Show Summary Details
Page of

Aortic emergencies 

Aortic emergencies
Chapter:
Aortic emergencies
Author(s):

Parla Astarci

, Laurent de Kerchove

, and Gébrine el Khoury

DOI:
10.1093/med/9780199687039.003.0061

February 22, 2018: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

Page of

PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2016. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy and Legal Notice).

date: 22 October 2019

Acute aortic dissections account for the leading and most feared of aortic emergencies. Acute dissections are associated with a dreadful mortality rate; therefore, an accurate diagnosis and immediate treatment are mandatory. The key point of a lifesaving management strategy is the distinction between acute type A dissection, uncomplicated type B dissection, and complicated type B dissection, and those including contained ruptured aorta (severe pleural effusion) and/or malperfusion syndrome (by end-organ ischaemia: paraplegia, intestinal ischaemia, renal insufficiency, limb ischaemia). Type A generally requires urgent surgery; uncomplicated type B dissections are treated conservatively, while complicated type B dissections are currently managed by means of minimally invasive endovascular techniques, eventually associated with a tight surgical time (e.g. in the case of limb ischaemia). Surgical repair of type A dissection consists of the replacement of the ascending aorta. The repair is extended proximally towards the aortic root and valve, and distally towards the aortic arch, in function of the lesions found and the clinical presentation of the patient (haemodynamic status, age, comorbidities). The emergence of endovascular techniques and the contribution of thoracic endovascular aortic repair, with thoracic stent-grafts deployed from the proximal descending aorta to reopen the true lumen and to seal the entry tear in type B dissections, have revolutionized the surgical treatment algorithm in this pathology, and thus the patient’s immediate and medium-term survival. In the same group of acute aortic syndromes, traumatic aortic isthmic ruptures are also life-threatening conditions and account for one of the main causes of death at the time of traumatic accidents. As in the case of complicated type B dissections, the introduction of aortic stent-grafts has changed the outcome of these patients.

Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.

Please subscribe or login to access full text content.

If you have purchased a print title that contains an access token, please see the token for information about how to register your code.

For questions on access or troubleshooting, please check our FAQs, and if you can't find the answer there, please contact us.