An aortic dissection is an emergency with your aorta, which is the largest blood vessel in your body and the main artery that takes blood from your heart to the rest of your body during an. It is part of the acute aortic syndrome an umbrella term for aortic dissection, intramural haematoma, and symptomatic aortic ulcer table. Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. Salvage endovascular septectomy in patients with chronic.
Excluding aortic dissection before thrombolysis in patients with ischemic stroke has been insufficiently adviced. About 60% of people who survive the first 2 weeks are still alive 5 years after treatment, and 40% live at least 10 years. Eagle, md,x valentin fuster, md, phd abstract aortic dissection is the most devastating complication of thoracic aortic disease. The european guidelines state that with stable disease, imaging every. A tear in the innermost layer of the aorta the intima allowing for blood to dissect between layers of the aortic wall, which may lead to endorgan damage or death. There are two types of aortic dissection, type 1 and type 2.
Acute medical management of acute aortic syndromes including aortic dissection involves controlling pain, and providing antiimpulse therapy in the form of blood pressure lowering and decreasing the velocity of left ventricular contraction, to decrease aortic shear stress and minimize the tendency for the dissection to propagate. Setting the international registry of acute aortic dissection, consisting of 12 inter. Aortic dissection aortic dissection can result in ar by four mechanisms. Aortic dissection is an exceptionally complex disease and remains one of the most misdi agnosed diseases across the globe. The overall in hospital mortality rate for acute aortic dissection is reported to be. Aortic dissection is a more common problem than is ruptured abdominal aortic aneurysm. Chronic aortic dissection cad is a critical clinical condition with a high mortality and warrants sophisticated therapeutic techniques.
Objectives this study sought to evaluate the early and longterm effect of thoracic endovascular aortic repair tevar on typeb acute aortic dissection aad. Debakey developed aortic dissection himself at age 97 in 2005, and underwent surgery in 2006. Jan 08, 2019 aortic dissection see the image below is defined as separation of the layers within the aortic wall. Antihypertensive therapy in acute aortic dissection aims specifically to lessen pulsatile load or aortic stress dpdt, in order to retard the propagation of the dissection and prevent aortic rupture 7. A new appraisal of the management of acute aortic dissection is timely because of recent developments in diagnostic strategies including biomarkers and imaging, endograft design, and surgical treatment, which have led to a better understanding of the epidemiology, risk. While the majority of patients who present with aortic dissection are. Aortic dissection heart and blood vessel disorders. Endovascular treatment of an aortic dissection society.
Aortic dissection, though uncommon, when it occurs, it is most frequently in men aged 60 to 70. A ct angiogram is used to determine the location and extent of the dissection, and to evaluate what part of the aorta and which aortic branches may be involved 3. Untreated, it is associated with mortality rates of 1% to 2% per hour after the onset of symptoms, and 90% at three months. If endovascular treatment is appropriate, one of the two procedures below will likely be recommended.
Aortic dissection in marfans syndrome stephen westaby, frcs the oxford heart centre, john radcliffe hospital, oxford, england background. An extensive stanford type a aortic dissection involving. Aortic dissection occurs once per 10,000 patients admitted to the hospital. Shortly after listening to your podcast on the way to work, were heading out to transport a mid40s male to a tertiary center who was suffering an aortic dissection nonmarfanoid as well, but with a similar aged sibling who had suffered and survived the issue years earlier. Design case series with patients enrolled between january 1996 and december 1998. Residents can get free access to all of their resources and attending can get a discount on some of their great products at the eb medicine em basic page. The intimal tear may be a primary event or secondary to hemorrhage within the media. It is three times more common than aaa rupture and associated with a high mortality. Because aortic dissection is a lifethreatening condition, treatment is typically needed immediately. Aortic dissection can cause extensive injury to various organs and rapid death, and should always be. Background uncomplicated typeb aad is generally treated with medical management.
