Survivors of aortic dissection wiley online library. A case of an abdominal aortic dissection in a hemodynamically. Based on the debakey classification, type i dissections involve the whole aorta, type ii only the ascending aorta, and type iii only the descending aorta. Citations may include links to fulltext content from pubmed central and publisher web sites.
Operative results of the anterolateral thoracotomy with partial sternotomy approach for chronictype b aortic dissection involving the aortic arch. Aortic dissection is found in approximately 80% to 90% of the acute aortic syndromes, whereas others will manifest with acute intramural hematoma or penetrating atherosclerotic ulcer. Percentage type i 1015% il 2530% debakey ill stanford b distal stanford a proximal tear intima onset of dissect ion ion of. A bulge in the aorta that develops in a weakened area of the aorta wall. On rare occasions, it can have an atypical presentation such as stroke, paraplegia, mesenteric ischemia, or lower limb malperfusion.
Aortic dissection cardiovascular disorders merck manuals. Once ad is diagnosed, rapid mobilization of consultant services is critical to increase the chance for survival. Jul 21, 2016 aortic dissection is a lifethreatening condition caused by a tear in the intimal layer of the aorta or bleeding within the aortic wall, resulting in the separation dissection of the layers of. Acute aortic dissectioninduced paraplegia and respiratory distress mimicking the ascending flaccid paralysis of guillainbarre syndrome. Medical management if not complicated type b complications include a decrease.
Chest, back or abdominal pain syncope symptoms consistent with perfusion deficit i. Thoracic aortic aneurysms without dissection comprise a smaller subset of patients with aortic emergencies. Management of acute aortic dissection and related syndromes requires a multidisciplinary approach with input from the patient, clinician, imager, surgeon, and anesthesiologist. Blood surges through the tear, causing the inner and middle layers of the aorta to separate dissect. Tearing in the layers of the aorta that can cause lifethreatening internal bleeding. An aortic dissection with an entry tear in zone 1 or.
Aortic dissection ad how common is aortic dissection. Anatomically, acute aortic dissection can be classi. High risk for progressive aortic dilatation and dissection. Based on the stanford classification, type a aortic dissections involve only the ascending aorta. Therefore, an indeterminate dissection extending from zone 0 to. Many ad patients do not fit the textbook presentation. Acute aortic dissection aad is a lifethreatening emer gency that involves a tear in the intimal wall.
Aortic dissection occurs with an annual incidence of 10 to 30 per million individuals. 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. Studies have shown good longterm survival after initial. An aortic dissection can mimic many other conditions, so doctors must include aortic dissection among the list of possible diagnoses to avoid missing it in patients complaining of chest pain. Understanding the molecular pathogenesis may lead to targeted therapy to prevent aortic disease. Transthoracic echocardiography is indicated for the diagnosis of aortic regurgitation but quantifying severity is challenging, in particular when classifying regurgitation. A patient with an aortic dissection may not appear to be a typical chest pain patient he or she may be younger, tallthin, and have no known risk factors for heart disease. The biochemical alterations identified in the aortic tissue have the potential to serve as biomarkers for aortic disease. Dissection below the aortic arch community ed ct available wont delay transport stable unstable to uw ed to uw ed ct no aortic dissection cd145670308p call access center for oncall vascular surgeon in madison. Thoracic aortic dissection is usually suspected clinically from the history and physical examination when a patient presents with severe, sharp, or tearing often migratory anterior chest pain in ascending aortic dissection or posterior chest or back pain arch or descending aortic dissection.
I was told that this could quickly turn catastrophic and that they would immediately need to begin to slow my heart rate down for emergency open heart surgery. When taking medical history, the following should raise suspicion of aortic dissection. Oct 20, 2010 not too long after the cat scan test, the doctor came in and said that i had suffered an aortic dissection which they later found out was caused by an aortic aneurysm. Family history of aortic aneurysmdissection or unexplained sudden cardiac death, especially.
Aortic causes of ar include annuloaortic ectasia idiopathic root dilatation, marfans syndrome, aortic dissection, collagen vascular disease, and syphilis. Symptomatic non aortic intraabdominal aneurysm 3 do not postpone asymptomatic non aortic intraabdominal aneurysm 2a consider postponing aortic dissection acute aortic dissection with rupture or malperfusion 3 do not postpone aortic emergency nos aef with septichemorrhagic shock, or signs of impending rupture 3 do not postpone. For language access assistance, contact the ncats public information officer. Pubmed comprises more than 26 million citations for biomedical literature from medline, life science journals, and online books. The role of imaging in aortic dissection and related. 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 the most common form of the acute aortic syndromes and a type of arterial dissection. Aortic emergencies ucsf emergency medicine ultrasound. The dissection occurs when there is a weakening of the trilaminar aortic wall such that the intima is disrupted and the flow of high pressure blood then strips that layer from the media layer. Type a aortic dissection taad is a complex cardiovascular disease that is associated with high perioperative morbidity and mortality. Medical management if not complicated type b complications.
