title: Acute aortic syndromes: definition, prognosis and treatment options.
abstract: Acute aortic syndromes (AAS) are life-threatening vascular conditions of the thoracic aorta presenting with acute pain as the leading symptom in most cases. The incidence is approximately 3-5/100,000 in western countries with increase during the past decades. Clinical suspicion for AAS requires immediate confirmation with advanced imaging modalities. Initial management of AAS addresses avoidance of progression by immediate medical therapy to reduce aortic shear stress. Proximal symptomatic lesions with involvement of the ascending aorta are surgically treated in the acute setting, whereas acute uncomplicated distal dissection should be treated by medical therapy in the acute period, followed by surveillance and repeated imaging studies. Acute complicated distal dissection requires urgent invasive treatment and thoracic endovascular aortic repair has become the treatment modality of choice because of favorable outcomes compared to open surgical repair. Intramural hematoma, penetrating aortic ulcers, and traumatic aortic injuries of the descending aorta harbor specific challenges compared to aortic dissection and treatment strategies are not as uniformly defined as in aortic dissection. Moreover these lesions have a different prognosis. Once the acute period of aortic syndrome has been survived, a lifelong medical treatment and close surveillance with repeated imaging studies is essential to detect impending complications which might need invasive treatment within the short-, mid- or long-term.
authors.affiliation: German Aortic Center Department for Vascular Medicine University Heart Center Hamburg, University Hospital Hamburg‑Eppendorf Hamburg, Germany - s.carpenter@uke.de.
authors.forename: S W
authors.initials: SW
authors.lastname: Carpenter
authors.forename: Y V
authors.initials: YV
authors.lastname: Kodolitsch
authors.forename: E S
authors.initials: ES
authors.lastname: Debus
authors.forename: S
authors.initials: S
authors.lastname: Wipper
authors.forename: N
authors.initials: N
authors.lastname: Tsilimparis
authors.forename: A
authors.initials: A
authors.lastname: Larena-Avellaneda
authors.forename: H
authors.initials: H
authors.lastname: Diener
authors.forename: T
authors.initials: T
authors.lastname: Kölbel
mesh_terms: D000208:Acute Disease; D000784:Aortic Dissection / Q000175:diagnosis / Q000628:therapy; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001013:Aorta, Thoracic / Q000187:drug effects* / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000628:therapy; D001018:Aortic Diseases / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001027:Aortography / Q000379:methods; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D006406:Hematoma / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D018579:Patient Selection; D011237:Predictive Value of Tests; D012307:Risk Factors; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014456:Ulcer / Q000175:diagnosis / Q000628:therapy; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
chemical_list: D000959:Antihypertensive Agents