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The Journal of Thoracic and... Nov 2021
Topics: Aortic Dissection; Aortic Aneurysm, Thoracic; Humans
PubMed: 32284145
DOI: 10.1016/j.jtcvs.2020.02.115 -
Journal of the American Heart... Apr 2022
Topics: Aortic Dissection; Aortic Aneurysm, Thoracic; Humans; Pedigree; Risk Assessment
PubMed: 35383462
DOI: 10.1161/JAHA.122.025441 -
Texas Heart Institute Journal 2011Two hundred fifty years have passed since Frank Nicholls' history-making, accurate observations on the anatomic findings and cause of death of King George II were... (Review)
Review
Two hundred fifty years have passed since Frank Nicholls' history-making, accurate observations on the anatomic findings and cause of death of King George II were published. Several decades later, the disease was named, using--for the first time--the terms dissection and dissecting attached to an aortic disease process. Another century went by before effective surgical treatment was developed. In sharp contrast, the evolution of the last 20 years has been nothing short of amazing. Our understanding of AD, while not yet complete, has improved dramatically. In addition, the introduction of nonsurgical endovascular therapy has had a profoundly transformative impact--and we are just at the beginning! It would not be unreasonable to predict that stent-graft repair will likely replace (or nearly replace) open surgery in the treatment of complicated type B dissection in the near future, especially as technologies continue to improve and indication-specific designs are developed and tested in the clinical setting. Moreover, it is predictable that endovascular solutions for some patients with type A aortic dissection will become available in the years to come as surgical results continue to be suboptimal. Finally, and amidst this plethora of “good news,” it is appropriate to reflect on the formidable challenge that endovascular therapies face as they gear to “compete” with optimal medical therapy in the management of patients with acute uncomplicated type B dissection, because it will obviously be difficult (if not impossible) to improve on the already-achieved 30-day mortality rate of less than 10%. Long-term gains may well become the winning card when and if the late results of TEVAR can be shown to improve on the rather compromised outlook of medically treated dissection patients. Stay tuned.
Topics: Aortic Dissection; Aortic Aneurysm; Blood Vessel Prosthesis Implantation; Endovascular Procedures; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Vascular Surgical Procedures
PubMed: 22199439
DOI: No ID Found -
Methodist DeBakey Cardiovascular Journal 2011The biology of aortic aneurysm and dissection has evolved to where we now understand the genetic implications of changes in extracellular matrix proteins, smooth muscle... (Review)
Review
The biology of aortic aneurysm and dissection has evolved to where we now understand the genetic implications of changes in extracellular matrix proteins, smooth muscle cells, and growth factors and how they affect aortic wall homeostasis. These predeterminants are influenced by smoking, hypertension, and atherosclerosis, and the result in an inflammatory response coupled to an accelerated proteolytic cascade that disrupts both elastin and collagen in the aortic wall.
Topics: Aortic Dissection; Animals; Aorta; Aortic Aneurysm; Biomarkers; Extracellular Matrix Proteins; Genetic Predisposition to Disease; Humans; Oxidative Stress; Phenotype; Prognosis; Reactive Oxygen Species; Risk Factors
PubMed: 21979117
DOI: 10.14797/mdcj-7-3-2 -
European Journal of Cardio-thoracic... Oct 2022Type A aortic dissection is a cardiovascular emergency. Its incidence seems to have increased in the last few years; it is not clear whether this is a consequence of the...
Type A aortic dissection is a cardiovascular emergency. Its incidence seems to have increased in the last few years; it is not clear whether this is a consequence of the ageing population or better awareness of the diagnosis (Erbel R, Alfonso F, Boileau C, Dirsch O, Eber B, Haverich A et al.; Task Force on Aortic Dissection, European Society of Cardiology. Diagnosis and management of aortic dissection Task Force on Aortic Dissection, European Society of Cardiology. Eur Heart J 2001;15;22:1642-81). Acute type A aortic dissection is often lethal without urgent surgical treatment with mortality rates of around 17% (Conzelmann LO, Weigang E, Mehlhorn U, Abugameh A, Hoffmann I, Blettner M et al. Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg 2016;49:e44-e52). Pheochromocytomas are rare tumours, though often asymptomatic, they could be lethal if left untreated. The incidence is around 0.6 per 100,000 persons per year. The association of both aortic dissection and pheochromocytoma is rare. Here, we report a case of a 36-year-old patient with pheochromocytoma and hypertension, whose delay of surgery due to the Covid-19 pandemic led to acute type A aortic dissection.
