Abstract
Aortic dissection (AD)was first described in 1760. Treatment options have been medical and surgical and are guided by the Stanford and De Bakey classifications based on the location of intimal tears and false lumens. More recently, endovascular treatment options have been suggested.
Penetrating aortic ulcers (PAU) were first described in 1934 as a focal, atherosclerotic plaque that corrodes a variable depth through the internal elastic lamina into the media. It is predominantly found in elderly men, closely related to atherosclerosis, and most often located in the descending thoracic aorta.
Intramural hematomas (IMH) are often found on CT-scans in patients with typical aortic pain. They are characterized by the presence of a hematoma in the media , but the absence of flow in the false lumen and the absence of a primary intimal tear. An intimal tear may, however, occur secondary to the IMH, complicating the distinction between an IMH and a thrombosed false lumen of an AD.
In 2000 Shimizu et al(1) published a series of 96 patients admitted on the diagnosis ”Aortic dissection”. On CT evaluation 51 of these turned out to have an IMH without an intimal tear. Interestingly, this subgroup of patients had a much better survival rate than the patients with ”true” AD. This observation prompted Vilacosta in 2001 to introduce the term ”Acute Aortic Syndrome” (AAS) (2), including AD, PAU, and IMH. While later observations from Asian populations confirmed the finding of IMH as a relatively common and benign condition, this does not seem to be the case in Western populations, where the incidence is relatively lower and the prognosis closer to that of patients with AD (3).
In a recent review, Nienaber and Powell added the clinical entities of leaking thoracic aneurysm and traumatic dissection or rupture to the definition of AAS (4).
The concept of AAS may have a justification by reminding clinicians that not all patients presenting with aortic pain have AD. It should, however, not lead us to believe that a treatment scheme that is based on evidence from treating one subgroup of patients with AAS is necessarily applicable to other subgroups.
1.Shimizu H, Yoshino H, Udagawa H, et al. Prognosis of Aortic Intramural Hemorrage compared With Classic Aortic Dissection. Am J Cardiol 2000;85:792-5
2.Vilacosta I, San Román JA. Acute Aortic Syndrome. Heart 2001;85:365-8
3.Pelzel JM, Braverman AC, Hirsch AT, et al. International heterogeneity in diagnostic frequency and clinical outcomes of ascending aortic intramural hematoma. J Am Soc Echocardiogr 2007;20:1260-8
4.Nienaber CA, Powell J. Management of Acute Aortic Syndromes. European Heart Journal 2012; 33:26-35
Penetrating aortic ulcers (PAU) were first described in 1934 as a focal, atherosclerotic plaque that corrodes a variable depth through the internal elastic lamina into the media. It is predominantly found in elderly men, closely related to atherosclerosis, and most often located in the descending thoracic aorta.
Intramural hematomas (IMH) are often found on CT-scans in patients with typical aortic pain. They are characterized by the presence of a hematoma in the media , but the absence of flow in the false lumen and the absence of a primary intimal tear. An intimal tear may, however, occur secondary to the IMH, complicating the distinction between an IMH and a thrombosed false lumen of an AD.
In 2000 Shimizu et al(1) published a series of 96 patients admitted on the diagnosis ”Aortic dissection”. On CT evaluation 51 of these turned out to have an IMH without an intimal tear. Interestingly, this subgroup of patients had a much better survival rate than the patients with ”true” AD. This observation prompted Vilacosta in 2001 to introduce the term ”Acute Aortic Syndrome” (AAS) (2), including AD, PAU, and IMH. While later observations from Asian populations confirmed the finding of IMH as a relatively common and benign condition, this does not seem to be the case in Western populations, where the incidence is relatively lower and the prognosis closer to that of patients with AD (3).
In a recent review, Nienaber and Powell added the clinical entities of leaking thoracic aneurysm and traumatic dissection or rupture to the definition of AAS (4).
The concept of AAS may have a justification by reminding clinicians that not all patients presenting with aortic pain have AD. It should, however, not lead us to believe that a treatment scheme that is based on evidence from treating one subgroup of patients with AAS is necessarily applicable to other subgroups.
1.Shimizu H, Yoshino H, Udagawa H, et al. Prognosis of Aortic Intramural Hemorrage compared With Classic Aortic Dissection. Am J Cardiol 2000;85:792-5
2.Vilacosta I, San Román JA. Acute Aortic Syndrome. Heart 2001;85:365-8
3.Pelzel JM, Braverman AC, Hirsch AT, et al. International heterogeneity in diagnostic frequency and clinical outcomes of ascending aortic intramural hematoma. J Am Soc Echocardiogr 2007;20:1260-8
4.Nienaber CA, Powell J. Management of Acute Aortic Syndromes. European Heart Journal 2012; 33:26-35
Original language | English |
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Publication date | 2015 |
Publication status | Published - 2015 |
Event | Dansk Karkirurgisk Selskabs Årsmøde - Aarhus, Denmark Duration: 23. Oct 2015 → 24. Oct 2015 Conference number: 2015 |
Conference
Conference | Dansk Karkirurgisk Selskabs Årsmøde |
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Number | 2015 |
Country/Territory | Denmark |
City | Aarhus |
Period | 23/10/2015 → 24/10/2015 |