Dake md, in comprehensive vascular and endovascular surgery second edition, 2009. Aneurysm chronic dissection an aortic aneurysm in the ascending aorta can also lead to leaking of the aortic valve. When an aortic dissection is detected early and treated promptly, chance of survival greatly improves. Diagnosis and clinical management of aortic dissection. An aortic dissection is a medical emergency requiring immediate treatment. Pdf acute type a aortic dissection in a 36week pregnant. Treatment for type a aortic dissection may include. Also, vomiting, sweating, and lightheadedness may occur. Apr 08, 2009 acute aortic dissection is a lifethreatening condition associated with high morbidity and mortality.
Aortic dissection cardiovascular disorders merck manuals. Management of a complex aortic dissection with combined. Practice guidelines, american association for thoracic. In its natural evolution, without treatment, acute type a aortic dissection reportedly has a mortality rate of about 1% per hour initially, with half of the patients expected to be dead by the 3rd day, and almost 80% by the end of the 2nd week. Cocaine use and aortic dissection posted in cocaine by datreatment aortic dissection is an extremely serious, frequently fatal health emergency that occurs when a rupture or tear forms in the inner surface of the aorta, the main artery that sends blood from the heart to the rest of the body. Aortic dissection, a sudden delamination of the aortic wall in its medial layer, is a lifethreatening arterial event associated with a very poor outcome, and requires rapid diagnosis and decision. Aortic dissection occurs when the wall of the aorta the major artery of the body develops a tear, which allows blood to enter the vessel wall, dissecting or tearing apart the layers of the wall. Ritter rules are a compilation of reminders, symptoms, and risk factors designed to prevent the misdiagnosis of thoracic aortic dissection. Treatment is first given is to control your blood pressure and heart rate, usually in the emergency room. Aortic dissection 19 congenital connective tissue diseases 22 contents. Acute aortic dissection, aad, is the most common and most lethal of the acute syndromes, and requires urgent diagnosis and treatment.
The task force for the diagnosis and treatment of aortic diseases of the european society of cardiology esc authorstask force members. This is a medical emergency and requires immediate treatment at a hospital. Guidelines aortic diseases aortic aneurysm acute aortic syndrome. Definition of complications in acute aortic dissec tion. Timing of intervention differs for ascending type a and descending type b thoracic aortic dissection. We present a rare case of continuous, extensive aortic dissection ad involving the bilateral common carotid arteries, the ascending, thoracic, and abdominal aorta, and bifurcation of the right common iliac artery. The goals of treatment are to prevent myocardial ischemia, decrease left ventricular afterload. An aortic dissection, sometimes referred to as a dissecting aorta or dissecting aneurysm, is the most common catastrophe of the aorta. We must make do with inadequate tools since most endografts are not diseasespecific, and an ideal graft to treat aortic dissec. Although it is rare, doctors with an expertise in identifying.
Intramural haematoma is characterized by a dynamic evolution and may lead to classic aortic dissection 28% to 47% andor aortic rupture 20% to 45%. Aortic dissection is a medical emergency and can quickly lead to death should the bloodfilled section rupture through the outside aortic wall. For untreated acute dissection of the ascending aorta, the mortality rate is 12% per hour early after symptom onset. A aortic dissection was written with the general cardiac sur geon in mind, the. Aortic dissection can cause extensive injury to various organs and rapid death, and should always be considered a medical emergency. Look for marphans, listen for an aortic regurgitation murmur and f eel for a. In addition to coronary and peripheral artery diseases, aortic diseases contribute to the wide spectrum of arterial diseases.
Aortic dissection is a relatively rare but highly lethal disease. Ruptured aneurysm of the descending thoracic aorta. Hypertensive emergency in aortic dissection and thoracic. Aortic dissection is a severe condition where there is a tear in the wall of the major artery bring blood from the heart aorta. Although some advances have been achieved in endovascular aortic repair evar, it remains ineffective in the treatment of some patients with complicated cad. Cocaine use and aortic dissection drug addiction treatment. Incidence 16100,000 for men, 9100,000 for women milewicz 2011 ratio of aortic dissection ad to acute coronary syndrome is 1. Aortic dissection is a potentially lethal clinical entity that requires rapid diagnosis, appropriate medical management, and potential surgical intervention.