Topics: Acute Disease; Adrenal Gland Neoplasms; Adult; Aortic Dissection; COVID-19; Humans; Pandemics; Pheochromocytoma; Registries
PubMed: 36165703
DOI: 10.1093/ejcts/ezac477 -
Der Internist May 2013Aortic aneurysms and aortic dissection represent a significant health risk due to the demographic developments and current life styles. The mortality of ruptured aortic... (Review)
Review
Aortic aneurysms and aortic dissection represent a significant health risk due to the demographic developments and current life styles. The mortality of ruptured aortic aneurysms is up to 80 % and the prevalence of aneurysms varies depending on the localization (thoracic or abdominal). Most commonly affected is the infrarenal abdominal aorta; however, there is evidence that the prevalence is diminishing but in contrast the incidence of thoracic aortic aneurysms is increasing. Aortic dissection is often fatal and is the most common acute aortic disease but the incidence is presumed to be underestimated. The pathogenesis of aortic aneurysms is manifold and is based on an interplay between degenerative, proteolytic and inflammatory processes. An aortic dissection arises from a tear in the intima which results in a separation of the aortic wall layers with infiltration of bleeding and the danger of aortic rupture. Various genetic disorders of connective tissue promote degeneration of the aortic media, most notably Marfan syndrome. Risk factors for aortic aneurysms and aortic dissection are nicotine abuse, arterial hypertension, age and male gender. Aortic aneurysms initially have an uneventful course and as a consequence are mostly discovered incidentally. The clinical course and symptoms of aortic dissection are very much dependent on the section of the aorta affected and the manifestations are manifold. Acute aortic dissection is in 80 % of cases first manifested as sudden extremely severe pain. The diagnostics and subsequent course control can be achieved by a variety of imaging procedures but the modality of choice is computed tomography.
Topics: Aged; Aortic Dissection; Aortic Aneurysm; Cardiovascular Surgical Procedures; Humans; Incidence; Male; Middle Aged; Prevalence; Survival Rate
PubMed: 23558776
DOI: 10.1007/s00108-012-3217-0 -
Journal of the American College of... Jun 2022
Topics: Aortic Dissection; Aortic Aneurysm, Thoracic; Blood Flow Velocity; Hemodynamics; Humans; Magnetic Resonance Imaging
PubMed: 35710194
DOI: 10.1016/j.jacc.2022.04.023 -
Brazilian Journal of Cardiovascular... Dec 2019Aortic dissection (AD) has been recognized to be associated with an inflammatory process. Clinical observations demonstrated that patients with AD had an elevated... (Review)
Review
Aortic dissection (AD) has been recognized to be associated with an inflammatory process. Clinical observations demonstrated that patients with AD had an elevated interleukin (IL)-6 level in comparison to hypertensive or healthy controls. Adverse events such as acute lung injury, postimplantation syndrome, and death are associated with an elevated IL-6 level. Thus, circulating IL-6 could be a reliable biomarker for the diagnosis of AD and for the eveluation of the therapeutic outcomes and the prognosis of AD patients. Therapeutic interventions aiming at attenuating the inflammatory status by IL-6 neutralization could effectively decrease the IL-6 level and thus reverse the progression of the disorder of AD patient. Endovascular aortic repair can effectively control the inflammatory cytokines. Selective antegrade cerebral perfusion with deep hypothermic circulatory arrest during aortic arch replacement shows better neuroprotectve effect with an improved IL-6 level of the cerebrospinal fluid. These results facilitate the understanding of the etiology of AD and guide the directions for the treatment of acute AD in the future. More effective therapeutic agents developed based on the theories of IL-6 signaling involved in the mechasims of AD are anticipated.
Topics: Aortic Dissection; Aortic Aneurysm; Cytokines; Humans; Interleukin-6; Predictive Value of Tests; Prognosis; Reference Values; Time Factors
PubMed: 31112020
DOI: 10.21470/1678-9741-2018-0287 -
Seminars in Vascular Surgery Mar 2022Aortic dissection confers high mortality and morbidity rates despite advances in treatment, impacts quality of life, and contributes immense burden to the healthcare... (Review)
Review
Aortic dissection confers high mortality and morbidity rates despite advances in treatment, impacts quality of life, and contributes immense burden to the healthcare system globally. Efforts to prevent aortic dissection through screening and management of modifiable risk factors and early detection of aneurysms should incorporate genomic information, as it is integral to stratifying risk. However, effective integration of genomic-guided risk assessment into clinical practice will require addressing implementation barriers that currently permeate our healthcare systems. The Aortic Dissection Collaborative was established to define aortic dissection research priorities through patient engagement. Using a collaborative patient-centered feedback model, our Genomic Medicine Working Group identified related research priorities that could be investigated by pragmatic interventional studies aimed at aortic dissection prevention, utilization of genomic information to improve patient outcomes, and access to genomic medicine services. Further research is also needed to identify the genomic, lifestyle, and environmental risk factors that contribute to aortic dissection so these data can be incorporated into future comparative effectiveness studies to prevent aortic dissection.
Topics: Aortic Dissection; Genomic Medicine; Humans; Quality of Life; Risk Assessment; Risk Factors
PubMed: 35501041
DOI: 10.1053/j.semvascsurg.2022.02.003 -
Archivos de Cardiologia de Mexico 2022
Topics: Aortic Dissection; Aortic Valve; Humans; Treatment Outcome
PubMed: 34987238
DOI: 10.24875/ACM.20000514