Acute aortic syndrome

Acute aortic syndrome
SpecialtyVascular surgery

Acute aortic syndrome (AAS) describes a range of severe, painful, potentially life-threatening abnormalities of the aorta.[1] These include aortic dissection, intramural thrombus, and penetrating atherosclerotic aortic ulcer.[2] AAS can be caused by a lesion on the wall of the aorta that involves the tunica media, often in the descending aorta.[3] It is possible for AAS to lead to acute coronary syndrome.[4] The term was introduced in 2001.[5][6]

Signs and symptoms

Causes

Causes can include aortic dissection (which is the most common type),[7] intramural hematoma, penetrating atherosclerotic ulcer or a thoracic aneurysm that has become unstable.[8] The potential causes of AAS are life-threatening and present with similar symptoms, making it difficult to distinguish the ultimate cause, though high resolution, high contrast computerised tomography can be used.[8][9]

Diagnosis

The condition can be mimicked by a ruptured cyst of the pericardium,[10] ruptured aortic aneurysm[9] and acute coronary syndrome.[11]

Misdiagnosis is estimated at 39% and is associated with delays correct diagnosis and improper treatment with anticoagulants producing excessive bleeding and extended hospital stays.[11]

Management

AAS is life-threatening, with a high mortality rate if appearing acutely, reduced only when diagnosed early and treated by a surgeon with considerable expertise.[3] If patients survive acute presentation, within three to five years 30% will develop complications and require close follow-up.[3] Early diagnosis is essential for survival and management is challenging though greater awareness of the syndrome and improving management strategies are improving patient outcomes.[12]

References

  1. ↑ Ahmad F, Cheshire N, Hamady M (May 2006). "Acute aortic syndrome: pathology and therapeutic strategies". Postgrad Med J. 82 (967): 305–12. doi:10.1136/pgmj.2005.043083. PMC 2563796. PMID 16679467.
  2. ↑ Macura, KJ; Corl FM; Fishman EK; Bluemke DA (1 August 2003). "Pathogenesis in acute aortic syndromes: aortic dissection, intramural hematoma, and penetrating atherosclerotic aortic ulcer". American Journal of Roentgenology. 181 (2): 309–316. doi:10.2214/ajr.181.2.1810309. PMID 12876003.
  3. 1 2 3 Evangelista Masip A (April 2007). "[Progress in the acute aortic syndrome]". Rev Esp Cardiol (in Spanish). 60 (4): 428–39. doi:10.1157/13101646. PMID 17521551.
  4. ↑ Manghat NE, Morgan-Hughes GJ, Roobottom CA (December 2005). "Multi-detector row computed tomography: imaging in acute aortic syndrome". Clin Radiol. 60 (12): 1256–67. doi:10.1016/j.crad.2005.06.011. PMID 16291307.
  5. ↑ van der Loo B, Jenni R (August 2003). "Acute aortic syndrome: proposal for a novel classification". Heart. 89 (8): 928. doi:10.1136/heart.89.8.928. PMC 1767786. PMID 12860875.
  6. ↑ Vilacosta I, Román JA (April 2001). "Acute aortic syndrome". Heart. 85 (4): 365–8. doi:10.1136/heart.85.4.365. PMC 1729697. PMID 11250953.
  7. ↑ Gregory, Stephen H.; Yalamuri, Suraj M.; Bishawi, Muath; Swaminathan, Madhav (December 2018). "The Perioperative Management of Ascending Aortic Dissection". Anesthesia & Analgesia. 127 (6): 1302–1313. doi:10.1213/ANE.0000000000003747. ISSN 0003-2999. PMID 30211773. S2CID 52195386.
  8. 1 2 Smith AD, Schoenhagen P (January 2008). "CT imaging for acute aortic syndrome". Cleve Clin J Med. 75 (1): 7–9, 12, 15–7 passim. doi:10.3949/ccjm.75.1.7. PMID 18236724.
  9. 1 2 Marijon E, Vilanculos A, Tivane A, et al. (2007). "Thoracic aortic aneurysm: direct sign of rupture". Cardiovasc J Afr. 18 (3): 180–1. PMID 17612751.
  10. ↑ Nishigami K, Hirayama T, Kamio T (February 2008). "Pericardial cyst rupture mimicking acute aortic syndrome". Eur. Heart J. 29 (14): 1752. doi:10.1093/eurheartj/ehn038. PMID 18296680.
  11. 1 2 Hansen MS, Nogareda GJ, Hutchison SJ (March 2007). "Frequency of and inappropriate treatment of misdiagnosis of acute aortic dissection". Am. J. Cardiol. 99 (6): 852–6. doi:10.1016/j.amjcard.2006.10.055. PMID 17350381.
  12. ↑ Ince H, Nienaber CA (May 2007). "[Management of acute aortic syndromes]". Rev Esp Cardiol (in Spanish). 60 (5): 526–41. doi:10.1016/S1885-5857(07)60194-7. PMID 17535765.
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