Acute aortic syndromes: definition, prognosis and treatment options
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Acute aortic syndromes: definition, prognosis and treatment options. / Carpenter, S W; Kodolitsch, Y V; Debus, E S; Wipper, S; Tsilimparis, N; Larena-Avellaneda, A; Diener, H; Kölbel, T.
In: J CARDIOVASC SURG, Vol. 55, No. 2 Suppl 1, 04.2014, p. 133-144.Research output: SCORING: Contribution to journal › SCORING: Review article › Research
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TY - JOUR
T1 - Acute aortic syndromes: definition, prognosis and treatment options
AU - Carpenter, S W
AU - Kodolitsch, Y V
AU - Debus, E S
AU - Wipper, S
AU - Tsilimparis, N
AU - Larena-Avellaneda, A
AU - Diener, H
AU - Kölbel, T
PY - 2014/4
Y1 - 2014/4
N2 - 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.
AB - 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.
KW - Acute Disease
KW - Aneurysm, Dissecting/diagnosis
KW - Antihypertensive Agents/adverse effects
KW - Aorta, Thoracic/drug effects
KW - Aortic Aneurysm, Thoracic/diagnosis
KW - Aortic Diseases/diagnosis
KW - Aortography/methods
KW - Endovascular Procedures/adverse effects
KW - Hematoma/diagnosis
KW - Humans
KW - Patient Selection
KW - Predictive Value of Tests
KW - Risk Factors
KW - Syndrome
KW - Tomography, X-Ray Computed
KW - Treatment Outcome
KW - Ulcer/diagnosis
KW - Vascular Surgical Procedures/adverse effects
M3 - SCORING: Review article
C2 - 24796906
VL - 55
SP - 133
EP - 144
JO - J CARDIOVASC SURG
JF - J CARDIOVASC SURG
SN - 0021-9509
IS - 2 Suppl 1
ER -