Aortic dissection natural history, complications and prognosis: Difference between revisions

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{{Template:Aortic dissection}}
{{Template:Aortic dissection}}
{{CMG}}; '''Associate Editor-In-Chief:'''  {{CZ}}{{Sahar}}
==Overview==
The [[symptoms]] of aortic dissection usually develop in the fifth decade of life and start with [[symptoms]] such as sudden onset [[Chest pain|chest]]/[[back pain]]. If left untreated, [[patients]] with aortic dissection may progress to develop [[aortic regurgitation]], [[myocardial ischemia]], and [[cardiac tamponade]]. The [[complications]] of aortic dissection include but not limited to [[aortic rupture]], [[pericardial tamponade]], [[myocardial ischemia]], compression of nearby organs and etc. Aortic dissection carries a poor [[prognosis]]. [[Mortality rate]] differs based on the type of dissection and is higher in type A compared to type B (25% versus 12%).
== Natural History, Complications, and Prognosis ==


{{CMG}}; '''Associate Editor-In-Chief:'''  {{CZ}}
=== Natural History ===


==Overview==
*The [[symptoms]] of aortic dissection usually develop in the fifth decade of life and start with [[symptoms]] such as sudden onset [[Chest pain|chest]]/[[back pain]].<ref name="JuangBraverman2008">{{cite journal|last1=Juang|first1=Derek|last2=Braverman|first2=Alan C.|last3=Eagle|first3=Kim|title=Aortic Dissection|journal=Circulation|volume=118|issue=14|year=2008|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.108.799908}}</ref>
Aortic dissection carries a very poor prognosis if left untreated. 90% of patients who are untreated will be dead at one year.  Type A dissection is associated with a worse prognosis than type B dissection.  aortic dissection can be complicated by extension to the coronary arteries in myocardial infarction, involvement of the aortic arch to cause stroke, dilation of the route to cause aortic insufficiency and heart failure, and aortic rupture.
*If left untreated, [[patients]] with aortic dissection may progress to develop [[aortic regurgitation]], [[myocardial ischemia]], and [[cardiac tamponade]].


== Natural History ==
===Complications===
If the patient remains untreated, the mortality is:
The complications of aortic dissection include:<ref name="CambriaBrewster1988">{{cite journal|last1=Cambria|first1=Richard P.|last2=Brewster|first2=David C.|last3=Gertler|first3=Jonathan|last4=Moncure|first4=Ashby C.|last5=Gusberg|first5=Richard|last6=Tilson|first6=M.David|last7=Darling|first7=R.Clement|last8=Hammond|first8=Grahme|last9=Megerman|first9=Joseph|last10=Abbott|first10=William M.|title=Vascular complications associated with spontaneous aortic dissection|journal=Journal of Vascular Surgery|volume=7|issue=2|year=1988|pages=199–209|issn=07415214|doi=10.1016/0741-5214(88)90137-1}}</ref><ref name="FadahunsiRomeo2014">{{cite journal|last1=Fadahunsi|first1=Opeyemi|last2=Romeo|first2=Michael|title=Cardiac tamponade – presentation of type A aortic dissection|journal=Journal of Community Hospital Internal Medicine Perspectives|volume=4|issue=5|year=2014|pages=25449|issn=2000-9666|doi=10.3402/jchimp.v4.25449}}</ref><ref name="CaiCao2012">{{cite journal|last1=Cai|first1=Jingjing|last2=Cao|first2=Yu|last3=Yuan|first3=Hong|last4=Yang|first4=Kan|last5=Zhu|first5=Yuan-Shan|title=Inferior myocardial infarction secondary to aortic dissection associated with bicuspid aortic valve|journal=Journal of Cardiovascular Disease Research|volume=3|issue=2|year=2012|pages=138–142|issn=09753583|doi=10.4103/0975-3583.95370}}</ref><ref name="SiegelmanSprayregen1970">{{cite journal|last1=Siegelman|first1=Stanley S.|last2=Sprayregen|first2=Seymour|last3=Strasberg|first3=Zeno|last4=Attai|first4=Lari A.|last5=Robinson|first5=George|title=Aortic Dissection and the Left Renal Artery|journal=Radiology|volume=95|issue=1|year=1970|pages=73–78|issn=0033-8419|doi=10.1148/95.1.73}}</ref><ref name="BlancoDíez-Tejedor1999">{{cite journal|last1=Blanco|first1=M.|last2=Díez-Tejedor|first2=E.|last3=Larrea|first3=J. L.|last4=Ramírez|first4=U.|title=Neurologic complications of type I aortic dissection|journal=Acta Neurologica Scandinavica|volume=99|issue=4|year=1999|pages=232–235|issn=00016314|doi=10.1111/j.1600-0404.1999.tb07352.x}}</ref><ref name="ArataImagama2015">{{cite journal|last1=Arata|first1=Kenichi|last2=Imagama|first2=Itsumi|last3=Shigehisa|first3=Yoshiya|last4=Mukaihara|first4=Kousuke|last5=Toyokawa|first5=Kenji|last6=Matsuba|first6=Tomoyuki|last7=Imoto|first7=Yutaka|title=Aortic Fenestration for Type B Chronic Aortic Dissection Complicated with Lower Limb Malperfusion Induced by Walking Exercise|journal=Annals of Vascular Diseases|volume=8|issue=1|year=2015|pages=29–32|issn=1881-641X|doi=10.3400/avd.cr.14-00101}}</ref>
* 1% per hour during the first day
==== Cardiovascualr Complications====
* 75% at 2 weeks
* 90% at 1 year


