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3.1.12 - Aortic Dissection

from Section 3.1 - Cardiac and Circulatory Failure

Published online by Cambridge University Press:  27 July 2023

By
Simon Mattison
Edited by
Ned Gilbert-Kawai ,
Debashish Dutta  and
Carl Waldmann
Ned Gilbert-Kawai
Affiliation:
The Royal Liverpool Hospital
Debashish Dutta
Affiliation:
Princess Alexandra Hospital NHS Trust, Harlow
Carl Waldmann
Affiliation:
Royal Berkshire Hospital, Reading
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Summary

Key Learning Points

  1. 1. Acute aortic dissection is a rare, but life-threatening disorder.

  2. 2. Presentation may be similar to that of an acute coronary syndrome and should always be considered as a differential diagnosis.

  3. 3. Immediate treatment should focus on analgesia and blood pressure control, followed by rapid referral to a specialist unit.

  4. 4. ECG-gated computed tomography is usually the imaging modality of choice.

  5. 5. Urgent surgery is usually required for type A dissections.

Keywords

acute aortic dissectionacute aortic syndrome
Type
Chapter
Information
Intensive Care Medicine
The Essential Guide
 , pp. 137 - 139
Publisher: Cambridge University Press
Print publication year: 2021

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References

References and Further Reading

Chiappini, B, Schepens, M, Tan, E, et al. Early and late outcomes of acute type A aortic dissection: analysis of risk factors in 487 consecutive patients. Eur Heart J 2005;26:180–6.CrossRefGoogle ScholarPubMed
Erbel, R, Aboyans, V, Boileau, C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 2014;35:2873–926.Google ScholarPubMed
Erbel, R, Engberding, R, Daniel, W, Roelandt, J, Visser, C, Rennollet, H. Echocardiography in diagnosis of aortic dissection. Lancet 1989;1:457–61.Google ScholarPubMed
Hiratzka, LF, Bakris, GL, Beckman, JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010;121:e266–369.Google Scholar
Iliceto, S, Ettorre, G, Francioso, G, Antonelli, G, Biasco, G, Rizzon, P. Diagnosis of aneurysm of the thoracic aorta. Comparison between two non-invasive techniques: two-dimensional echocardiography and computed tomography. Eur Heart J 1984;5:545–55.CrossRefGoogle ScholarPubMed
Khandheria, BK, Tajik, AJ, Taylor, CL, et al. Aortic dissection: review of value and limitations of two-dimensional echocardiography in a six-year experience. J Am Soc Echocardiogr 1989;2:17–24.CrossRefGoogle Scholar
Mintz, GS, Kotler, MN, Segal, BL, Parry, WR. Two dimensional echocardiographic recognition of the descending thoracic aorta. Am J Cardiol 1979;44:232–8.CrossRefGoogle ScholarPubMed
Nienaber, CA, von Kodolitsch, Y, Nicolas, V, et al. The diagnosis of thoracic aortic dissection by non-invasive imaging procedures. N Engl J Med 1993;328:1–9.CrossRefGoogle Scholar
Novelline, RA, Rhea, JT, Rao, PM, Stuk, JL. Helical CT in emergency radiology. Radiology 1999;213:321–39.CrossRefGoogle ScholarPubMed
Sommer, T, Fehske, W, Holzknecht, N, et al. Aortic dissection: a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography, and MR imaging. Radiology 1996;199:347–52.CrossRefGoogle ScholarPubMed
Trimarchi, S, Nienaber, CA, Rampoldi, V, et al. Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience. J Thorac Cardiovasc Surg 2005;129:112–22.CrossRefGoogle ScholarPubMed

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