Signs and symptoms of aortic dissection include a tearing or ripping pain, nausea, sweating, weakness, shortness of breath, sweating, or fainting. Blood pressure is reduced with medications, usually to 100 to 120 mmhg systolic. Endovascular treatment of aortic dissection has been possible for more than 20 years, but can only be offered to select patients by skilled physicians. Acute aortic dissection is a lifethreatening condition associated with high morbidity and mortality. The acute onset of severe aortic regurgitation ar, also called aortic insufficiency is usually a medical emergency due to the inability of the left ventricle to quickly adapt to the abrupt increase in enddiastolic volume caused by the regurgitant flow.
Aortic dissection show notes word format aortic dissection show notes pdf irad study link free full text irad study pdf free full text check out our bandwidth sponsor eb medicine. Video transcript how do you manage an aortic dissection. The dissection may occur anywhere along the aorta and extend proximally or distally into other arteries. Aortic dissection ad occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart. The incidence of aortic dissection is estimated to be 530 cases per 1 million people per year. The force of the blood entering the middle layer the media causes the tear to extend. In the event that it is necessary to replace the thoracic aorta. Current options and recommendations for the treatment of. A 61yearold man with history of chronic hypertension presented with a oneday history of chest pain, vertigo, left facial drooping, and left hemiparesis. A new appraisal of the management of acute aortic dissection is timely because of recent developments in diagnostic strategies including biomarkers and imaging, endograft design, and surgical treatment, which have led to a better understanding of the epidemiology, risk factors, and molecular nature of aortic dissection.
If not surgically corrected, acute severe ar commonly results in cardiogenic shock. Endovascular treatment of aortic dissection was developed in the 1990s. A patient has an intravenous iv line placed, so that medications can be delivered directly into the blood stream. Surgical strategies in acute type a dissection cryolife, inc. Surgery for acute type a aortic dissection the journal of thoracic. As the tear extends along the wall of the aorta, blood can flow between the layers of the blood vessel wall dissection. General guidelines stipulate a target systolic blood pressure of. Aortic dissection patients true stories aortic dissection. Involvement of the ascending aorta type a imh carries a high inhospital mortality up to 40%. Update in the management of type b aortic dissection university of. Medical management consists of decreasing the blood pressure and the shearing forces of myocardial contractility in order to decrease the intimal tear and propagation of the dissection.
Treatment depends on the type of aortic dissection, and the severity of. In most cases, this is associated with a sudden onset of severe chest or back pain, often described as tearing in character. Management of descending thoracic aorta diseases european. Acute medical management of acute aortic syndromes including aortic dissection involves controlling pain, and providing antiimpulse therapy in the form of blood pressure lowering and decreasing the velocity of left ventricular contraction, to decrease aortic shear stress and minimize the tendency for the dissection to propagate table 1. Jan 20, 2017 aortic dissection is a severe condition where there is a tear in the wall of the major artery bring blood from the heart aorta. Risk analysis for hospital mortality in patients with acute type a aortic dissection. Medication may also be used to stabilize a patients condition before surgery. Therapy may include surgery or medications, depending on the area of the aorta involved. Clinical prediction of acute aortic dissection surgery. The task force for the diagnosis and treatment of aortic. Aortic dissection is caused by an intimal and medial tear in the aorta with propagation of a false lumen within the aortic media. An aortic dissection begins with a tear in the inner layer of the aortic wall the intima. This is a very challenging disease to diagnose because patients have lots of different presentations that can make it difficult to diagnose. Objective to assess the presentation, management, and outcomes of acute aortic dissection.
The international registry of acute aortic dissection irad. Goda m, imoto k, suzuki s, uchida k, yanagi h, yasuda s, masuda m. Acute aortic dissection ad is the most frequent and catastrophic manifestation of the socalled acute aortic syndrome which also includes intramural hematoma, penetrating aortic ulcer, and ruptured thoracic aortic aneurysm. In its natural evolution, without treatment, acute type a aortic dissection. Clinical practice guidelines of the european society for vascular surgery esvs. Predicting death in patients with acute type a aortic dissection. Guidelines for the early management of adults with ischemic stroke. Aortic dissection is the most common acute aortic syndrome and it is an important differential of chest pain. So when you develop a tear, blood will start to get in there and start to tear the layers away from each other. The goals of early management of aortic dissection are to control pain and limit the extension of the dissection using antiimpulse therapy, which typically involves administration of beta blockers and control of blood pressure.
