Optimal Clinical Pathway for the Patient With Type B Acute Aortic Dissection

Niino, Tetsuya; Hata, Mitsumasa; Sezai, Akira; Yoshitake, Isamu; Unosawa, Satoshi; Kazuma, Satoshi; Osaka, Shunji; Minami, Kazutomo

doi:10.1253/circj.cj-08-0319

Cited by 30 publications

(20 citation statements)

References 13 publications

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“…3,8,9 The serious complications secondary to an aortic dissection may include stroke, heart attack, aortic insufficiency, congestive heart failure, cardiac tamponade, aortic rupture, renal and/or mesenteric ischemia, and hemorrhage. 5,7,9,10,[13][14][15] Dissection typically occurs in older patients. 1,7,13,16 Nearly 75% of patients are between the ages of 40 and 70, with the majority being 50 to 65 years old.…”

Section: Literature Reviewmentioning

confidence: 99%

“…The Stanford classification divides dissections into type A and type B based on their location. 2,3,5,9,10,15,17 Type A dissections originate in the ascending aorta and may extend through the aortic arch to involve the descending aorta as well; type B dissections occur distal to the brachiocephalic (innominate) artery. 8,14,17,21 The DeBakey classification system helps distinguish dissections requiring surgical intervention from those not needing surgery.…”

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The Role of CTA, MRA, and Sonography in Aortic Dissection

Sentz

2015

Journal of Diagnostic Medical Sonography

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Aortic dissection is a serious life-threatening condition and is one of the most common potentially deadly conditions of the aorta. [1][2][3][4][5] In the United States, nearly 10,000 people are affected by this condition each year. 3,6 Aortic dissection is a tear in the aorta caused by a weakened wall in which the intima, or inner wall, separates from the media (middle wall layer). 3,7-12 The separation in the wall causes the formation of two separate lumens, a true lumen and a false lumen, with blood flow penetrating the intima into the false lumen. 5,8,9,11 Once the intima is penetrated, the dissection may propagate toward the iliac arteries (an antegrade dissection) or back toward the heart (a retrograde dissection). In either case, blood may pool in the false lumen, constricting the true lumen and causing a low volume of blood flow to other parts of the body, creating a fatal compromise of blood flow to essential organs at or downstream from the constriction. 3,8,9 The serious complications secondary to an aortic dissection may include stroke, heart attack, aortic insufficiency, congestive heart failure, cardiac tamponade, aortic rupture, renal and/or mesenteric ischemia, and hemorrhage. 5,7,9,10,[13][14][15] Dissection typically occurs in older patients. 1,7,13,16 Nearly 75% of patients are between the ages of 40 and 70, with the majority being 50 to 65 years old. 1,3,6,7,9 Men are more likely to have an aortic dissection compared with women and blacks more commonly than whites. 3,4,7,13,[16][17][18][19] The cause of aortic dissection is unknown, but several risk factors precipitate its occurrence in individuals. 7 Some of the most common risk factors are chronic hypertension, atherosclerosis, and a blunt-force trauma to the chest or abdomen. 3,7,9,16,17,20 Other risk factors may include a bicuspid aortic valve, prior heart surgery, narrowing of the aorta, connective tissue disorders, or genetic disorders such as Marfan syndrome. [1][2][3]7,9,13,16,20 There are two classification systems for aortic dissections. The Stanford classification divides dissections into type A and type B based on their location. 2,3,5,9,10,15,17 Type A dissections originate in the ascending aorta and may extend through the aortic arch to involve the descending aorta as well; type B dissections occur distal to the brachiocephalic (innominate) artery. 8,14,17,21 The DeBakey classification system helps distinguish dissections requiring surgical intervention from those not needing surgery. 1,2,5,8,[22][23][24] Type I dissections originate in the ascending aorta but propagate to involve both the ascending and descending aorta; these constitute approximately 60% of cases, tend to occur in younger patients, and are the most lethal of all dissection types. Type II dissections are the least common, making up approximately 10% to 15% of cases, and only involve the ascending aorta; type III dissections constitute approximately 25% to 30% of cases and involve only the descending aorta. 1,8,22 Stanford Type A dissections include both the DeBak...

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Section: Literature Reviewmentioning

confidence: 99%

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confidence: 99%

The Role of CTA, MRA, and Sonography in Aortic Dissection

Sentz

2015

Journal of Diagnostic Medical Sonography

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“…"Fast-track" or "enhanced recovery after surgery" (ERAS) programs following surgical interventions is now standard in the care of patients with several surgical indications [1][2][3][4][5]. These programs use a multimodal approach to maximize effectiveness and minimize cost, thus optimizing perioperative care pathways [6].…”

Section: Introductionmentioning

confidence: 99%

Effects of implementing an “enhanced recovery after surgery” program on patients undergoing resection of hepatocellular carcinoma

et al. 2016

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“…9) This incidence is much higher than that of iatrogenic aortic dissection associated with open surgery. In our hospital, the best medical care and a fast-track clinical pathway are provided for patients with type B acute aortic dissections, 10) and open surgery with a left thoracotomy is recommended to treat chronic type B dissecting aneurysms. 11) Retrograde aortic dissection, a mortal complication of cardiac surgery, is well known, with reported incidence rates as high as 3% during femoral cannulation or secondary to aortic cross-clamping.…”

Section: Discussionmentioning

confidence: 99%

Case of Sudden Death from Retrograde Type A Dissection Two Days after Surgery for a Type B Dissecting Aneurysm

Hata

Akiyama

Orime

et al. 2014

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A 64-year-old man underwent a descending aortic replacement for a chronic type B dissecting aneurysm with left thoracotomy. The patient was weaned from the mechanical ventilator immediately after surgery without any neurological complications. However, on the second post-operative day, he suddenly suffered from cardiopulmonary arrest when talking with his family. Despite 6 hours of cardiopulmonary resuscitation, the patient died. The postmortem examination revealed a 1000 mL blood volume and huge hematoma in the pericardium owing to a retrograde type A dissection, which descended from an intimal laceration between the common carotid and left subclavian arteries that corresponded with aortic cross clamping. We here report a rare case of iatrogenic retrograde type A dissection caused by surgical clamping on the aortic arch 2 days post-surgery.

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Optimal Clinical Pathway for the Patient With Type B Acute Aortic Dissection

Cited by 30 publications

References 13 publications

The Role of CTA, MRA, and Sonography in Aortic Dissection

The Role of CTA, MRA, and Sonography in Aortic Dissection

Effects of implementing an “enhanced recovery after surgery” program on patients undergoing resection of hepatocellular carcinoma

Case of Sudden Death from Retrograde Type A Dissection Two Days after Surgery for a Type B Dissecting Aneurysm

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