Imaging and Surveillance of Chronic Aortic Dissection: A Scientific Statement From the American Heart Association

Fleischmann, Dominik; Afifi, Rana O.; Casanegra, Ana I.; Elefteriades, John A.; Gleason, Thomas G.; Hanneman, Kate; Roselli, Eric E.; Willemink, Martin J.; Fischbein, Michael P.

doi:10.1161/hci.0000000000000075

Cited by 43 publications

(66 citation statements)

References 205 publications

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“…Until recently, there were no guidelines or recommendations for imaging surveillance in patients with chronic aortic dissection. In a recent scientific statement from the American Heart Association, imaging and measurement techniques for patients with chronic aortic dissection are presented, while the need for standardized measurements and reporting for lifelong surveillance are clarified [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Chronic Thoracic Aortic Dissection: How to Treat, When to Intervene

Papakonstantinou

Benia

Polyzos

et al. 2022

Life

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Thoracic aortic dissection (AD) is associated with increased morbidity and mortality. Acute aortic syndrome is the first presentation of the disease in most cases. While acute AD management follows concrete guidelines because of its urgent and life-threatening nature, chronic AD is usually overlooked, although it concerns a wide spectrum of patients surviving an acute event. Acute AD survivors ultimately enter a chronic aortic disease course. Patients with chronic thoracic AD (CTAD) require lifelong surveillance and a proportion of them may present with symptoms and late complications demanding further surgical or endovascular treatment. However, the available data concerning the management of CTAD is sparse in the literature. The management of patients with CTAD is challenging as far as determining the best medical therapy and deciding on intervention are concerned. Until recently, there were no guidelines or recommendations for imaging surveillance in patients with chronic AD. The diagnostic methods for imaging aortic diseases have been improved, while the data on new endovascular and surgical approaches has increased significantly. In this review, we summarize the current evidence in the diagnosis and management of CTAD and the latest recommendations for the surgical/endovascular aortic repair of CTAD.

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Section: Introductionmentioning

confidence: 99%

Chronic Thoracic Aortic Dissection: How to Treat, When to Intervene

Papakonstantinou

Benia

Polyzos

et al. 2022

Life

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“…However, for some patients with type B aortic dissections, the disease presents sufficiently stable for a conservative, non-surgical approach [ 4 ]. In the scientific literature, dissections are referred to as “acute” within 14 days or less after dissection [ 5 ] and as “chronic” if 14 days or more have passed since dissection [ 6 ] with a refined classification distinguishing between a subacute period (15–90 days after dissection) and a chronic phase commencing 90 days after dissection [ 7 ]. Chronic dissections bear an impending risk for worsening and aortic rupture.…”

Section: Introductionmentioning

confidence: 99%

“…Chronic dissections bear an impending risk for worsening and aortic rupture. Lifelong monitoring is required [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Acute, Chronic, and Treated Aortic Diseases Present Distinguishable Serum Proteome Fingerprints with Protein Profiles That Correlate with Disease Severity

et al. 2022

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Aortic diseases are a rare but potentially life-threatening condition. We present a serum proteomic study for a spectrum of aortic diseases including thoracic aortic aneurysms (n = 11), chronic dissections (n = 9), acute aortic dissections (n = 11), and surgically treated dissections (n = 19) as well as healthy controls (n = 10) and patients of coronary heart disease (n = 10) to represent non-aortic cardiovascular disease. In total, we identified and quantified 425 proteins across all 70 samples. The different aortic diseases represented distinguishable proteome profiles. We identified protein clusters that positively or negatively correlate with disease severity, including increase of cytosolic tissue leakage proteins and decrease of components of the coagulation and complement system. Further, we identified a serum proteome fingerprint of acute aortic dissections, consisting, among others, of enriched inflammatory markers such as C-reactive protein and members of the S100 protein family. The study underlines the applicability of serum proteomics for the investigation of aortic diseases and highlights the possibility to establish disease-specific prognostic markers.

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“…To date there are no published studies focused specifically on small intimal flaps in asymptomatic patients and the natural history and clinical significance of such abnormalities is poorly understood. Given this lack of evidence, clinical management approaches can be highly variable ranging from being ignored to being treated as chronic dissections and surveilled by regular imaging ( 7 ). A recent study of 273 patients with asymptomatic PAUs undergoing imaging surveillance described a very low rate of growth or complications with such lesions ( 8 ), although a study of 315 patients with PAU including those symptomatic lesions described a comparatively higher rate of complications and surgical repair ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

Natural history and clinical significance of aortic focal intimal flaps

Maas

Bakel

Ahmed

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveFocal intimal flaps (FIF) are a variety of defects of the aorta that result in a short, flap-like projection into the lumen, and are often encountered in asymptomatic patients undergoing computed tomography angiography (CTA) surveillance for aortic aneurysm, but the natural history and clinical significance of such lesions has not yet been studied.MethodsWe retrospectively identified patients with an asymptomatic FIF and available imaging follow-up (>1 year). FIF was defined as flap-like intimal irregularity < 4 cm in length involving the thoracic aorta (TA), abdominal aorta (AA) or common iliac arteries (CIA). FIF characteristics included length and circumferential extent as well as the presence and size (width and depth) of associated penetrating aortic ulcers (PAUs). Patient characteristics, adverse events and history of surgical repair was determined by chart review. FIFs and associated PAUs were assessed for progression by comparing baseline and follow-up CTA studies.ResultsA total of 84 FIFs were identified in 77 patients. Average age was 69.2 ± 10.1 years, and 81% were male (81%). Common co-morbidities included: hypertension (78%), hyperlipidemia (68%), smoking (60%), coronary artery disease (41%), aortic aneurysm (34%), type II diabetes mellitus (27%) and prior cardiovascular surgery (25%). FIFs were most commonly located in the abdominal aorta (n = 50, 60%). Nearly all FIFs were associated with local atherosclerotic plaque (93%). Mean follow-up interval was 3.5 ± 2.6 years (259 cumulative follow-up years). Change in FIF length and local aortic diameter over follow-up were 0.7 ± 2.3 mm and 0.8 ± 1.1 mm, respectively. Nearly half (47%) of FIFs were associated with penetrating aortic ulcers (PAU) with baseline depth of 7.3 mm (IQR: 6.1–10.2) and change in depth of 0.5 ± 1.4 mm. Only 12% of FIFs and 0% of associated PAUs demonstrated growth (≥3 mm) at follow-up. No acute pathology developed in the location of FIFs and no aortic interventions were performed specifically to treat FIFs.ConclusionFocal intimal flaps identified in asymptomatic patients with aortic disease were co-localized with atherosclerotic plaque and PAUs, and demonstrated indolent behavior, not leading to significant growth or acute aortic events, supporting a conservative management approach.

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Imaging and Surveillance of Chronic Aortic Dissection: A Scientific Statement From the American Heart Association

Cited by 43 publications

References 205 publications

Chronic Thoracic Aortic Dissection: How to Treat, When to Intervene

Chronic Thoracic Aortic Dissection: How to Treat, When to Intervene

Acute, Chronic, and Treated Aortic Diseases Present Distinguishable Serum Proteome Fingerprints with Protein Profiles That Correlate with Disease Severity

Natural history and clinical significance of aortic focal intimal flaps

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