Aortic dissection an overview sciencedirect topics. The wc uses the wording of the esvs clinical practice guidelines on the management of. Eagle, md,x valentin fuster, md, phd abstract aortic dissection is the most devastating complication of thoracic aortic. Jul 27, 2015 today marks the 4th anniversary of the em basic podcast. Chronic abdominal aortic dissection caad with multiple visceral entries is. Pdf on oct 1, 2009, marina feldman and others published medical. Type a aortic dissection have marfan syndrome with dissection occurring at. Stanford type b aortic dissection tbad is a lifethreatening.
Aortic dissection heart and blood vessel disorders merck. Well to remind you, an aortic dissection is when you develop a tear between your intima and your media in your aortic wall. Remember the big pain pearls when taking a history. Patel an aortic dissection is a tear in the lining of the aorta that creates two blood flow channels. Open surgery treatment of an aortic dissection open surgery treatment of an aortic dissection by dr. Raimund erbel, department of cardiology, westgerman heart centre essen, university duisburgessen, hufelandstrasse 55, de45122 essen, germany. Endovascular management of acute aortic dissection ncbi. Lowrisk elective surgery of the abnormal aortic root has the potential to prevent this complication. Aortic dissection epidemiology in the united states, aortic dissection is an uncommon disease.
Acute aortic dissection is one of the most rapidly fatal clinical entities that can be encountered in the emergency department setting. Take home points for aortic dissection diagnosis and management. Aortic intramural hematoma is considered a precursor of classic dissection, originating from ruptured vasa vasorum in medial wall layers, and may provoke a secondary tear and communication with the aortic lumen. Treatment of descending thoracic aortic disease using. Acute type a aortic dissection ataad is still one of the most. Aortic dissection is the most frequent cause of premature death in marfans syndrome. Although open surgery is the main treatment for proximal aortic repair, use of endovascular management is now established for complicated distal dissection and distal arch repair, and has recently been discussed as a preemptive measure to avoid late complications by inducing aortic remodelling. Acute aortic dissection is the most frequently fatal condition in the spectrum of chest pain syndromes. Treatment of patients with a type i11 dissection is basically medical unless. Early recognition and treatment are crucial for survival. One channel is called the true lumen, which feeds blood to most of the important branches of the aorta and is surrounded by the. Medical management with antihypertensive therapy, including beta blockers, is the treatment of choice for all stable chronic aortic dissections. Two populationbased studies indicated incidences of 2. To celebrate this occasion, we are going to do a screencast on aortic dissection.
Mortality is still high despite advances in diagnostic and therapeutic modalities. Tears in the intimal layer result in the propagation of dissection proximally or distally secondary to blood entering the intimamedia space. The initial management for an aortic dissection often occurs in the emergency room. Aortic dissection is a relatively rare yet often fatal condition. With treatment, about 70% who have dissection of the first part of the aorta and about 90% of those who have dissection of the aorta farther from the heart survive to leave the hospital. Diagnosis and clinical management of aortic dissection phillips b harrington, james e davies, spencer j melbydivision of cardiothoracic surgery, department of surgery, university of alabama at birmingham, birmingham, al, usaabstract. Aortic dissection is the surging of blood through a tear in the aortic intima with separation of the intima and media and creation of a false lumen channel. Acute dissection of the thoracic aorta is a potentially lifethreatening condition. Prompt establishment of the diagnosis, through focused. Treatment of aortic dissection in the emergency department. Endovascular repair of ascending aortic dissection jacc. The estimated incidence is 530 cases per million people per year. Pdf medical management of acute type a aortic dissection.
112 705 684 650 1340 1231 1340 1465 1016 523 654 829 452 773 9 155 696 815 1510 1300 446 904 1186 169 475 1046 267 1207 345 837 1048 1608 685 163 342 277 1370 707 1176 1342 780 339 356 579 1329 1399 1299 232 1072