Pathophysiology, diagnosis, and management of aortic dissection

Abstract

Aortic dissection is an uncommon but potentially fatal disease with catastrophic complications. A high level of suspicion is required for successful diagnosis as presenting symptoms are so variable that dissection may be overlooked in up to 39% of cases. It most commonly presents in the elderly population with a history of chronic hypertension. Rapid intervention is necessary as delay leads to higher mortality. Despite advances in diagnostic and therapeutic techniques, morbidity and mortality remains high. Advances in diagnostic imaging have raised the awareness of variants of aortic dissection, including intramural hemorrhage and penetrating aortic ulcer. This distinction is important as the clinical course of these variants differs from that of classical aortic dissection, and thus treatment may also differ. Understanding of these variants has also led to the recognition of markers that may help predict progression to classical aortic dissection and thus warrant closer vigilance in selected patient populations. The recognition that rapid diagnosis is required for management of aortic dissection has led to the investigation of serum tests as diagnostic aids. Serum smooth muscle myosin heavy chain, d-dimer, and serum soluble elastin fragments are promising tests that may help raise suspicion for the diagnosis of acute aortic dissection. The high mortality associated with surgical therapy has led to investigation of alternative approaches. Endovascular therapy has emerged as a viable option in patients with type B dissection who are too unstable for surgery. However, long-term follow up is required to validate this procedure.

Dissecting Aortic Aneurysm in Real–life Clinical Practice: Diagnostics, Treatment and Prognosis

“…Предрасполагающим к рас-слоению фактором в 85 % случаев была АГ, что также отмечал в своей работе P.D. Patel [10], по данным ко-торого в 70 % случаев пациенты с РАА имели в анам-незе повышенные показатели АД.…”

Type I aortic dissection in a patient with human immunodeficiency virus infection

“…A high degree of caution is required for its successful diagnosis as presenting symptoms are so variable that dissection may be overlooked in up to 39% of cases (16). Rapid advances in noninvasive imaging technology have facilitated the early diagnosis of this condition and should be considered in the differential diagnosis of any patient with chest, back, or abdominal pain.…”

A patient with ascending aortic dilatation, similar to phenotypes of connective tissue disorders

“…Despite advances in diagnostic and therapeutic techniques, morbidity and mortality remain high. Advances in diagnostic imaging have raised the awareness of variants of aortic dissection, including intramural hemorrhage and penetrating aortic ulcer (Patel and Arora, 2008). Visualization of an intimal flap separating the true and false channels on morphological examinations is a pathognomonic sign of aortic dissection, confirming the positive diagnosis.…”