Aortic Dissection

DeSanctis, Roman W.; Doroghazi, Robert M.; Austen, W. Gerald; Buckley, Mortimer J.

doi:10.1056/nejm198710223171705

Cited by 370 publications

(188 citation statements)

References 69 publications

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“…Although retrograde AD occurs more commonly than is generally realized, 3,6,7,9,17,18 there are few reports about natural history and specific therapeutic problems of patients with retrograde AD. [3][4][5]9 The precise clinical, aortographic, and pathologic features of 6 patients who presented with acute retrograde dissection of the ascending aorta was reported by Cipiriano et al 3 They recommended early surgery for these patients with retrograde AD.…”

Section: Discussionmentioning

confidence: 99%

Prognosis of Retrograde Dissection From the Descending to the Ascending Aorta

Kaji

Katayama²,

Yamamuro³

et al. 2003

Circulation

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Background-Natural history of aortic dissection (AD) with intimal tear in the descending or abdominal aorta and retrograde extension into the ascending aorta (retrograde AD) remains unknown. The purpose of this study was to elucidate medium-term prognosis of patients with retrograde AD. Methods and Results-Study population consisted of 109 patients with acute type A AD. There were 27 patients (25%) with retrograde AD and 82 patients (75%) with intimal tear in the ascending aorta (antegrade AD). In antegrade AD patients, 60 patients underwent surgery and 22 patients were treated medically. In retrograde AD patients, 14 patients showed localized crescentic high attenuation area along the ascending aortic wall without enhancement in computed tomography. Transesophageal echocardiography revealed complete thrombosis of false lumen (FL) in the ascending aorta (retrograde thrombosed). The remaining 13 patients showed incomplete or no thrombosis (retrograde nonthrombosed). All retrograde nonthrombosed AD patients underwent surgery except for 1 patient with stroke, whereas all retrograde thrombosed AD patients were treated medically. In-hospital mortality rate of retrograde AD patients was significantly lower than that of antegrade AD patients (15% versus 38%, Pϭ0.027). The survival rates in retrograde AD patients were all 85% at 1, 2, and 5 years, which were significantly higher than those of antegrade AD patients (63%, 62%, and 57%, respectively)(Pϭ0.009). Conclusions-Patients

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Section: Discussionmentioning

confidence: 99%

Prognosis of Retrograde Dissection From the Descending to the Ascending Aorta

Kaji

Katayama²,

Yamamuro³

et al. 2003

Circulation

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“…Stroke is less common (21%), and presentation with an ischemic leg or peripheral ischemic neuropathy is encountered on occasion. [2][3][4]8,13,66,68,69 Patients with uncomplicated type B dissection have a 30-day mortality rate of 10% 3 ( Figure 4). Conversely, those who develop an ischemic leg, renal failure, visceral ischemia, or contained rupture often require urgent aortic repair; their mortality rate is 20% by day 2 and 25% by day 30.…”

Section: Type B (Distal) Dissectionmentioning

confidence: 99%

“…Despite recent progress in recognition of both the epidemiological problem and diagnostic and therapeutic advances, the cardiology community and the medical community in general are far from comfortable in understanding the spectrum of aortic syndromes and defining an optimal pathway to manage aortic diseases. [1][2][3][4][5][6][7][8][9][10][11][12][13] This comprehensive review is organized in two parts, with a focus on the etiology, natural history, and classification (with vascular staging) of aortic wall disease in Part I and emphasis on therapeutic management and follow-up in Part II. Both parts may help to better integrate the complexities of acute aortic syndromes.…”

mentioning

confidence: 99%

Aortic Dissection: New Frontiers in Diagnosis and Management

2003

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“…[1][2][3] Although there is consensus about the definition and treatment of classic AD, 1,4 the approach to acute intramural hematoma (IMH) of the aorta remains elusive. 5 Much of the controversy stems from an incomplete knowledge of its natural history.…”

mentioning

confidence: 99%

Acute Intramural Hematoma of the Aorta

Evangelista¹,

Mukherjee²,

Mehta³

et al. 2005

Circulation

442

183

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Background-The definition, prevalence, outcomes, and appropriate treatment strategies for acute intramural hematoma (IMH) continue to be debated. Methods and Results-We studied 1010 patients with acute aortic syndromes who were enrolled in the International Registry of Aortic Dissection (IRAD) to delineate the prevalence, presentation, management, and outcomes of acute IMH by comparing these patients with those with classic aortic dissection (AD). Fifty-eight (5.7%) patients had IMH, and this cohort tended to be older (68.7 versus 61.7 years; PϽ0.001) and more likely to have distal aortic involvement (60.3% versus 35.3%; PϽ0.001) compared with 952 patients with AD. Patients with IMH described more severe initial pain than did those with AD but were less likely to have ischemic leg pain, pulse deficits, or aortic valve insufficiency; moreover, they required a longer time to diagnosis and more diagnostic tests. Overall mortality of IMH was similar to that of classic AD (20.7% versus 23.9%; Pϭ0.57), as was mortality in patients with IMH of the descending aorta (8.3% versus 13.1%; Pϭ0.60) and the ascending aorta (39.1% versus 29.9%; Pϭ0.34) compared with AD. IMH limited to the aortic arch was seen in 7 patients, with no deaths, despite medical therapy in only 6 of the 7 individuals. Among the 51 patients whose initial diagnostic study showed IMH only, 8 (16%) progressed to AD on a serial imaging study. Conclusions-The IRAD data demonstrate a 5.7% prevalence of IMH in patients with acute aortic syndromes. Like classic AD, IMH is a highly lethal condition when it involves the ascending aorta and surgical therapy should be considered, but this condition is less critical when limited to the arch or descending aorta. Fully 16% of patients have evidence of evolution to dissection on serial imaging.

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Aortic Dissection

Cited by 370 publications

References 69 publications

Prognosis of Retrograde Dissection From the Descending to the Ascending Aorta

Prognosis of Retrograde Dissection From the Descending to the Ascending Aorta

Aortic Dissection: New Frontiers in Diagnosis and Management

Acute Intramural Hematoma of the Aorta

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