Management of Type B Aortic Dissection

Khoynezhad, Ali; Worthington, Tiffany; Jaber, Raffat; Altshuler, Jeffrey; White, Rodney A.

doi:10.1007/978-3-030-66668-2_27

Cited by 2 publications

(3 citation statements)

References 53 publications

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“…La combinación del aumento de la presión arterial con la disminución de la presión del fluido espinal, es la clave para reducir el daño posdisección que lleva a parálisis tempranas. 23 Los autores declaran no tener ningún tipo de conflicto de interés.…”

Section: Prevención Y Mejora De La Disfunción Neurológica Después De ...unclassified

Síntomas neurológicos en disección de aorta: un desafío

Corrales Morales,

Gómez Patiño

2022

Repert. Med. Cir.

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Introducción: la posibilidad de disección de la aorta se debe considerar cuando aparece dolor torácico o abdominal de instauración súbita, con pico de dolor máximo rápidamente progresivo. Los síntomas neurológicos transitorios o ermanentes al inicio no solo son frecuentes (17-40%) sino que a menudo pueden enmascarar la afección subyacente, en especial ante la ausencia de dolor (5-15%). Objetivo: reportar un paciente con síntomas neurológicos causados por disección de la aorta sin evidencia de lesiones en las neuroimagenes. Presentación del caso: paciente atendido en hospital de mediana complejidad en Caldas, Antioquia, Colombia, por presentar manifestaciones neurológicas sugestivas de accidente cerebro vascular; se remitió a un centro de alta complejidad en Envigado, Colombia, donde se diagnosticó disección aórtica mediante angiotomografía. Discusión y conclusiones: la disección de aorta cursa con un gran espectro clínico y ante síntomas neurológicos no podemos descartarla, pues en caso de trombolizar sería fatal; la disección indolora existe y constituye un reto diagnóstico. Los síntomas neurológicos se asocian con alta mortalidad pero no son contraindicación para la cirugía.

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Section: Prevención Y Mejora De La Disfunción Neurológica Después De ...unclassified

Síntomas neurológicos en disección de aorta: un desafío

Corrales Morales,

Gómez Patiño

2022

Repert. Med. Cir.

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“…Our secondary objective is to highlight the management of peri-operative issues common to all vascular emergencies: acute renal injury, transfusion; heparinisation; and postoperative care. Type B aortic dissections start distal to the left subclavian artery [1] and can be classified as either complicated or uncomplicated based on the presence of end-organ malperfusion (e.g. acute kidney injury, bowel ischaemia, limb ischaemia).…”

Section: Introductionmentioning

confidence: 99%

“…Management of type B aortic dissection is dependent on chronicity and the presence of complicating features. Acute type B dissection is defined as ≤ 14 days from symptom onset [1]. Thoracic endovascular aortic repair is the recommended treatment for most acute complicated type B dissections [2,3], whereas uncomplicated dissections are generally treated with medical management and close monitoring.…”

Section: Introductionmentioning

confidence: 99%

Anaesthesia for vascular emergencies – a state of the art review

et al. 2022

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Summary In this state‐of‐the‐art review, we discuss the presenting symptoms and management strategies for vascular emergencies. Although vascular emergencies are best treated at a vascular surgical centre, patients may present to any emergency department and may require both immediate management and safe transport to a vascular centre. We describe the surgical and anaesthetic considerations for management of aortic dissection, aortic rupture, carotid endarterectomy, acute limb ischaemia and mesenteric ischaemia. Important issues to consider in aortic dissection are extent of the dissection and surgical need for bypasses in addition to endovascular repair. From an anaesthetist's perspective, aortic dissection requires infrastructure for massive transfusion, smooth management should an endovascular procedure require conversion to an open procedure, haemodynamic manipulation during stent deployment and prevention of spinal cord ischaemia. Principles in management of aortic rupture, whether open or endovascular treatment is chosen, include immediate transfer to a vascular care centre; minimising haemodynamic changes to reduce aortic shear stress; permissive hypotension in the pre‐operative period; and initiation of massive transfusion protocol. Carotid endarterectomy for carotid stenosis is managed with general or regional techniques, and anaesthetists must be prepared to manage haemodynamic, neurological and airway issues peri‐operatively. Acute limb ischaemia is a result of embolism, thrombosis, dissection or trauma, and may be treated with open repair or embolectomy, under either general or local anaesthesia. Due to hypercoagulability, there may be higher numbers of acutely ischaemic limbs among patients with COVID‐19, which is important to consider in the current pandemic. Mesenteric ischaemia is a rare vascular emergency, but it is challenging to diagnose and associated with high morbidity and mortality. Several peri‐operative issues are common to all vascular emergencies: acute renal injury; management of transfusion; need for heparinisation and reversal; and challenging postoperative care. Finally, the important development of endovascular techniques for repair in many vascular emergencies has improved care, and the availability of transoesophageal echocardiography has improved monitoring as well as aids in surgical placement of endovascular grafts and for post‐procedural evaluation.

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Management of Type B Aortic Dissection

Cited by 2 publications

References 53 publications

Síntomas neurológicos en disección de aorta: un desafío

Síntomas neurológicos en disección de aorta: un desafío

Anaesthesia for vascular emergencies – a state of the art review

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