==Complications==
*[[Aortic rupture]]
The complications of aortic dissection include:
* The aorta may rupture, leading to [[massive blood loss]] resulting in death. Indeed, aortic dissection accounts  for 3-4% of [[sudden deaths]].
*[[Hypotension]] and [[shock]] due to [[aortic rupture]]
*[[Pericardial tamponade]]
*[[Pericardial tamponade]]
*[[Acute aortic regurgitation]]due to the aortic dissection generating into [[Valsalva]] with an aortic valve insufficiency
*[[Acute aortic regurgitation]]  
*[[Pulmonary edema]]
*[[Myocardial ischemia]]
*[[Myocardial ischemia]] or myocardial infarction due to involvement from the right or left coronary ostium (but most commonly the [[right coronary artery]] is involved
*[[Thoracic aortic aneurysm]]
*[[Mesenteric]] and [[renal ischemia]]- can lead to [[hematuria]], [[renal infarction]], [[acute renal failure]], or visceral ischemia
*[[Renal ischemia]]
*[[Claudication]] due to an extension of the dissection into the iliac arteries
*[[Superior mesenteric artery]] dissection and resultant [[visceral]] [[ischemia]]
*Redissection and aortic diameter enlargement
*[[Pleural effusion]]
*Aneurysmal dilatation and [[saccular aneurysm]]
*[[Claudication]] due to an extension of the dissection into the [[iliac arteries]]
 
======Neurologic Complications======


Neurologic findings include:
*[[Ischemic]] [[cerebrovascular accident]] ([[CVA]]) due to dissection into the head [[vessel]]s
*Ischemic [[cerebrovascular accident]] ([[CVA]])
*[[Hemiplegia]] due to dissection into the [[spinal cord|spinal]] [[artery|arteries]]
*[[Hemiplegia]]
*[[anesthesia|Hemianesthesia]] due to dissection into the [[spinal cord|spinal]] [[artery|arteries]]
*[[Hemianesthesia]]


Compressive symptoms include:
===== Compression of Nearby Organs=====
*[[Superior vena cava syndrome]]
*[[Horner syndrome]] (involves superior cervical ganglia)
*[[Dysphagia]] (involves the esophagus)
*Airway compromise
*[[Hemoptysis]] (involves the compression of the bronchus)
*[[Vocal cord paralysis]] and hoarseness


==Prognosis==
*[[Superior vena cava syndrome]] due to compression of the [[superior vena cava]]
The mortality rate is in large part determined by the patient's age and comorbidities.
*[[Horner syndrome]] (compression of the [[superior cervical ganglia]])
*[[Dysphagia]] due to (compression of the [[esophagus]])
*[[Stridor]] and [[wheezing]] (compression of the airway)
*[[Hemoptysis]] (compression of and erosion into the [[bronchus]])
*[[Vocal cord paralysis]] and [[hoarseness]] (compression of the [[recurrent laryngeal nerve]])


*30% in hospital mortality
===Prognosis===
*60% 10-year survival rate among treated patients


