Acute Aortic Dissection in the Emergency Department: Diagnostic Challenges and Evidence-Based Management

Upadhye, Suneel; Schiff, Karen

doi:10.1016/j.emc.2011.12.001

Cited by 22 publications

(28 citation statements)

References 70 publications

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“…Although there is more than one classification system, the Stanford system classifies by anatomical location and extent of dissection into types A or B (Scaglione et al, 2008;Steuer, Eriksson, Nyman, Björck, & Wanhainen, 2011). This system is preferred by many emergency medicine (EM) physicians and surgeons as a simple guide to whether urgent surgical treatment is needed (Golledge & Eagle, 2008;Upadhye & Schiff, 2012).…”

Section: Aortic Dissection Classification Systemmentioning

confidence: 99%

“…It is designed to present an unbiased representative population of patients and currently has data on 1,600 acute AD cases. Data from a questionnaire that includes 290 variables designed by IRAD investigators are used for analysis, and many of the samples in the studies referenced have come from this registry (Hagan et al, 2000;Upadhye & Schiff, 2012).…”

Section: International Aortic Dissection Registry Databasementioning

confidence: 99%

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Acute Aortic Emergencies—Part 2 Aortic Dissections

White

Broder

Mando‐Vandrick

et al. 2013

Advanced Emergency Nursing Journal

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Patients with aortic disease are some of the highest acuity patients that emergency clinicians encounter. Dissection is the most common aortic catastrophe and involves separation of the aortic layers in a longitudinal fashion leading to diminished perfusion and systemic ischemia. Characteristics of pain, branch vessel involvement, and incidence lead to an understanding of patient presentation, morbidity, and mortality. Diagnosis, selection of diagnostic studies, the degree of preoperative ischemia, and risk of operative mortality can be accomplished using validated clinical decision tools. Emergency interventions are guided by the type of dissection according to the Stanford classification system. Medical management includes pain control and anti-impulse, antihypertensive therapy through vasodilatation and blockage of the sympathetic β-response. The patient may then be evaluated for open surgical intervention, aortic fenestration, endovascularly placed stent grafts, or a combination possibly in a staged approach. Morbidity includes rupture, stroke, paraplegia, acute renal failure, bowel ischemia, and peripheral ischemia.

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Section: Aortic Dissection Classification Systemmentioning

confidence: 99%

Section: International Aortic Dissection Registry Databasementioning

confidence: 99%

Acute Aortic Emergencies—Part 2 Aortic Dissections

White

Broder

Mando‐Vandrick

et al. 2013

Advanced Emergency Nursing Journal

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“…The initial pain of aortic dissection may be followed by a pain-free interval lasting from hours to days and then pain returns, is an ominous sign of impending rupture [48]. About 4% of acute dissections may be painless especially in diabetes and older individuals, making a delay in diagnosis [49]. Pulse deficits were reported in <20% of patients with aortic dissection (50% in proximal and 15% in distal dissections).…”

Section: Clinical Perspectivesmentioning

confidence: 99%

Proximal Aortic Dissection with Rupture into the Main Pulmonary Artery—A Case Report

Muthiah¹

2017

CRCM

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Aim: To present a rare occurrence of aortopulmonary fistula due to rupture of proximal aortic dissection in a 48-year-old woman. Introduction: Aortic dissection is defined as disruption of the medial layer provoked by intramural bleeding, resulting in separation of aortic wall layers and subsequent formation of a true lumen and a false lumen with or without communication. Case Report: A 48-year-old female presented with vague anterior chest discomfort, high blood pressure, systolic-diastolic murmur in the left sternal border with ECG changes of myocardial ischemia. Echocardiography revealed a dilated aortic root with intimal flaps, a leak into the pulmonary artery and regional hypokinesis with contractile dysfunction suggesting a proximal aortic dissection with rupture into the main pulmonary artery. Discussion: The etiology of aortic dissection was mostly hypertension in 80% of cases and aortopathies such as connective tissue disorders, inflammatory and idiopathic. Aortic wall stress is a major trigger of intimal tear and two-dimensional transthoracic echocardiography is an excellent, initial diagnostic gold standard to detect the dissecting flaps, especially in proximal aortic dissection. Conclusion: Blood pressure control is the mainstay of treatment and urgent surgery is indicated in proximal aortic dissection since there is higher chance of rupture with an increase in mortality.

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“…Type A dissections require urgent surgical repair, as they have a mortality rate over 50% within 48 hours if untreated (32,34). Conversely, type B dissections are generally managed conservatively, with follow-up examinations every three to six months (35).…”

Section: Vessels Thoracic Aortic Aneurysmmentioning

confidence: 99%

“…This creates a "false lumen" that is separated from the "true lumen" by an intimal flap. According to the Stanford classification, dissections of the ascending aorta are categorized as type A and account for 62% of cases, whereas dissections of the descending aorta are categorized as type B and account for 38% of cases (32,35). Type A dissections require urgent surgical repair, as they have a mortality rate over 50% within 48 hours if untreated (32,34).…”

Section: Vessels Thoracic Aortic Aneurysmmentioning

confidence: 99%