Acute dissecting aneurysms of the aorta: diagnosis and treatment—1979

Wheat, Myron W.

doi:10.1016/0002-8703(80)90353-1

Cited by 150 publications

(44 citation statements)

References 37 publications

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“…[1][2][3] Although aortic dissection was first described in the 18th century, 1 interest in this disorder has heightened recently because of major diagnostic and therapeutic advances. 4 -15 These developments have resulted in earlier recognition; more accurate diagnosis in an emergency situation; refined surgical, interventional, and medical treatment; and as a consequence, improved outcomes.…”

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confidence: 99%

Gender-Related Differences in Acute Aortic Dissection

et al. 2004

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Background-Few data exist on gender-related differences in clinical presentation, diagnostic findings, management, and outcomes in acute aortic dissection (AAD). Methods and Results-Accordingly, we evaluated 1078 patients enrolled in the International Registry of Acute Aortic Dissection (IRAD) to assess differences in clinical features, management, and in-hospital outcomes between men and women. Of the patients enrolled in IRAD (32.1%) with AAD, 346 were women. Although less frequently affected by AAD (32.1% of AAD), women were significantly older and had more often presented later than men (Pϭ0.008); symptoms of coma/altered mental status were more common, whereas pulse deficit was less common. Diagnostic imaging suggestive of rupture, ie, periaortic hematoma, and pleural or pericardial effusion were more commonly observed in women. In-hospital complications of hypotension and tamponade occurred with greater frequency in women, resulting in higher in-hospital mortality compared with men. After adjustment for age and hypertension, women with aortic dissection die more frequently than men (OR, 1.4, Pϭ0.04), predominantly in the 66-to 75-year age group. Moreover, surgical outcome was worse in women than men (Pϭ0.013); type A dissection in women was associated with a higher surgical mortality of 32% versus 22% in men despite similar delay, surgical technique, and hemodynamics. Conclusions-Our analysis provides insights into gender-related differences in AAD with regard to clinical characteristics, management, and outcomes; important diagnostic and therapeutic implications may help shed light on aortic dissection in women to improve their outcomes.

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Gender-Related Differences in Acute Aortic Dissection

et al. 2004

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“…[1][2][3][4] Distal or descending thoracic aortic dissection generally is associated with better survival compared with that involving the ascending aorta. 5,6 The introduction of newer management strategies that have shown the potential to improve outcomes has reduced the role of surgery to Ϸ15% of cases.…”

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Role and Results of Surgery in Acute Type B Aortic Dissection

et al. 2006

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are often reported for those in small series or for those cared for at a single institution over a long time period, during which a continuous evolution in techniques has occurred. Accordingly, we sought to evaluate the clinical features and surgical results of patients enrolled in the International Registry of Acute Aortic Dissection by identifying primary factors that influenced surgical outcome and estimating average surgical mortality for ABAD in the current era. Methods and Results-A comprehensive analysis of 290 clinical variables and their relation to surgical outcomes for 82 patients who required surgery for ABAD (from a population of 1256 patients; meanϮSD age, 60.6Ϯ15.0 years; 82.9% male) and who were enrolled in the International Registry of Acute Aortic Dissection was performed. The overall in-hospital mortality was 29.3%. Factors associated with increased surgical mortality based on univariate analysis were preoperative coma or altered consciousness, partial thrombosis of the false lumen, evidence of periaortic hematoma on diagnostic imaging, descending aortic diameter Ͼ6 cm, right ventricle dysfunction at surgery, and shorter time from the onset of symptoms to surgery. Factors associated with favorable outcomes included radiating pain, normotension at surgery (systolic blood pressure 100 to 149 mm Hg), and reduced hypothermic circulatory arrest time. The 2 independent predictors of surgical mortality were age Ͼ70 years (odds ratio, 4.32; 95% confidence interval, 1.30 to 14.34) and preoperative shock/hypotension (odds ratio, 6.05; 95% confidence interval, 1.12 to 32.49). Conclusions-The

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“…[1][2][3][4] Advances in the understanding of this disease have established that lesions limited to the descending aorta (type B) generally have better survival compared with those involving the ascending aorta. 5,6 Introduction of newer diagnostic techniques and management strategies have shown potential to improve diagnosis and management.…”

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confidence: 99%

Clinical Profiles and Outcomes of Acute Type B Aortic Dissection in the Current Era: Lessons From the International Registry of Aortic Dissection (IRAD)

et al. 2003

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Background-Clinical profiles and outcomes of patients with acute type B aortic dissection have not been evaluated in the current era. Methods and Results-Accordingly, we analyzed 384 patients (65Ϯ13 years, males 71%) with acute type B aortic dissection enrolled in the International Registry of Acute Aortic Dissection (IRAD). A majority of patients had hypertension and presented with acute chest/back pain. Only one-half showed abnormal findings on chest radiograph, and almost all patients had computerized tomography (CT), transesophageal echocardiography, magnetic resonance imaging (MRI), and/or aortogram to confirm the diagnosis. In-hospital mortality was 13% with most deaths occurring within the first week. Factors associated with increased in-hospital mortality on univariate analysis were hypotension/ shock, widened mediastinum, periaortic hematoma, excessively dilated aorta (Ն6 cm), in-hospital complications of coma/altered consciousness, mesenteric/limb ischemia, acute renal failure, and surgical management (all PϽ0.05). A risk prediction model with control for age and gender showed hypotension/shock (odds ratio [OR] 23.8, PϽ0.0001), absence of chest/back pain on presentation (OR 3.5, Pϭ0.01), and branch vessel involvement (OR 2.9, Pϭ0.02), collectively named 'the deadly triad' to be independent predictors of in-hospital death. Conclusions-Our study provides insight into current-day profiles and outcomes of acute type B aortic dissection. Factors associated with increased in-hospital mortality ("the deadly triad") should be identified and taken into consideration for risk stratification and decision-making.

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Acute dissecting aneurysms of the aorta: diagnosis and treatment—1979

Cited by 150 publications

References 37 publications

Gender-Related Differences in Acute Aortic Dissection

Gender-Related Differences in Acute Aortic Dissection

Role and Results of Surgery in Acute Type B Aortic Dissection

Clinical Profiles and Outcomes of Acute Type B Aortic Dissection in the Current Era: Lessons From the International Registry of Aortic Dissection (IRAD)

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