Title:Aortic Dissection: A Review of the Pathophysiology, Management and Prospective Advances
Volume: 17
Issue: 4
Author(s): Ahmed Sayed*, Malak Munir and Eshak I. Bahbah
Affiliation:
- Faculty of Medicine, Ain Shams University, Cairo,Egypt
Keywords:
Aortic dissection, acute aortic syndrome, endovascular surgery, aortic replacement, cardiovascular emergency,
D-dimer.
Abstract: Aortic dissection is an emergent medical condition, generally affecting the elderly, characterized
by a separation of the aortic wall layers and subsequent creation of a pseudolumen that
may compress the true aortic lumen. Predisposing factors mediate their risk by either increasing tension
on the wall or by causing structural degeneration. They include hypertension, atherosclerosis,
and a number of connective tissue diseases. If it goes undetected, aortic dissection carries a significant
mortality risk; therefore, a high degree of clinical suspicion and a prompt diagnosis are required
to maximize survival chances. Imaging methods, most commonly a CT scan, are essential
for diagnosis; however, several studies have also investigated the effect of several biomarkers to
aid in the detection of the condition. The choice of intervention varies depending on the type of dissection,
with open surgical repair remaining of choice in those with type. In dissections, however,
the role of conventional open surgery has considerably diminished in complicated type B dissections,
with endovascular repair, a much less invasive technique, proving to be more effective. In uncomplicated
type B dissections, where medical choice reigned supreme as the optimal intervention,
endovascular repair is being explored as a viable option which may reduce long- term mortality outcomes,
although the ideal intervention in this situation is far from settled.