Types of aortic dissections university of michigan. Volume 15, number 12 to acute aortic syndromes author. Discuss the definition and causes of an aorticthoracic aneurysm 2. Aortic dissection presenting as ischemic limb a 40yearold man with a history of hypertension and alcohol abuse presented with acute onset of mild chest tightness, left leg pain, and increasing agitation, which prevented us from obtaining additional meaningful information from him. While mfs commonly leads to aortic root aneurysm and descending thoracic aortic aneurysms, the presence of an abdominal aortic aneurysm aaa and abdominal aortic dissection is rarely reported 3, 4, 79. Eagle, md,x valentin fuster, md, phd abstract aortic dissection is the most devastating complication of thoracic aortic disease. We used data from our registry of acute aortic dissection patients to better understand the relationship between aortic diameter and type a dissection. Aortic dissection michigan medicine university of michigan. Case report acute aortic dissectioninduced paraplegia and.
Methods and resultswe examined 591 type a dissection patients enrolled in the international registry of acute aortic dissection between 1996 and 2005 mean age, 60. Aortic dissection identify patients at risk evaluation pathway aod ep. Aortic dissection diagnosis and treatment mayo clinic. Delay in diagnosis and surgical treatment is associated with increased mortality 2,6. Structure and function of the aorta in inherited and congenital heart. Management of acute aortic dissection christoph a nienaber, rachel e clough 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. Surgical management and outcomes of type a dissectionthe. Dissection of descending aorta dissection of ascending aorta heart aortic arch right left aortic dissection blood flow cross section of dissection true. Treatment for type a aortic dissection may include.
To view these files please visit the journal online. Aortic dissection may occur in any location along the aorta and therefore the range of presentations is broad. The objective of this study was to evaluate the evolution of surgical approach and outcomes of acute aortic dissection in realworld practice by using a regional database. Regional practice patterns and outcomes of surgery for. Rare but we should think about it most days because the inhospital mortality is 27% increasing by 1% per hour that we miss the diagnosis because it is very rare it means that it is hard to have a reliable decision rule. Ct, tee and mri are the most reliable methods to diagnose ad. Get a printable copy pdf file of the complete article 6. These reports about changing practice patterns and improving outcomes are mostly limited to singlecenter and highvolume aortic centers. I had been having a lot of body aches and shortness of breath which is not uncommon for my once a year brush with bronchitis. An aortic dissection is a serious condition in which the inner layer of the aorta, the large blood vessel branching off the heart, tears. Normally, the aortic valve has three flaps controlling blood flow, but a person with a bicuspid aortic valve has only two flaps. It occurs when blood enters the medial layer of the aortic wall through a tear or penetrating ulcer in the intima and tracks along the media, forming a second bloodfilled channel within the wall. If the aortic valve leaks as a result of the damaged aorta, it may be replaced at the. Aortic dissection and malperfusion syndrome aortic dissection is most often associated with acute onset of sharp chest pain and upper back pain.
Aortic dilatation in patients with bicuspid aortic valve. Aortic dissection university of wisconsin hospital and. Aortic arch aortic dissection university of michigan. Surgeons remove as much of the dissected aorta as possible, block the entry of blood into the aortic wall and reconstruct the aorta with a synthetic tube called a graft. Aortic aneurysm and acute aortic syndrome are not uncommon conditions. Guidelines for the diagnosis and management of patients with. To further complicate matters, he was diagnosed with a bicuspid aortic valve, a defect in the hearts aortic valve that is present at birth. An aortic dissection is a tear that occurs between the innermost and middle layers of the aorta.
Desai md phd codirector, penn thoracic aortic surgery. Abdominal aortic dissection can present with abdominal pain radiating to the flank or back. Aortic dissection columbia university department of surgery. In most cases, this is associated with a sudden onset of severe chest or back pain, often described as tearing in character. They have the advantage of using standard, offtheshelf materials and being technically less. Fulton the cleveland clinic foundation, departments of vascular surgery and biomedical engineering, 9500 euclid ave s40, cleveland, oh 44195, usa aortic dissection is a complex manifestation of disease of the arterial wall. The aortic root comprises the aortic sinuses, aortic valve, and coronary ostia. Risk factors for aortic dissection conditions associated with medial degeneration marfans, loesdietz, bav, familial aneursm, etc 1119% of patients with aneurysm or dissection have 1st degree relative with aneurysm or dissection conditions that increase wall stress hypertension pregnancy cocaine use weight lifting. Vascular conditions by category, with tier class category.
