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.
Moon
Marc R
MR
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
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