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(Circulation. 2008;117:1460-1473.)
© 2008 American Heart Association, Inc.

Aortic Diseases

Endovascular Management of Thoracic Dissections

Warren Swee, MD, MPH; Michael D. Dake, MD

From the Department of Radiology, Division of Angiography and Interventional Radiology, University of Virginia Health System, Charlottesville, Va.

Correspondence to Michael D. Dake, MD, University of Virginia Health System, Department of Radiology, PO Box 800170, Charlottesville, VA 22908. E-mail mdd2n@virginia.edu

Key Words: aortic diseases • disease management • percutaneous transluminal coronary angioplasty • revascularization • stents

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The first surgical management of aortic dissection was reported in 1935 by Gurin et al,¹ who created a distal reentry point in the iliac artery to decompress the false lumen. In 1949, Abbott² reported the repair of a chronic dissection by wrapping cellophane around the descending aorta to reinforce it. Despite the efforts of these early pioneers and other investigators, it was not until 1955 that a major therapeutic advance was made; this was the year that DeBakey, Cooley, and Creech introduced a revolutionary surgical treatment that involved excision of the intimal tear, obliteration of the false lumen, and either direct reanastomosis or insertion of a prosthetic graft.³ The next great milestone in therapy was introduced by Wheat et al⁴ in 1965, when they described medical therapy directed toward lowering blood pressure and dP/dt. Since then, investigators have made significant advances in the detection, characterization, and treatment of aortic dissection; however, the morbidity and mortality of this debilitating disease remain alarmingly high, with an overall in-hospital mortality of 27.4% reported by the International Registry of Aortic Dissection (IRAD).⁵

The latest additions to the armamentarium to treat dissection have been based on percutaneous interventional techniques. The minimally invasive nature of these techniques makes them an attractive alternative to open surgical intervention; however, the exact role and long-term durability of these procedures remain to be proven. The earliest endovascular therapies were directed toward the complications of aortic dissections and included angioplasty of an obstructed aorta, stenting of obstructed branch vessels, and fenestration . . . [Full Text of this Article]

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