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Review
. 2022 Mar;24(3):209-216.
doi: 10.1007/s11886-022-01642-3. Epub 2022 Jan 14.

Diagnosis and Management of Acute Aortic Syndromes: Dissection, Penetrating Aortic Ulcer, and Intramural Hematoma

Rebecca Sorber  1 , Caitlin W Hicks  2
Affiliations
Review

Diagnosis and Management of Acute Aortic Syndromes: Dissection, Penetrating Aortic Ulcer, and Intramural Hematoma

Rebecca Sorber et al. Curr Cardiol Rep. 2022 Mar.

Abstract

Purpose of review: Acute aortic syndromes, including aortic dissection, intramural hematoma, and penetrating aortic ulcer, are a group of highly morbid, related pathologies that are defined by compromised aortic wall integrity. The purpose of this review is to summarize current management strategies for acute aortic syndromes.

Recent findings: All acute aortic syndromes have potential for high morbidity and mortality and must be quickly identified and managed with the appropriate algorithm to prevent suboptimal outcomes. Recent trials suggest that TEVAR is increasingly useful in stabilizing pathology of the descending thoracic aorta but when possible should be applied in a delayed fashion and with limited coverage to minimize neurologic complications. Treatment for acute aortic syndrome is frequently dictated by the anatomic location and extent of the wall compromise as well as patient comorbidities. Therapy is often individualized and often includes some combination of medical, procedural, and surgical intervention.

Keywords: Acute aortic syndrome; Aortic dissection; Intramural hematoma; Penetrating aortic ulcer; TEVAR; Type B dissection.

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Conflict of interest statement

Conflict of Interest Dr. Hicks reports grants from NIH/NIDDK, the Society for Vascular Surgery, and the American College of Surgeons, and others from Cook Medical Inc. and W.L. Gore & Associates, outside the submitted work. The authors declare that they have no conflicts of interest or relevant financial relationships to disclose. This work did not receive funding from any public or private institution or individual.

Figures

Fig. 1
Fig. 1
a 84F with acute TAAD requiring surgical repair. b 42 M with hypertensive crisis and TBAD. c 84F with thickening and intramural hematoma of the descending thoracic aorta. d 78F with penetrating aortic ulcer of the abdominal aorta adjacent to the celiac axis
See this image and copyright information in PMC

References

    1. Bonaca MP, O’Gara PT. Diagnosis and management of acute aortic syndromes: dissection, intramural hematoma and penetrating aortic ulcer. Curr Cardiol Rep. 2014:16:536. - PubMed
    1. Mussa FF, Horton JD, Moridzadeh R, et al. Acute aortic dissection and intramural hematoma: a systematic review. JAMA. 2016:316(7):754–63. - PubMed
    1. Harris KM, Strauss CE, Eagle KA, et al. Correlates of delayed recognition and treatment of acute type A aortic dissection: the International Registry of Acute Aortic Dissection (IRAD). Circulation. 2011:124:1911–8. - PubMed
    1. Abdulameer H, Al Tail H, Al-Kindi SG, et al. Epidemiology of fatal ruptured aortic aneurysms in the United States (1999–2016). J Vase Surg. 2019:69:378–84. - PubMed
    1. Virani SS, Alonso A, Aparicio HJ, et al. Heart disease and stroke statistics—2021 update: a report from the American Heart Association. Circulation. 2021;143(8):e254–e743. - PubMed