Data are entered from a prospectively collected questionnaire of 290 variables and have been externally validated at each site. All patients with acute aortic dissection confirmed by diagnostic imaging studies, by direct visualization in the operating room, or at autopsy are included in the registry. It initially included 12 centers in 6 countries and has grown to 24 referral centers in 11 countries. The International Registry of Acute Aortic Dissection (IRAD) is a multinational registry that began enrolling patients in January of 1996. Death due to an acute dissection of the ascending aorta is usually secondary to the central cardioaortic complications of aortic rupture into the pericardium, acute aortic regurgitation, and coronary ostia compromise, 7, 8 whereas descending aortic dissections are more commonly associated with death from end-organ compromise due to obstruction of visceral or extremity vessels. Indeed, Khan et al 6 predicted that the mortality of acute dissection that is left untreated will exceed 22.7% within 6 hours, 50% within 24 hours, and 68% within the first week. This substantial mortality rate in undiagnosed patients underscores the importance of early diagnosis and initiation of appropriate therapy. In a population-based epidemiologic study by Clouse et al, 5 38% of aortic dissections were diagnosed at autopsy. 3, 4 Despite improvements in both medical and surgical therapeutic options, overall mortality associated with acute dissection remains significant. Early studies indicated that without treatment, the majority of patients with the condition died within 3 months of presentation and few survived the chronic phase more than 5 years because of aneurysmal degeneration and rupture of the outer wall of the false lumen. An additional source of diagnostic confusion is the presence of other pathologies of the thoracic aorta, such as intramural hematoma and penetrating aortic ulcer, which have clinical and radiographic similarity with acute dissection.Īortic dissection is a lethal disease. The terms dissection and aneurysm should not be used interchangeably although dissection can occur in a preexistent degenerative aneurysm and aneurysms can complicate chronic dissections, the presence of one does not depend on the other. The term anurysme dissequant, or dissecting aneurysm, introduced by Laennec in 1819, 2 remains a source of confusion because acute dissections can occur in both dilated diseased aortas and aortas of normal diameter in seemingly healthy individuals. The first report of aortic dissection and the concept of a true and false lumen is attributed to Shekelton 1 in the early 1800s. Acute aortic dissection is the most common catastrophic event affecting the aorta, with an incidence exceeding that of ruptured abdominal aortic aneurysm.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |