant proportion of patients with medically managed acute uncomplicated TBAD have late aorta-related complications, such as aneurysmal degeneration, that increase mortality and often necessitate surgical intervention. In this review, the authors review existing literature on uncomplicated TBAD and highlight contemporary surgical and medical strategies to manage this condition. Looking ahead, efforts are underway to identify and characterize a high-risk subgroup of acute uncomplicated TBAD patients who may benefit from early intervention.
Topics: Algorithms; Aortic Dissection; Aortic Aneurysm, Thoracic; Humans
PubMed: 31514953
DOI: 10.1016/j.jacc.2019.07.063 -
The American Journal of Emergency... Jul 1999The presentation of aortic dissection in the emergency department may be more subtle than the classic description of a shocked patient with "ripping" chest pain. The... (Review)
Review
The presentation of aortic dissection in the emergency department may be more subtle than the classic description of a shocked patient with "ripping" chest pain. The epidemiology, variation in presentation, investigation, and management of aortic dissection are reviewed.
Topics: Aortic Dissection; Aortic Aneurysm; Chest Pain; Humans; Shock
PubMed: 10452437
DOI: 10.1016/s0735-6757(99)90090-6 -
The New England Journal of Medicine Oct 1987
Review
Topics: Aortic Dissection; Aortic Aneurysm; Follow-Up Studies; Humans
PubMed: 3309654
DOI: 10.1056/NEJM198710223171705 -
The Journal of Cardiovascular Nursing Jul 2001Aortic dissection is the most common catastrophic condition affecting the aorta. Its clinical presentation is variable and can mimic any number of medical and surgical... (Review)
Review
Aortic dissection is the most common catastrophic condition affecting the aorta. Its clinical presentation is variable and can mimic any number of medical and surgical conditions. The most prevalent symptom is excruciating chest pain. Essential treatment includes rapid initiation of pharmacologic agents to control hypertension. Aortic dissection involving the ascending aorta also necessitates immediate surgical repair. Surgical treatment of aortic dissection involving only the descending aorta generally is reserved for patients with persistent pain, intractable hypertension, or evidence of propagation of the dissection. Nursing management includes blood pressure monitoring, serial physical assessment, and postoperative care, as appropriate.
Topics: Aortic Dissection; Aortic Aneurysm, Thoracic; Aortic Rupture; Blood Vessel Prosthesis Implantation; Chest Pain; Humans; Hypertension; Postoperative Complications; Stents
PubMed: 11419663
DOI: 10.1097/00005082-200107000-00003