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. 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 resulting in [[myocardial infarction]], involvement of the aortic arch to cause [[stroke]], dilation of the route to cause [[aortic insufficiency]], extension into the pericardium to cause [[pericardial tamponade]], 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:
*[[Pericardial tamponade]]
=== Cardiac===
*[[Acute aortic regurgitation]]  
* [[Aortic rupture]] leading to [[massive blood loss]], [[hypotension]] and [[shock]] often resulting in death. Indeed, aortic dissection accounts  for 3-4% of [[sudden deaths]].
*[[Myocardial ischemia]]
*[[Pericardial tamponade]] due to extension of the dissection into the pericardium
*[[Thoracic aortic aneurysm]]
*[[Acute aortic regurgitation]]due to the aortic dilation and dissection into the valve structure which can then cause acute [[pulmonary edema]]
*[[Renal ischemia]]
*[[Myocardial ischemia]] or [[myocardial infarction]] due to dissection into either the right or left coronary ostium (but most commonly the [[right coronary artery]])
*[[Superior mesenteric artery]] dissection and resultant [[visceral]] [[ischemia]]
*Redissection and aortic diameter enlargement
*[[Pleural effusion]]
*Aneurysmal dilatation and [[saccular aneurysm]] chronically
*[[Claudication]] due to an extension of the dissection into the [[iliac arteries]]


===Kidney===
======Neurologic Complications======
*[[Mesenteric]] and [[renal ischemia]]  due to dissection into the ostium of the parent vessels which can lead to [[hematuria]], [[renal infarction]], [[acute renal failure]], or visceral ischemia


===Peripheral Arterial===
*[[Ischemic]] [[cerebrovascular accident]] ([[CVA]]) due to dissection into the head [[vessel]]s
*[[Claudication]] due to an extension of the dissection into the iliac arteries
*[[Hemiplegia]] due to dissection into the [[spinal cord|spinal]] [[artery|arteries]]
*[[anesthesia|Hemianesthesia]] due to dissection into the [[spinal cord|spinal]] [[artery|arteries]]


===Neurologic===
===== Compression of Nearby Organs=====
*Ischemic [[cerebrovascular accident]] ([[CVA]]) due to dissection into the head vessels
*[[Hemiplegia]] due to dissection into the spinal arteries
*[[Hemianesthesia]] due to dissection into the spinal arteries


=== Compression of Nearby Organs===
*[[Superior vena cava syndrome]] due to compression of the [[superior vena cava]]
*Swelling of the neck and face (compression of the superior vena cava or [[Superior vena cava syndrome]])
*[[Horner syndrome]] (compression of the [[superior cervical ganglia]])
*[[Horner syndrome]] (compression of the [[superior cervical ganglia]])
*[[Dysphagia]] (compression of the [[esophagus]])
*[[Dysphagia]] due to (compression of the [[esophagus]])
*[[Stridor]] and [[wheezing]] (compression of the airway)
*[[Stridor]] and [[wheezing]] (compression of the airway)
*[[Hemoptysis]] (compression of and erosion into the [[bronchus]])
*[[Hemoptysis]] (compression of and erosion into the [[bronchus]])
*[[Vocal cord paralysis]] and [[hoarseness]] (compression of the [[recurrent laryngeal nerve]])
*[[Vocal cord paralysis]] and [[hoarseness]] (compression of the [[recurrent laryngeal nerve]])


==Prognosis==
===Prognosis===
The mortality rate is in large part determined by the patient's age and comorbidities.
 
*30% in hospital mortality
*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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Case #1


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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