Management of Acute Aortic Syndromes

Acute aortic syndrome (AAS) is a modern term to describe interrelated emergency aortic conditions with similar clinical characteristics and challenges.

These conditions include aortic dissection, intramural haematoma (IMH), and penetrating atherosclerotic ulcer (PAU and aortic rupture); trauma to the aorta with intimal laceration may also be considered. The common denominator of AAS is disruption of the media layer of the aorta with bleeding within IMH, along the aortic media resulting in separation of the layers of the aorta (dissection), or transmurally through the wall in the case of ruptured PAU or trauma.

Population-based studies suggest that the incidence of acute dissection ranges from 2 to 3.5 cases per 100 000 person-years; hypertension and a variety of genetic disorders with altered connective tissues are the most prevalent risk conditions. Patients with AAS often present in a similar fashion, regardless of the underlying condition of dissection, IMH, PAU, or contained aortic rupture.

Pain is the most commonly presenting symptom of acute aortic dissection and should prompt immediate attention including diagnostic imaging modalities (such as multislice computed tomography, transoesophageal ultrasound, or magnetic resonance imaging).

Prognosis is clearly related to undelayed diagnosis and appropriate surgical repair in the case of proximal involvement of the aorta; affection of distal segments of the aorta may call for individualized therapeutic approaches favouring endovascular in the presence of malperfusion or imminent rupture, or medical management.

PMID: 21810861

Schoenhagen Paul

Cardiovascular Imaging
Imaging Institute and
Heart&Vascular Institite
Cleveland Clinic
Cleveland, OH
Posted in Magnetic Resonance Imaging and tagged , , , .

2 Comments

  1. See post from November 21, 2010

    Outcomes of patients with acute type a aortic intramural hematoma.
    Song JK, Yim JH, Ahn JM, Kim DH, Kang JW, Lee TY, Song JM, Choo SJ, Kang DH, Chung CH, Lee JW, Lim TH.
    Circulation. 2009 Nov 24;120(21):2046-52.
    PMID: 19901188

  2. This is a great review paper with lots of interesting information on a topic that never loses its relevance!

    Another great review from the imaging point of view was published a few years ago:

    Pathogenesis in acute aortic syndromes: aortic dissection, intramural hematoma, and penetrating atherosclerotic aortic ulcer.
    Macura KJ, Corl FM, Fishman EK, Bluemke DA.
    AJR Am J Roentgenol. 2003 Aug;181(2):309-16.
    PMID: 12876003

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