Up to 20% of patients with infrarenal aaas have a family history of aaas, suggesting there is a likely inherited component. Aortic dissection occurs when a tear occurs in the inner muscle wall lining of the aorta, allowing blood to split apart the muscle layers of the aortic wall symptoms of aortic dissection include a tearing or ripping pain in the chest, sweating, nausea, shortness of breath, weakness, or syncope. If the bloodfilled channel ruptures through the outside aortic wall, aortic dissection is often fatal. Aortic dissection is a potentially lifethreatening diagnosis, and it requires a heightened suspicion. Feb 23, 2020 while mfs commonly leads to aortic root aneurysm and descending thoracic aortic aneurysms, the presence of an abdominal aortic aneurysm aaa and abdominal aortic dissection is rarely reported 3, 4, 79. Regional practice patterns and outcomes of surgery for acute. Percentage type i 1015% il 2530% debakey ill stanford b distal stanford a proximal tear intima onset of dissect ion ion of dissection progr esslon of d ssection. Consider acute aod in all patients presenting with. Aortic dissection, axial views aortic dissection, sagittal views intramural hematoma type b lesions e f a,typeaaorticdissection,axial contrastenhancedcomputed tomographyctatthelevelofthe pulmonaryarterybifurcation starfalselumen. Pdf acute aortic dissection is one of the most rapidly fatal clinical entities that can be encountered in the emergency department setting. Symptomatic nonaortic intraabdominal aneurysm 3 do not postpone asymptomatic nonaortic intraabdominal aneurysm 2a consider postponing aortic dissection acute aortic dissection with rupture or malperfusion 3 do not postpone aortic emergency nos aef with septichemorrhagic shock, or signs of impending rupture 3 do not postpone. The dissection may occur anywhere along the aorta and. Aortic dissection in pregnancy is a rare but lethal catastrophe. Symptoms vary according to where the dissection occurs and progresses to.
Caring for women with connective tissue disorders 1 define a connective tissue disorder and medical implications and diagnosis of marfan and loeysdietz syndrome. 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. B,typebaortic dissection,axialcontrastenhanced ctatthelevelofthecarina starfalselumen. An aortic dissection is often a complication of a bicuspid aortic valve. Type a dissections are an emergency and typically require surgical intervention, while type b dissections may be managed without surgery by carefully controlling blood pressure. My aortic dissection and current recovery walts journey. Aortic dissection university of wisconsin hospital and clinics. Using the national inpatient sample files from 2012, hospitals performing transfemoral tftavi and transapical tatavi were. Aortic dissections occur in approximately 3 per 100,000 patients per year. The most effective approach is still being debatedsuch as the best cannulation technique, and conservative versus extensive initial surgery. Aortic dissection lentiginosis genetic and rare diseases. Below is a brief overview of aortic dissection and its risk factors. 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 dissection may occur anywhere along the aorta and extend proximally or distally into other arteries. Five of 7 aortic dissections, including all 3 type b, and the coronary dissection 75% of all dissections occurred in the postpartum period. Unfortunately, the diagnosis of aortic dissection in the emergency department ed is missed 16% to 38% of the time. Rare but we should think about it most days because the inhospital mortality is 27% increasing by 1% per hour that we miss the diagnosis because it is very rare it means that it is hard to have a reliable decision rule or single clinical test that rules out the disease. Collective efforts from different groups in the last 20 years have aimed to improve outcomes, but there are still many aspects in its management that have yet to be agreed upon 7,8.
The objective of this study was to evaluate the evolution of surgical approach and outcomes of acute aortic dissection in realworld practice by. The pressure of the blood pumping through it causes the weakened section to bulge out like a balloon. Focused bedside pretest risk assessment for acute aod. Genetic and rare diseases information center gard po box 8126, gaithersburg, md 208988126 tollfree. Aortic dissection michigan college of emergency physicians. Uchino g, yunoki k, sakoda n, hattori s, kawabata t, saiki m, fujita y, hisamochi k, yoshida h, oba o. Ascending aortic dissection remains one of the most catastrophic emergencies amongst cardiovascular diseases 15. If the dissection interrupts blood supply to the brain, the patient may suffer a stroke. If you have problems viewing pdf files, download the latest version of adobe reader. The intimal tear may be a primary event or secondary to hemorrhage within the media. An aortic dissection is classified as type a if it occurs in the ascending portion of the aorta, or type b if it occurs in the descending portion of the aorta.
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