Aortic dissection natural history, complications and prognosis: Difference between revisions
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==Complications== | ==Complications== | ||
The complications of aortic dissection include: | The complications of aortic dissection include: | ||
* | === Cardiac=== | ||
*[[ | * [[Aortic rupture]] leading to [[massive blood loss]], [[hypotension]] and [[shock]] often resulting in death. Indeed, aortic dissection accounts for 3-4% of [[sudden deaths]]. | ||
*[[Pericardial tamponade]] due to extension of the dissection into the pericardium | |||
*[[Acute aortic regurgitation]]due to the aortic dissection | *[[Acute aortic regurgitation]]due to the aortic dilation and dissection into the valve structure which can then cause acute [[pulmonary edema]] | ||
*[[Myocardial ischemia]] or [[myocardial infarction]] due to dissection into either the right or left coronary ostium (but most commonly the [[right coronary artery]]) | |||
*[[Myocardial ischemia]] or myocardial infarction due to | *Redissection and aortic diameter enlargement | ||
*[[Mesenteric]] and [[renal ischemia]] | *Aneurysmal dilatation and [[saccular aneurysm]] chronically | ||
===Kidney=== | |||
*[[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=== | |||
*[[Claudication]] due to an extension of the dissection into the iliac arteries | *[[Claudication]] due to an extension of the dissection into the iliac arteries | ||
Neurologic | ===Neurologic=== | ||
*Ischemic [[cerebrovascular accident]] ([[CVA]]) due to dissection into the head vessels | *Ischemic [[cerebrovascular accident]] ([[CVA]]) due to dissection into the head vessels | ||
*[[Hemiplegia]] due to dissection into the spinal arteries | *[[Hemiplegia]] due to dissection into the spinal arteries | ||
*[[Hemianesthesia]] due to dissection into the spinal arteries | *[[Hemianesthesia]] due to dissection into the spinal arteries | ||
=== Compression of Nearby Organs=== | |||
*[[Superior vena cava syndrome]] | *[[Superior vena cava syndrome]] | ||
*[[Horner syndrome]] ( | *[[Horner syndrome]] (compression of the superior cervical ganglia) | ||
*[[Dysphagia]] (involves the esophagus) | *[[Dysphagia]] (involves the esophagus) | ||
*Airway compromise | *Airway compromise with [[stridor]] and [[wheezing]] | ||
*[[Hemoptysis]] (involves the compression of the bronchus) | *[[Hemoptysis]] (involves the compression of the bronchus) | ||
*[[Vocal cord paralysis]] and hoarseness | *[[Vocal cord paralysis]] and hoarseness | ||
Revision as of 00:01, 29 October 2012
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Aortic dissection Microchapters |
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Diagnosis |
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Treatment |
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Special Scenarios |
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Case Studies |
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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]
Overview
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.
Natural History
If the patient remains untreated, the mortality is:
- 1% per hour during the first day
- 75% at 2 weeks
- 90% at 1 year
Complications
The complications of aortic dissection include:
Cardiac
- Aortic rupture leading to massive blood loss, hypotension and shock often resulting in death. Indeed, aortic dissection accounts for 3-4% of sudden deaths.
- Pericardial tamponade due to extension of the dissection into the pericardium
- Acute aortic regurgitationdue to the aortic dilation and dissection into the valve structure which can then cause acute pulmonary edema
- Myocardial ischemia or myocardial infarction due to dissection into either the right or left coronary ostium (but most commonly the right coronary artery)
- Redissection and aortic diameter enlargement
- Aneurysmal dilatation and saccular aneurysm chronically
Kidney
- 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
- Claudication due to an extension of the dissection into the iliac arteries
Neurologic
- 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
- Horner syndrome (compression of the superior cervical ganglia)
- Dysphagia (involves the esophagus)
- Airway compromise with stridor and wheezing
- Hemoptysis (involves the compression of the bronchus)
- Vocal cord paralysis and hoarseness
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
- Surgical treatment-30% mortality rate
- Medical treatment-60% mortality rate
Type B aortic dissection
- Surgical treatment-10% mortality rate
- Medical treatment- 30% mortality rate