Aortic dissection represents the most common aortic emergency, affecting 3 to 4 per 100 000 people per year and is still associated with a high mortality. Twenty percent of the patients with aortic dissection die before reaching hospital and 30% die during hospital admission. Aortic dissections may be classified in 3 ways: according to their anatomical extent (the Stanford or DeBakey systems), according to the time from onset (acute or chronic), and according to the underlying pathology (the European Society of Cardiologists’ system). Advances in endovascular technology have provided new treatment options. Hybrid endovascular and conventional open surgical repair represent the mainstay of treatment for acute type A dissection. Medical management remains the gold standard for acute and uncomplicated chronic type B dissection, though endovascular surgery offers exciting potential in the management of complicated type B dissection through sealing of the intimal entry tear.
Morgagni JBDe sedibus et causis morborum per Anatomen Indagatis Libri Quinque, Venice, Italy, Ex Typographia Remondiana, 1761.
2.
Clouse WD, Hallett JW Jr, Schaff HV, et al. Acute aortic dissection: population-based incidence compared with degenerative aortic aneurysm rupture. Mayo Clin Proc . 2004;79(2): 176-180.
3.
Meszaros I., Morocz J., Szlavi J., et al. Epidemiology and clinicopathology of aortic dissection. Chest. 2000;117(5):1271-1278.
4.
Olsson C., Thelin S., Stahle E., Ekbom A., Granath F.Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002. Circulation. 2006 ;114(24): 2611-2618.
5.
Mehta RH, Manfredini R., Hassan F., et al. Chronobiological patterns of acute aortic dissection. Circulation. 2002;106(9): 1110-1115.
6.
Manfredini R. , Boari B., Gallerani M., et al. Chronobiology of rupture and dissection of aortic aneurysms. J Vasc Surg. 2004;40(2): 382-388.
7.
Srichai MB, Lieber ML, Lytle BW, Kasper JM, White RDAcute dissection of the descending aorta: noncommunicating versus communicating forms. Ann Thorac Surg. 2004;77(6):2012-2020; discussion 20.
8.
Sundt TMIntramural hematoma and penetrating atherosclerotic ulcer of the aorta. Ann Thorac Surg. 2007;83(2):S835-S8341; discussion S46-S50.
9.
Collins JS, Evangelista A., Nienaber CA, et al. Differences in clinical presentation, management, and outcomes of acute type a aortic dissection in patients with and without previous cardiac surgery. Circulation. 2004;110(11 suppl 1):11237-11242.
10.
Suzuki T., Mehta RH, Ince H., et al. Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD). Circulation. 2003;108(suppl 1):11312-11317.
11.
Eagle KA, Isselbacher EM, DeSanctis RWCocaine-related aortic dissection in perspective. Circulation . 2002;105(13):1529-1530.
Pepin M., Schwarze U., Superti-Furga A., Byers PHClinical and genetic features of Ehlers-Danlos syndrome type IV, the vascular type. N Engl J Med. 2000;342(10):673-680.
14.
He R., Guo DC, Estrera AL, et al. Characterization of the inflammatory and apoptotic cells in the aortas of patients with ascending thoracic aortic aneurysms and dissections . J Thorac Cardiovasc Surg. 2006;131(3):671-678.
15.
Bonderman D. , Gharehbaghi-Schnell E., Wollenek G., Maurer G., Baumgartner H., Lang IMMechanisms underlying aortic dilatation in congenital aortic valve malformation. Circulation. 1999; 99(16):2138-2143.
16.
Albornoz G. , Coady MA, Roberts M., et al. Familial thoracic aortic aneurysms and dissections-incidence, modes of inheritance, and phenotypic patterns. Ann Thorac Surg. 2006;82(4):1400-1405.
17.
Crawford ES , Svensson LG, Coselli JS, Safi HJ, Hess KR Surgical treatment of aneurysm and/or dissection of the ascending aorta, transverse aortic arch, and ascending aorta and transverse aortic arch. Factors influencing survival in 717 patients. J Thorac Cardiovasc Surg. 1989;98(5 pt 1):659-673; discussion 73-74..
18.
DeBakey ME, McCollum CH, Crawford ES, et al. Dissection and dissecting aneurysms of the aorta: twenty-year follow-up of five hundred twenty-seven patients treated surgically. Surgery. 1982; 92(6):1118-1134.
19.
Erbel R., Alfonso F., Boileau C., et al. Diagnosis and management of aortic dissection. Eur Heart J. 2001;22(18):1642-1681.