Type A aortic dissection
*Aortic dissection carries a poor [[prognosis]].<ref>{{cite journal|title=Correspondence|journal=The Annals of Thoracic Surgery|volume=67|issue=2|year=1999|pages=593|issn=00034975|doi=10.1016/S0003-4975(99)00037-5}}</ref>
*Surgical treatment-30% mortality rate
*[[Mortality rate]] differs based on the type of dissection and is higher in type A compared to type B (25% versus 12%).
*Medical treatment-60% mortality rate
Type B aortic dissection
*Surgical treatment-10% mortality rate
*Medical treatment- 30% mortality rate


== References ==
== References ==
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Latest revision as of 15:54, 24 December 2019

Aortic dissection Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] Sahar Memar Montazerin, M.D.[3]

Overview

The symptoms of aortic dissection usually develop in the fifth decade of life and start with symptoms such as sudden onset chest/back pain. If left untreated, patients with aortic dissection may progress to develop aortic regurgitation, myocardial ischemia, and cardiac tamponade. The complications of aortic dissection include but not limited to aortic rupture, pericardial tamponade, myocardial ischemia, compression of nearby organs and etc. Aortic dissection carries a poor prognosis. Mortality rate differs based on the type of dissection and is higher in type A compared to type B (25% versus 12%).

Natural History, Complications, and Prognosis

Natural History

Complications

The complications of aortic dissection include:[2][3][4][5][6][7]

Cardiovascualr Complications

Neurologic Complications
Compression of Nearby Organs

Prognosis

  • Aortic dissection carries a poor prognosis.[8]
  • Mortality rate differs based on the type of dissection and is higher in type A compared to type B (25% versus 12%).

References

  1. ↑ Juang, Derek; Braverman, Alan C.; Eagle, Kim (2008). "Aortic Dissection". Circulation. 118 (14). doi:10.1161/CIRCULATIONAHA.108.799908. ISSN 0009-7322.
  2. ↑ Cambria, Richard P.; Brewster, David C.; Gertler, Jonathan; Moncure, Ashby C.; Gusberg, Richard; Tilson, M.David; Darling, R.Clement; Hammond, Grahme; Megerman, Joseph; Abbott, William M. (1988). "Vascular complications associated with spontaneous aortic dissection". Journal of Vascular Surgery. 7 (2): 199–209. doi:10.1016/0741-5214(88)90137-1. ISSN 0741-5214.
  3. ↑ Fadahunsi, Opeyemi; Romeo, Michael (2014). "Cardiac tamponade – presentation of type A aortic dissection". Journal of Community Hospital Internal Medicine Perspectives. 4 (5): 25449. doi:10.3402/jchimp.v4.25449. ISSN 2000-9666.
  4. ↑ Cai, Jingjing; Cao, Yu; Yuan, Hong; Yang, Kan; Zhu, Yuan-Shan (2012). "Inferior myocardial infarction secondary to aortic dissection associated with bicuspid aortic valve". Journal of Cardiovascular Disease Research. 3 (2): 138–142. doi:10.4103/0975-3583.95370. ISSN 0975-3583.
  5. ↑ Siegelman, Stanley S.; Sprayregen, Seymour; Strasberg, Zeno; Attai, Lari A.; Robinson, George (1970). "Aortic Dissection and the Left Renal Artery". Radiology. 95 (1): 73–78. doi:10.1148/95.1.73. ISSN 0033-8419.
  6. ↑ Blanco, M.; Díez-Tejedor, E.; Larrea, J. L.; Ramírez, U. (1999). "Neurologic complications of type I aortic dissection". Acta Neurologica Scandinavica. 99 (4): 232–235. doi:10.1111/j.1600-0404.1999.tb07352.x. ISSN 0001-6314.
  7. ↑ Arata, Kenichi; Imagama, Itsumi; Shigehisa, Yoshiya; Mukaihara, Kousuke; Toyokawa, Kenji; Matsuba, Tomoyuki; Imoto, Yutaka (2015). "Aortic Fenestration for Type B Chronic Aortic Dissection Complicated with Lower Limb Malperfusion Induced by Walking Exercise". Annals of Vascular Diseases. 8 (1): 29–32. doi:10.3400/avd.cr.14-00101. ISSN 1881-641X.
  8. ↑ "Correspondence". The Annals of Thoracic Surgery. 67 (2): 593. 1999. doi:10.1016/S0003-4975(99)00037-5. ISSN 0003-4975.

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