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ALL ABOUT AORTIC DISSECTIONS
Estrera A. L. 1, De Rango P. 2, Safi H. J. 1
1 Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School, Memorial Hermann Heart and Vascular Institute,Houston, TX, USA
2 Division of Vascular and Endovascular Surgery, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
Acute aortic dissection remains the most common of all aortic catastrophes and is associated with significant morbidity and mortality. Early identification and initial assessment are critical for the successful management in order to achieve good outcomes in patients with this disease. A high index of suspicion for aortic dissection must be maintained when evaluating patients with chest and back pain. Multi-detector computed tomography angiography (CTA) and transesophageal echocardiography (TEE) are today the main imaging methods for confirming diagnosis and determining what portion of the aorta is involved. Acute type B aortic dissection can be managed medically with favorable early results. Urgent surgical intervention should be considered in all patients with acute type A aortic dissection. In our experience, immediate repair is performed for those who are hypotensive due to rupture and tamponade, and who exhibit malperfusion of the coronary, cerebrovascular, visceral, or peripheral arterial systems. Urgent repair should not be precluded in patients presenting with active stroke, older age, and previous cardiac surgery. Optimal medical management (including adequate anti-impulse therapy) should be applied to all patients with acute dissection, regardless of the method of repair and the comorbidities. Ultimately, each patient with acute dissection should have individualized treatment, with the decision to intervene left to the surgeon.