20.
Slater EE, DeSanctis RWThe clinical recognition of dissecting aortic aneurysm. Am J Med. 1976;60(5):625-633.
21.
Svensson LG , Crawford ESAortic dissection and aortic aneurysm surgery: clinical observations, experimental investigations, and statistical analyses. Part II. Curr Probl Surg. 1992;29(12): 913-1057.
22.
Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000 ;283(7):897-903.
23.
Golledge J. , Eagle KAAcute aortic dissection. Lancet. 2008; 372(9632):55-66.
24.
Shiga T., Wajima Z., Apfel CC, Inoue T., Ohe Y.Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis. Arch Intern Med. 2006;166(13):1350-1356.
25.
Johnson TR, Nikolaou K., Wintersperger BJ, et al. ECG-gated 64-MDCT angiography in the differential diagnosis of acute chest pain. AJR Am J Roentgenol. 2007;188(1):76-82.
26.
Svensson LG , Kouchoukos NT, Miller DC, et al. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Ann Thorac Surg. 2008;85(1 suppl):S1-S41.
27.
Rampoldi V. , Trimarchi S., Eagle KA, et al. Simple risk models to predict surgical mortality in acute type A aortic dissection: the International Registry of Acute Aortic Dissection score. Ann Thorac Surg. 2007;83(1):55-61.
28.
Mestres CA, Fernandez C., Josa M., Mulet J.Hybrid antegrade repair of the arch and descending thoracic aorta with a new integrated stent-Dacron graft in acute type A aortic dissection: a look into the future with new devices. Interact Cardiovasc Thorac Surg . 2007;6(2):257-259.
29.
Chavan A., Karck M., Hagl C., et al. Hybrid endograft for one-step treatment of multisegment disease of the thoracic aorta. J Vasc Interv Radiol. 2005;16(6):823-829.
30.
Herold U., Tsagakis K., Kamler M., et al. Change of paradigms in the surgical treatment of complex thoracic aortic disease [in German]. Herz. 2006;31(5):434-442.
31.
Taylor PR, Jacobs Mjhm.Thoracic and Thoraco-abdominal aortic aneurysms, dissections and acute aortic syndrome. In: Beard JD, Gaines PA, eds. Vascular and Endovascular Surgery. Philadelphia, PA: Elsevier Limited: 2006:249-26.
32.
Dake MD, Kato N., Mitchell RS, et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med. 1999;340(20):1546-1552.
33.
Estrera AL, Miller CC, Goodrick J., et al. Update on outcomes of acute type B aortic dissection. Ann Thorac Surg. 2007;83(2): S842-S845; discussion S46-S50..
34.
Eggebrecht H., Nienaber CA, Neuhauser M., et al. Endovascular stent-graft placement in aortic dissection: a meta-analysis. Eur Heart J. 2006;27(4):489-498.
35.
Bockler D., Schumacher H., Ganten M., et al. Complications after endovascular repair of acute symptomatic and chronic expanding Stanford type B aortic dissections. J Thorac Cardiovasc Surg. 2006;132(2):361-368.
36.
Moon MC, Pablo Morales J., Greenberg RKComplicated acute type B dissection and endovascular repair: indications and pitfalls. Perspect Vasc Surg Endovasc Ther. 2007;19(2): 146-159.
37.
Duebener L. , Hartmann F., Kurowski V., et al. Surgical interventions after emergency endovascular stent-grafting for acute type B aortic dissections. Interact Cardiovasc Thorac Surg. 2007; 6(3):288-292.
38.
Estrera AL, Miller CC 3rd, Chen EP, et al. Descending thoracic aortic aneurysm repair: 12-year experience using distal aortic perfusion and cerebrospinal fluid drainage. Ann Thorac Surg. 2005;80(4):1290-1296; discussion 96.
39.
Shores J., Berger KR, Murphy EA, Pyeritz REProgression of aortic dilatation and the benefit of long-term beta-adrenergic blockade in Marfan’s syndrome. N Engl J Med. 1994;330(19): 1335-1341.
40.
Davies RR, Goldstein LJ, Coady MA, et al. Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size. Ann Thorac Surg. 2002;73(1):17-27; discussion 27-28.
Umana JP, Lai DT, Mitchell RS, et al. Is medical therapy still the optimal treatment strategy for patients with acute type B aortic dissections? J Thorac Cardiovasc Surg. 2002;124(5): 896-910.
