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19 - Aortic Dissection

from Section 4 - Cardiovascular Emergencies

Published online by Cambridge University Press:  02 November 2023

Kaushal Shah
Affiliation:
Weill Cornell Medical Center, New York
Jarone Lee
Affiliation:
Massachusetts General Hospital, Boston
Clark G. Owyang
Affiliation:
Weill Cornell Medical Center, New York
Benjamin Christian Renne
Affiliation:
Massachusetts General Hospital, Boston
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Summary

  • Aortic dissection represents the most frequent aortic catastrophe with approximately 10,000 cases annually in the United States. Dissection occurs with a primary tear of the intimal layer of the aorta and then subsequent infiltration into the media layer, creating a false lumen that may extend the entire length of the aorta.

  • Propagation of the false lumen may result in obstruction of vascular branches of the aorta, leading to end organ hypoperfusion of the brain, heart, kidneys, spine or extremities.

  • The location of injury (i.e., ascending versus descending aorta) predicts mortality and guides management decisions.

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Chapter
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Publisher: Cambridge University Press
Print publication year: 2023

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References

Braverman, AC. Aortic dissection: Prompt diagnosis and emergency treatment are critical. Cleve Clin J Med 2011;78:685696.CrossRefGoogle ScholarPubMed
Golledge, J, & Eagle, KA. Acute aortic dissection. Lancet 2008;372(9632):5566.CrossRefGoogle ScholarPubMed
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):897903.CrossRefGoogle ScholarPubMed
Hines, G, Dracea, C, Katz, DS. Diagnosis and management of acute type A aortic dissection. Cardiol Rev 2011;19:226232.CrossRefGoogle ScholarPubMed
Klompas, M. Does this patient have an acute thoracic aortic dissection? JAMA 2002;287:22622272.CrossRefGoogle ScholarPubMed

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