Current Understanding of Aortic Dissection

Overview

Journal Life (Basel)

Specialty Biology

Date 2022 Oct 27

PMID 36295040

Authors

Xun Yuan

Andreas Mitsis

Christoph A Nienaber

Affiliations

Soon will be listed here.

Abstract

The aorta is the largest artery in the body, delivering oxygenated blood from the left ventricle to all organs. Dissection of the aorta is a lethal condition caused by a tear in the intimal layer of the aorta, followed by blood loss within the aortic wall and separation of the layers to full dissection. The aorta can be affected by a wide range of causes including acute conditions such as trauma and mechanical damage; and genetic conditions such as arterial hypertension, dyslipidaemia, and connective tissue disorders; all increasing the risk of dissection. Both rapid diagnostic recognition and advanced multidisciplinary treatment are critical in managing aortic dissection patients. The treatment depends on the severity and location of the dissection. Open surgical repair is the gold standard of treatment for dissections located to the proximal part of the aorta and the arch, while endovascular interventions are recommended for most distal or type B aortic dissections. In this review article, we examine the epidemiology, pathophysiology, contemporary diagnoses, and management of aortic dissection.

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References

Bogdan Y, Hines G . Management of acute complicated and uncomplicated type B dissection of the aorta: focus on endovascular stent grafting. Cardiol Rev. 2010; 18(5):234-9. DOI: 10.1097/CRD.0b013e3181e883c9. View

Clouse W, Hallett Jr J, Schaff H, Spittell P, Rowland C, Ilstrup D . Acute aortic dissection: population-based incidence compared with degenerative aortic aneurysm rupture. Mayo Clin Proc. 2004; 79(2):176-80. DOI: 10.4065/79.2.176. View

Hiratzka L, Bakris G, Beckman J, Bersin R, Carr V, Casey Jr D . 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.... Circulation. 2010; 121(13):e266-369. DOI: 10.1161/CIR.0b013e3181d4739e. View

Acosta S, Blomstrand D, Gottsater A . Epidemiology and long-term prognostic factors in acute type B aortic dissection. Ann Vasc Surg. 2007; 21(4):415-22. DOI: 10.1016/j.avsg.2007.01.012. View

Castro-Verdes M, Yuan X, Mitsis A, Li W, Nienaber C . Transesophageal Ultrasound Guidance for Endovascular Interventions on the Aorta. Aorta (Stamford). 2022; 10(1):3-12. PMC: 9179212. DOI: 10.1055/s-0042-1743107. View

Landenhed M, Engstrom G, Gottsater A, Caulfield M, Hedblad B, Newton-Cheh C . Risk profiles for aortic dissection and ruptured or surgically treated aneurysms: a prospective cohort study. J Am Heart Assoc. 2015; 4(1):e001513. PMC: 4330075. DOI: 10.1161/JAHA.114.001513. View

Yin H, Pickering J . Cellular Senescence and Vascular Disease: Novel Routes to Better Understanding and Therapy. Can J Cardiol. 2016; 32(5):612-23. DOI: 10.1016/j.cjca.2016.02.051. View

Riambau V, Bockler D, Brunkwall J, Cao P, Chiesa R, Coppi G . Editor's Choice - Management of Descending Thoracic Aorta Diseases: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2017; 53(1):4-52. DOI: 10.1016/j.ejvs.2016.06.005. View

Ante M, Mylonas S, Skrypnik D, Bischoff M, Rengier F, Brunkwall J . Prevalence of the Computed Tomographic Morphological DISSECT Predictors in Uncomplicated Stanford Type B Aortic Dissection. Eur J Vasc Endovasc Surg. 2018; 56(4):525-533. DOI: 10.1016/j.ejvs.2018.06.033. View

10.

Kreibich M, Siepe M, Berger T, Kondov S, Morlock J, Pingpoh C . The Frozen Elephant Trunk Technique for the Treatment of Type B and Type Non-A Non-B Aortic Dissection. Eur J Vasc Endovasc Surg. 2020; 61(1):107-113. DOI: 10.1016/j.ejvs.2020.08.040. View

11.

Nienaber C, Clough R . Management of acute aortic dissection. Lancet. 2015; 385(9970):800-11. DOI: 10.1016/S0140-6736(14)61005-9. View

12.

Norton E, Wu X, Farhat L, Kim K, Patel H, Deeb G . Dissection of Arch Branches Alone: An Indication for Aggressive Arch Management in Type A Dissection?. Ann Thorac Surg. 2019; 109(2):487-494. PMC: 6982577. DOI: 10.1016/j.athoracsur.2019.06.060. View

13.

Deng H, Lu Q, Xu H, Deng X, Yuan L, Yang Z . Identification of a Novel Missense FBN2 Mutation in a Chinese Family with Congenital Contractural Arachnodactyly Using Exome Sequencing. PLoS One. 2016; 11(5):e0155908. PMC: 4873217. DOI: 10.1371/journal.pone.0155908. View

14.

Bossone E, Eagle K . Epidemiology and management of aortic disease: aortic aneurysms and acute aortic syndromes. Nat Rev Cardiol. 2020; 18(5):331-348. DOI: 10.1038/s41569-020-00472-6. View

15.

Yuan X, Mitsis A, Semple T, Castro Verdes M, Cambronero-Cortinas E, Tang Y . False lumen intervention to promote remodelling and thrombosis-The FLIRT concept in aortic dissection. Catheter Cardiovasc Interv. 2018; 92(4):732-740. DOI: 10.1002/ccd.27599. View

16.

Luo W, Wang Y, Zhang L, Ren P, Zhang C, Li Y . Critical Role of Cytosolic DNA and Its Sensing Adaptor STING in Aortic Degeneration, Dissection, and Rupture. Circulation. 2019; 141(1):42-66. PMC: 6939474. DOI: 10.1161/CIRCULATIONAHA.119.041460. View

17.

Yuan X, Castro Verdes M, Capoccia M, Rosendahl U, Nienaber C . Urgent endovascular aortic dissection repair in a Marfan patient during COVID-19 pandemic. Clin Case Rep. 2021; 9(8):e04634. PMC: 8365008. DOI: 10.1002/ccr3.4634. View

18.

An K, de Mestral C, Tam D, Qiu F, Ouzounian M, Lindsay T . Surveillance Imaging Following Acute Type A Aortic Dissection. J Am Coll Cardiol. 2021; 78(19):1863-1871. DOI: 10.1016/j.jacc.2021.08.058. View

19.

Huckaby L, Sultan I, Trimarchi S, Leshnower B, Chen E, Brinster D . Sex-Based Aortic Dissection Outcomes From the International Registry of Acute Aortic Dissection. Ann Thorac Surg. 2021; 113(2):498-505. PMC: 9015734. DOI: 10.1016/j.athoracsur.2021.03.100. View

20.

Tieu B, Lee C, Sun H, LeJeune W, Recinos 3rd A, Ju X . An adventitial IL-6/MCP1 amplification loop accelerates macrophage-mediated vascular inflammation leading to aortic dissection in mice. J Clin Invest. 2009; 119(12):3637-51. PMC: 2786788. DOI: 10.1172/JCI38308. View