title: Management of acute aortic syndrome and chronic aortic dissection.
abstract: Acute aortic syndrome (AAS) describes several life-threatening aortic pathologies. These include intramural hematoma, penetrating aortic ulcer, and acute aortic dissection (AAD). Advances in both imaging and endovascular treatment have led to an increase in diagnosis and improved management of these often catastrophic pathologies. Patients, who were previously consigned to medical management or high-risk open surgical repair, can now be offered minimally invasive solutions with reduced morbidity and mortality. Information from the International Registry of Acute Aortic Dissection (IRAD) database demonstrates how in selected patients with complicated AAD the 30-day mortality from open surgery is 17% and endovascular stenting is 6%. Despite these improvements in perioperative deaths, the risks of stroke and paraplegia remain with endovascular treatment (combined outcome risk 4%). The pathophysiology of each aspect of AAS is described. The best imaging techniques and the evolving role of endovascular techniques in the definitive management of AAS are discussed incorporating strategies to reduce perioperative morbidity.
authors.affiliation: St. George's Vascular Institute, St. James' Wing, St George's Hospital, Blackshaw Road, London SW17 0QT, UK. inordon@sgul.ac.uk
authors.forename: Ian M
authors.initials: IM
authors.lastname: Nordon
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hinchliffe
authors.forename: Ian M
authors.initials: IM
authors.lastname: Loftus
authors.forename: Robert A
authors.initials: RA
authors.lastname: Morgan
authors.forename: Matt M
authors.initials: MM
authors.lastname: Thompson
mesh_terms: D000208:Acute Disease; D000784:Aortic Dissection / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy; D001018:Aortic Diseases / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy; D019917:Blood Vessel Prosthesis Implantation; D002908:Chronic Disease; D057510:Endovascular Procedures / Q000009:adverse effects; D006406:Hematoma / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D015607:Stents; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D014456:Ulcer / Q000175:diagnosis / Q000601:surgery