Dissection of the aorta: Pathogenesis, diagnosis, and treatment

Dalen, James E.; Pape, Linda; Cohn, Lawrence H.; Koster, J. Kenneth; Collins, John J.

doi:10.1016/0033-0620(80)90023-7

Cited by 36 publications

(9 citation statements)

References 25 publications

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“…Although the mechanisms by which smoking may predispose to aortic dissection are not well known, cigarette smoking is associated with increased oxidative stress [33] and induces endothelial damage [34,35], which may lead to aneurysm expansion, accelerate atheropoiesis, and aggravate hypertension, leading to aortic dissection. It is well known that dissection of the descending aorta is more likely to be associated with atherosclerosis than that of the ascending aorta [3][4][5][6][7]. In this regard, it may be interesting to note that the prevalence of smoking was higher in type B dissection than in type A dissection (see Table 2).…”

Section: Resultsmentioning

confidence: 94%

“…Atherosclerosis is considered not to be an important cause of aortic dissection of the ascending aorta where atherosclerosis is usually minimal [3][4][5][6][7]. Furthermore, dissection rarely begins in the abdominal aorta where atherosclerosis is most common [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…Aging also leads to degenerative destruction of the elastic tissue and smooth muscle cells, which compose the aortic media [1]. Besides, Marfan's and Ehlers-Danlos syndromes [2,3] are well-known risk factors, as they are marked by degenerative changes in elastic fibers of the media. In addition, iatrogenic vascular trauma during cardiac catheterization, cardiopulmonary bypass or intraaortic balloon counter pulsation may occasionally lead to aortic dissection [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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A case–control study found that low albumin and smoking were associated with aortic dissection

Takeuchi

Adachi

Ohuchida

et al. 2004

Journal of Clinical Epidemiology

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Section: Resultsmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A case–control study found that low albumin and smoking were associated with aortic dissection

Takeuchi

Adachi

Ohuchida

et al. 2004

Journal of Clinical Epidemiology

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“…Several postmortem examinations support that atherosclerosis may be not an important cause of type A aortic dissection, in which atherosclerotic lesions are usually minimal and the prevalence of dissection high. [107][108][109][110][111] Furthermore, dissection rarely begins in the abdominal aorta, which is where atherosclerosis is most common. A case -control study in a Japanese population found that smoking and hypoalbuminemia in addition to hypertension were significantly associated with both type A and type B aortic dissection (p<0.001).…”

Section: Smoking and Aortic Dissectionmentioning

confidence: 99%

Smoking and Aortic Diseases

Kakafika

Mikhailidis

2007

Circ J

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Cigarette smoking is a major cause of cardiovascular disease (CVD) and is responsible for approximately 11% of the annual total CVD deaths in the United States. 1 Smoking acts synergistically with other vascular risk factors (eg, hypertension, dyslipidaemia and diabetes) to increase vascular morbidity and mortality. 2 However, smoking has a variable magnitude of increased risk for different vascular diseases: the risk is highest for peripheral arterial disease and aortic aneurysm, and is lowest for coronary artery and cerebrovascular diseases. 2 These effects are thought to reverse after smoking cessation. The constituents of cigarette smoke with the major contribution to pathogenesis of vascular disease are nicotine, carbon monoxide, oxidant gases and polycyclic aromatic hydrocarbons. 2 Nonsmokers who are exposed to "secondhand" smoke experience on average a 30% excess risk of ischemic heart disease and nonfatal myocardial infarction. 3 Secondhand smoke exposure has been shown to activate platelets and to produce endothelial dysfunction, in both experimental animals and humans. 3 The mechanisms by which smoking causes acute cardiovascular events include endothelial dysfunction, thrombosis and inflammation.Endothelial dysfunction is an initiating event in atherogenesis, as well as a major factor in causing acute cardiovascular events. Cigarette smoking impairs flow-mediated endothelium-dependent peripheral arterial vasodilatation, an effect that is, at least partly, reversible after smoking Circulation Journal Vol.71, August 2007 cessation. 4 Smokers without atherosclerosis have coronary vasoconstrictor responses to acetylcholine that, in the presence of normal endothelium, produce vasodilatation. 5 Indeed, the oxidant chemicals of smoke degrade nitric oxide (NO) and reduce NO release, with subsequent impairment of vascular dilation and platelet function. 2 Smokers have lower than normal levels of antioxidant vitamins, reflecting their consumption in response to ongoing oxidant stress. 6 In addition, nicotine itself alters the structural and functional characteristics of vascular smooth muscle cells (VSMC) and endothelial cells. 7,8 Experimental data show that human aortic endothelial cells undergo apoptotic changes when they are exposed to cigarette smoke extracts. 9 This process may be prevented by pre-activation of NO synthase by Larginine. 9,10 Furthermore, smoking causes an increase in vascular superoxide production, which results in decreased NO bioactivity and concomitantly increases production of vasoconstrictor eicosanoids. 11 Cigarette smoke extracts, but not nicotine, also inhibit prostacyclin (PGI2: a vasodilator and inhibitor of platelet aggregation) synthesis in human, rabbit and rat vascular tissue. 12 Smoking-mediated endothelial dysfunction also results in reduced secretion of tissue plasminogen activator (tPA) 13 and increased secretion of plasminogen activator inhibitor (PAI)-1, 1 which results in impaired fibrinolysis. This acts in concert with the increased levels of tissue factor and fibrin...

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“…Dissection of the intima from the rest of the wall may follow an intimal tear and eventually lead to rupture. These instances are associated usually with hypertension and frequently not preceded by an aneurysm 7,8 . Finally, trauma such as deceleration injuries from motor vehicle accidents may lead to rupture in the absence of antecedent disease 2,4 .…”

mentioning

confidence: 99%

Spontaneous Rupture of the Thoracic Aorta

Kinzel

1986

J American Geriatrics Society

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Rupture of the aorta is usually a complication of aneurysm formation associated with atherosclerosis.1–5 Rupture also may be associated with cystic medial necrosis and Marfan's syndrome, aortitis, mycotic infection, or syphilis. In these instances, rupture usually is preceded by aneurysm.2,4,5 In children and adolescents, coarctation of the aorta may lead to aneurysm formation and rupture.6 Dissection of the intima from the rest of the wall may follow an intimal tear and eventually lead to rupture. These instances are associated usually with hypertension and frequently not preceded by an aneurysm.7,8 Finally, trauma such as deceleration injuries from motor vehicle accidents may lead to rupture in the absence of antecedent disease.2,4 This report is of an elderly man with the unusual occurrence of rupture of the aorta unassociated with aneurysm, dissection, or trauma.

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Dissection of the aorta: Pathogenesis, diagnosis, and treatment

Cited by 36 publications

References 25 publications

A case–control study found that low albumin and smoking were associated with aortic dissection

A case–control study found that low albumin and smoking were associated with aortic dissection

Smoking and Aortic Diseases

Spontaneous Rupture of the Thoracic Aorta

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