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Thoracic aortic dissections 

Thoracic aortic dissections
Chapter:
Thoracic aortic dissections
Author(s):

Ian M. Nordon

DOI:
10.1093/med/9780199658220.003.0059
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date: 23 October 2019

Thoracic aortic dissection (TAD) is the progressive separation of the layers of the thoracic aortic wall. TAD is most common in men, generally occurring in the sixth decade of life. Principle risk factors are hypertension, connective tissue disease, and bicuspid aortic valve. Key steps in TAD pathogenesis are aortic wall inflammation, apoptosis of vascular smooth muscle cells, degeneration of aortic media, elastin fracture, and subsequent vessel dissection. TADs are classified according to morphology, duration, and whether they are associated with life-threatening complications. Surgical repair of proximal (type A) dissection should be performed as early as possible. Primary management of uncomplicated distal (type B) dissection is medical, although trials are currently investigating the role of early endovascular repair. Complicated type B aortic dissection mandates surgical or endovascular intervention. Once dissected the remainder of the aorta is vulnerable to dilatation and should be closely monitored.

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