Approach to the treatment of aortic dissection.
Acute aortic dissection is a fatal disease if early diagnosis and institution of appropriate therapy are delayed. Unfortunately, the presentation of a dissection can be diabolical, leading to an initial misdiagnosis in more than 25% of patients. For type A dissections, surgical repair is essential because mortality rates approach 50% at 48 hours with expectant therapy alone. For type B dissections, medical management is successful in most patients, although a subset with complications or early dilation may benefit from newer endovascular techniques. The goal of this review is to summarize the diagnostic algorithm, initial therapeutic options, and long-term management regimen that offer patients with an acute aortic dissection the best chance for short-term and long-term survival. There is an emphasis on the specific practical approach that is applied at Washington University to patients who present with an aortic dissection.
Division of Cardiothoracic Surgery, Center for Diseases of the Thoracic Aorta, Washington University School of Medicine, 660 S. Euclid Avenue, Box 8234, Saint Louis, MO 63110, USA. moonm@wustl.edu
Marc R
MR
Moon
D000465:Algorithms; D000784:Aortic Dissection / Q000175:diagnosis* / Q000628:therapy*; D001014:Aortic Aneurysm / Q000175:diagnosis* / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D006801:Humans; D012307:Risk Factors; D014656:Vascular Surgical Procedures / Q000379:methods