Descending thoracic aortic dissection: evaluation and management in the era of endovascular technology.
Acute aortic dissection is a relatively uncommon but highly lethal condition. Without proper treatment, devastating consequences can occur due to aortic rupture, cardiac tamponade, or irreversible ischemia involving the spinal cord or the visceral organs. The treatment strategy of this condition is in part influenced by the location and the severity of aortic dissection as immediate surgical intervention is necessary in acute ascending aortic dissection, whereas medical therapy is the initial treatment approach in uncomplicated descending aortic dissection. Recent advances of endovascular technology have broadened the potential application of this catheter-based therapy in aortic pathologies, including descending thoracic aortic dissection. In this article, the etiology, pathogenesis, and classification of this condition are discussed. The diagnostic benefits of various imaging modalities for descending aortic dissection are also discussed. Current treatment strategies, including medical, surgical, and catheter-based interventions, are reviewed. Lastly, clinical experiences of endovascular treatment for descending aortic dissection and various endovascular devices potentially applicable for this condition are discussed.
Lin
Peter H
PH
Michael E. DeBakey Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX 77030, USA. plin@bcm.tmc.edu
Huynh
Tam T
TT
Kougias
Panagiotis
P
Huh
Joseph
J
LeMaire
Scott A
SA
Coselli
Joseph S
JS
D000208:Acute Disease; D000784:Aortic Dissection / Q000209:etiology / Q000473:pathology* / Q000628:therapy*; D017545:Aortic Aneurysm, Thoracic / Q000209:etiology / Q000473:pathology* / Q000628:therapy*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D006801:Humans; D018810:Magnetic Resonance Angiography; D011474:Prosthesis Design; D012307:Risk Factors; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome