Acute Aortic Dissection

Authors: Gary L A Cumberbatch / Editor: Jason M Kendall, Philip Delbridge / Reviewer: Iolo Roberts, Michael Perry / Code: A1, R1, R2 / Published: 05/03/2013 / Reviewed: 15/12/2023

This session covers the diagnosis and initial management of a patient with acute aortic dissection.

After completing this session you will be able to:

  • Recognise the symptoms and signs of acute aortic dissection
  • Describe the pathophysiology of the disease
  • Determine the value and limitations of the various tests that can be used to confirm the presence of an acute aortic dissection
  • Plan definitive intervention for different types of aortic dissection and control blood pressure where required.
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References

  1. Cigarroa JE, Isselbacher EM, DeSanctis RW, Eagle KA. Diagnostic imaging in the evaluation of suspected aortic dissection. Old standards and new directions. N Engl J Med. 1993 Jan 7;328(1):35-43.
  2. Sarasin FP, Louis-Simonet M, Gaspoz JM, Junod AF. Detecting acute thoracic aortic dissection in the emergency department: time constraints and choice of the optimal diagnostic test. Ann Emerg Med. 1996 Sep;28(3):278-88.
  3. Eggebrecht H, Nienaber CA, Neuhuser M, et al. Endovascular stent-graft placement in aortic dissection: a meta-analysis. Eur Heart J. 2006 Feb;27(4):489-98.
  4. Tsai TT, Fattori R, Trimarchi S, et al. Long-term survival in patients presenting with type B acute aortic dissection: insights from the International Registry of Acute Aortic Dissection. Circulation. 2006 Nov 21;114(21):2226-31.
  5. Grubb BP, Sirio C, Zelis R. Intravenous labetalol in acute aortic dissection. JAMA. 1987 Jul 3;258(1):78-9.
  6. Isselbacher EM, Cigarroa JE, Eagle KA. Cardiac tamponade complicating proximal aortic dissection: is pericardiocentesis harmful? Circulation 1994;90:2375-2378.
  7. Erbel R, Alfonso F, Boileau C. Diagnosis and management of aortic dissection. Eur Heart J. 2001 Sep;22(18):1642-81.
  8. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000 Feb 16;283(7):897-903.
  9. Ohara Y, Hiasa Y, Hosokawa S. Successful treatment in a case of acute aortic dissection complicated with acute myocardial infarction due to occlusion of the left main coronary artery. J Invasive Cardiol. 2003 Nov;15(11):660-2.
  10. Horszczaruk GJ, Roik MF, Kochman J, et al. Aortic dissection involving ostium of right coronary artery as the reason of myocardial infarction. Eur Heart J. 2006 Mar;27(5):518.
  11. Cardozo C, Riadh R, Mazem M. Acute myocardial infarction due to left main stem compression: aortic dissection treated by direct stenting. J Invas Cardiol 2004;16:89-91.
  12. Anand R, Cumberbatch G, Swallow R et al. Difficulties in the diagnosis of acute aortic dissection. Hosp Med 2003;64:241-243.
  13. Krenz JR, O’Brien ME, Lee J, Hayes BD. Evaluation of esmolol for heart rate control in patients with acute aortic dissection. Am J Emerg Med. 2021 Jun;44:312-314
  14. Rogers AM, Hermann LK, Booher AM, Nienaber CA, Williams DM, et al; IRAD Investigators. Sensitivity of the aortic dissection detection risk score, a novel guideline-based tool for identification of acute aortic dissection at initial presentation: results from the international registry of acute aortic dissection. Circulation. 2011 May 24;123(20):2213-8.
  15. Nazerian P, Mueller C, Soeiro AM, Leidel BA, Salvadeo SAT, et al. Diagnostic Accuracy of the Aortic Dissection Detection Risk Score Plus D-Dimer for Acute Aortic Syndromes: The ADvISED Prospective Multicenter Study. Circulation. 2018 Jan 16;137(3):250-258.
  16. Suzuki T, Distante A, Zizza A, Trimarchi S, Villani M, et al; IRAD-Bio Investigators. Diagnosis of acute aortic dissection by D-dimer: the International Registry of Acute Aortic Dissection Substudy on Biomarkers (IRAD-Bio) experience. Circulation. 2009 May 26;119(20):2702-7.
  17. Baliga RR, Nienaber CA, Bossone E, Oh JK, Isselbacher EM, et al. The role of imaging in aortic dissection and related syndromes. JACC Cardiovasc Imaging. 2014 Apr;7(4):406-24.
  18. von Kodolitsch Y, Nienaber CA, Dieckmann C, Schwartz AG, et al. Chest radiography for the diagnosis of acute aortic syndrome. Am J Med. 2004 Jan 15;116(2):73-7.
  19. Levy D, Goyal A, Grigorova Y, Farci F, Le JK. Aortic Dissection. [Updated Apr 2023]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Jan 2023.
  20. Evangelista A, Isselbacher EM, Bossone E, Gleason TG, Eusanio MD, et al; IRAD Investigators. Insights From the International Registry of Acute Aortic Dissection: A 20-Year Experience of Collaborative Clinical Research. Circulation. 2018 Apr 24;137(17):1846-1860.
  21. Isselbacher EM, Preventza O, Hamilton Black J 3rd, Augoustides JG, Beck AW, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2022 Dec 13;146(24):e334-e482.
  22. O’Connor B, Luntley JB. Acute dissection of the thoracic aorta. Esmolol is safer than and as effective as labetalol. BMJ. 1995 Apr 1;310(6983):875.

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