Acute aortic syndromes: Role of multi-detector row CT

Sarchi, Luca; Renda, Pietro; Fiore, Davide; Scaglione, Mariano; Piccoli, GianPiero; Giovagnoni, Andrea

doi:10.1016/j.ejrad.2007.09.020

Cited by 64 publications

(29 citation statements)

References 66 publications

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“…CTA is considered the first-line diagnostic imaging modality. 226,234,[238][239][240] It is widely available, permits assessment of other thoracic structures, and provides 3D reconstructed images that are essential in planning surgery or TEVAR. Moreover, CT is superior to TEE for detecting small ulcers.…”

Section: Paumentioning

confidence: 99%

Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Goldstein

Evangelista

Abbara

et al. 2015

Journal of the American Society of Echocardiography

526

434

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Section: Paumentioning

confidence: 99%

Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Goldstein

Evangelista

Abbara

et al. 2015

Journal of the American Society of Echocardiography

526

434

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“…In addition to the reconstruction of a three-dimensional perspective, certain descriptive features of the thoracic aorta outlining the condition of the aortic wall (atheroma, calciication, and thrombus) as well as shape and size of the aortic pathology (diameter, length, and shape) need to be elucidated before the formulation of treatment strategies [19].…”

Section: Anatomical Measurements For Thoracic Aortic Pathologymentioning

confidence: 99%

Role of Interventional Treatment of Thoracic Aorta

Akın¹,

Ansari²,

Nienaber³

2017

Aortic Aneurysm

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An aging western and oriental population coupled with breakthrough advances in modern diagnostic imaging modalities has evoked renewed interest in the hitherto underdiagnosed acute and chronic diseases of the aorta, which also include aortic aneurysm and aortic dissection. Although classical surgical strategies still dominate the clinical management of acute and chronic pathologies of the ascending aorta and the proximal arch region, the emergence of novel endovascular concepts has ofered an interesting therapy alternative for the treatment of descending aortic pathology in suitable patients and is highly likely to evolve as the primary treatment strategy in majority of the cases. Moreover, the use of hybrid approaches combining surgical head-vessel debranching and interventional stent-graft implantation in an atempt to improve clinical outcome in aortic arch pathologies has helped avoid the high risk of open arch repair or complete replacement. Notwithstanding these recent advancements, the complex nature of the underlying vascular disease still dictates that the proposed management of every diagnosed patient is discussed in a team constituting cardiologists, cardiac surgeons, anesthesiologists, and radiologists, with the conceptualization of individualized therapeutic strategies and conducted in a center with signiicant surgical and endovascular experience.

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“…In-hospital rupture rates of 25% have been reported, with serial surveillance imaging estimating continuing aortic expansion rates of 0.4 cm per annum. Angiography is unlikely to yield a positive diagnosis in cases of intramural haematoma, with CT and MRA, providing the gold standard in imaging [9][10][11].…”

Section: Intramural Haematomasmentioning

confidence: 98%

Dissections of the Thoracic Aorta and Evolving Endovascular Strategies

Ali¹,

Sayers²,

Biasi³

et al. 2009

CHYR

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Acute dissection is the most common life threatening condition of the aorta affecting 5-30 per million people per year [1].Left untreated, the majority of patients with dissections involving the ascending aorta will die within days of an acute episode [2].Patients presenting with descending thoracic aortic dissections seem to fare better, with one in ten patients dying before leaving hospital. Ultimately, these patients are at risk of aortic rupture with nearly 20% of these patients requiring some form of surgical or endovascular intervention [3].Judicious medical, surgical and endovascular management of this condition aims to reduce propagation of the dissection plane and concomitant branch vessel compromise, halt aortic expansion and prevent fatal aortic rupture.Early recognition of these disease entities in conjunction with urgent and pertinent management is the key to a successful outcome in these patients. DEFINITIONAcute dissection results from sudden tear of the intima and separation of the layers within the aortic wall. This results in the longitudinal and spiralling flow of pulsatile blood between the inner and outer layers of the tunica media propagating the extent of dissection with the variable formation of both true and false lumina Fig. (1).Dynamic obstruction of the true lumen by the expanding false lumen will result in organ ischaemia unless spontaneous and adequate fenestration of the distal intimal flap does not occur [4]. Often these fenestrations can be found at the site of branched vessel ostia leaving the native aorta to supply target organs. Disruption of the intima here, often leads to invagination of the intima within the target vessel with static obstruction of laminar blood flow in the true lumen and the high probability of arterial thrombosis and end organ infarction. ACUTE AORTIC SYNDROMEIn addition to aortic dissections, two further aortic pathologies often encountered are penetrating aortic ulcers and intramural haematomas. Both these conditions are found in a more elderly hypertensive population in whom women predominate. Grouped together, the three pathologies have been coined the acute aortic syndrome and are representative of Fig. (1). Arch aortogram demonstrating true lumen collapse (T) and extraluminal expansion of false lumen (F) in a Stanford type B aortic dissection. The main communication between the true and the false lumens occurs immediately beyond the left subclavian artery (C).degenerative changes encountered in the atherosclerotic aortic wall. In comparison to acute aortic dissection, visceral and limb ischaemia do not appear to be a prevalent feature of either penetrating ulcers or intramural haematomas.

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Acute aortic syndromes: Role of multi-detector row CT

Cited by 64 publications

References 66 publications

Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Role of Interventional Treatment of Thoracic Aorta

Dissections of the Thoracic Aorta and Evolving Endovascular Strategies

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