CLINICAL PERSPECTIVE

This Article Abstract Full Text (PDF) All Versions of this Article: 116/10/1120    most recent CIRCULATIONAHA.107.702720v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pape, L. A. Search for Related Content PubMed PubMed Citation Articles by Pape, L. A. Related Collections CV surgery: aortic and vascular disease Related Article

(Circulation. 2007;116:1120-1127.)
© 2007 American Heart Association, Inc.

Cardiovascular Surgery

CLINICAL PERSPECTIVE

Prompt diagnosis of acute aortic dissection continues to challenge clinicians. Clinical suspicion remains the strongest diagnostic tool. Once the diagnosis is considered, a number of accurate imaging tests are now widely available to confirm the diagnosis. Treatment approaches have evolved, with catheter-based techniques used with increasing frequency to treat type B (descending aorta) dissections. The greater challenge, however, is prevention. Prevention of dissection and rupture currently includes surgery or placement of stent grafts (depending on location) for aortic aneurysms, monitoring of patients with known connective tissue disorders and prior aortic surgery, and/or aggressive treatment of hypertension. The investigators of the International Registry of Acute Aortic Dissection asked the question, if the aortic diameter at presentation were the same as before dissection occurred, how many patients would have met current guidelines for prophylactic aortic surgical repair? The results show that nearly 60% of the 591 type A dissection patients enrolled in the International Registry of Acute Aortic Dissection had diameters <5.5 cm, and 40% had diameters <5.0 cm. It was assumed that, if they had been measured immediately before dissection occurred, aortic diameters would have been even smaller than at presentation because dissection causes an expansion of the aortic media and/or adventitia (information not available). Only a small number of patients are identified as high risk before aortic dissection. The results of the present descriptive study in a large population of patients highlight the need for predictors other than aortic size to identify patients at risk for aortic dissection.

	Footnotes

 
Guest Editor for this article was William R. Hiatt, MD.

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This Article Abstract Full Text (PDF) All Versions of this Article: 116/10/1120    most recent CIRCULATIONAHA.107.702720v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pape, L. A. Search for Related Content PubMed PubMed Citation Articles by Pape, L. A. Related Collections CV surgery: aortic and vascular disease Related Article