Aortic dissection: medical, interventional and surgical management

Silaschi, Miriam; Byrne, Jonathan; Wendler, Olaf

doi:10.1136/heartjnl-2015-308284

Cited by 66 publications

(59 citation statements)

References 52 publications

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“…Aortic dissection is an aggressive vascular disease with high mortality and poor prognosis [1,2] . Usually, aortic dissection is initiated by an intimal tear, which further results in blood flow into extracellular matrix.…”

Section: Introductionmentioning

confidence: 99%

Macrophage metabolic reprogramming aggravates aortic dissection through the HIF1α-ADAM17 pathway✰

Lian

Zhang

et al. 2019

eBioMedicine

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Background: Aortic dissection is a severe inflammatory vascular disease with high mortality and limited therapeutic options. The hallmarks of aortic dissection comprise aortic inflammatory cell infiltration and elastic fiber disruption, highlighting the involvement of macrophage. Here a role for macrophage hypoxiainducible factor 1-alpha (HIF-1 α) in aortic dissection was uncovered.Methods: Immunochemistry, immunofluorescence, western blot and qPCR were performed to test the change of macrophage HIF-1 α in two kinds of aortic dissection models and human tissues. Metabolomics and Seahorse extracellular flux analysis were used to detect the metabolic state of macrophages involved in the development of aortic dissection. Chromatin Immunoprecipitation (ChIP), enzyme-linked immunosorbent assay (ELISA) and cytometric bead array (CBA) were employed for mechanistic studies. Findings: Macrophages involved underwent distinct metabolic reprogramming, especially fumarate accumulation, thus inducing HIF-1 α activation in the development of aortic dissection in human and mouse models. Mechanistic studies revealed that macrophage HIF-1 α activation triggered vascular inflammation, extracellular matrix degradation and elastic plate breakage through increased a disintegrin and metallopeptidase domain 17 (ADAM17), identified as a novel target gene of HIF-1 α. A HIF-1 α specific inhibitor acriflavine elicited protective effects on aortic dissection dependent on macrophage HIF-1 α. Interpretation: This study reveals that macrophage metabolic reprogramming activates HIF-1 α and subsequently promotes aortic dissection progression, suggesting that macrophage HIF-1 α inhibition might be a potential therapeutic target for treating aortic dissection.

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Section: Introductionmentioning

confidence: 99%

Macrophage metabolic reprogramming aggravates aortic dissection through the HIF1α-ADAM17 pathway✰

Lian

Zhang

et al. 2019

eBioMedicine

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“…Among the 7 cases of isolated abdominal aortic dissection complicating Takayasu disease reported in the literature, only 1 patient is surgically treated considering ischemic lesions [8] . The endovascular treatment is still a useful alternative applied in simple cases, especially on the descending aorta, with a good prognosis in the short and medium-term [6 , 8 , 12] .…”

Section: Discussionmentioning

confidence: 99%

Chronic dissection of the abdominal aorta as a rare complication of Takayasu disease

Echchikhi

Hatim

Sergio

et al. 2020

Radiology Case Reports

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Takayasu's arteritis exposes to complications of varying severity, such as arterial stenosis, thrombosis, and more rarely aneurysms. Aortic dissection is a rare complication of Takayasu's disease, reported in few times in the literature, only 7 of which concern the abdominal aorta. We report the case of a 41-year-old woman followed for Takayasu disease for 15 years, who presented an asymptomatic and chronic dissection of the abdominal subrenal aorta. The patient underwent conservative medical treatment. After a follow-up of 17 months, the aortic dissection was still asymptomatic, with a stable appearance on follow-up imaging. To our knowledge, this is the first case report of asymptomatic aortic dissection as a rare complication of Takayasu disease.

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“…AD is a much-feared clinical presentation with a high mortality rate, particularly if definitive treatment is delayed. 6 Many risk factors contribute to the development of AD, such as poorly controlled hypertension, Marfan syndrome, connective tissue disease, Ehlers-Danlos syndrome, history of cardiac surgery, and previous trauma. 6 Hyperhomocysteinemia is also a risk factor for AD, 7 as in our patient.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonographic detection of chronic type A aortic dissection extending to the right extracranial internal carotid artery: A case report

Sun

Dong

et al. 2019

J of Clinical Ultrasound

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We report the case of a patient with chronic type A aortic dissection (AD), who had been admitted, 18 months ago, to another hospital with acute chest‐tearing pain accompanied with transient loss of consciousness. His symptoms resolved but he reported after discharge a toothache and fluctuating right mandibular pain. He presented to our outpatient clinic because his facial pain aggravated. Physical examination demonstrated a bruit over the right carotid artery. Transthoracic echocardiography and carotid sonography demonstrated aortic dissection extending into the extracranial right internal carotid artery (ICA), which was tortuous. The patient refused surgery. This case reminds us that AD can involve the extracranial ICA, and that long‐term survival is possible with type A acute AD without treatment. Carotid ultrasonography is noninvasive, inexpensive, easily performed, and can lead to the detection of chronic type A AD extending to the extracranial ICA.

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Aortic dissection: medical, interventional and surgical management

Cited by 66 publications

References 52 publications

Macrophage metabolic reprogramming aggravates aortic dissection through the HIF1α-ADAM17 pathway✰

Macrophage metabolic reprogramming aggravates aortic dissection through the HIF1α-ADAM17 pathway✰

Chronic dissection of the abdominal aorta as a rare complication of Takayasu disease

Ultrasonographic detection of chronic type A aortic dissection extending to the right extracranial internal carotid artery: A case report

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