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==Overview== | ==Overview== | ||
'''Acute aortic syndrome''' ('''AAS''') describes a range of severe, [[pain]]ful, potentially life-threatening abnormalities of the [[aorta]].<ref name="pmid16679467">{{cite journal |author=Ahmad F, Cheshire N, Hamady M |title=Acute aortic syndrome: pathology and therapeutic strategies |journal=Postgrad Med J |volume=82 |issue=967 |pages=305–12 |date=May 2006 |pmid=16679467 |doi=10.1136/pgmj.2005.043083 |url=http://pmj.bmjjournals.com/cgi/pmidlookup?view=long&pmid=16679467 |pmc=2563796}}</ref> These include [[aortic dissection]], intramural [[thrombus]], and [[penetrating atherosclerotic ulcer|penetrating atherosclerotic aortic ulcer]].<ref name="Macura">{{cite journal | last=Macura | first=KJ |author2=Corl FM|author3=Fishman EK|author4=Bluemke DA | title=Pathogenesis in acute aortic syndromes: aortic dissection, intramural hematoma, and penetrating atherosclerotic aortic ulcer | journal=American Journal of Roentgenology | volume=181 | issue=2 | pages=309–316 | date=1 August 2003 | pmid=12876003 | url=http://www.ajronline.org/cgi/content/full/181/2/309 | accessdate=2008-05-28 | doi=10.2214/ajr.181.2.1810309}}</ref> AAS can be caused by a [[lesion]] on the wall of the [[aorta]] that involves the [[tunica media]], often in the [[descending aorta]].<ref name="pmid17521551">{{cite journal |author=Evangelista Masip A |title=[Progress in the acute aortic syndrome] |language=Spanish; Castilian |journal=Rev Esp Cardiol |volume=60 |issue=4 |pages=428–39 |date=April 2007 |pmid=17521551 | url=http://www.revespcardiol.org/cgi-bin/wdbcgi.exe/cardio/mrevista_cardio.pubmed_full?inctrl=05ZI0113&vol=60&num=4&pag=428 |doi=10.1157/13101646}}</ref> It is possible for AAS to lead to [[acute coronary syndrome]].<ref name="pmid16291307">{{cite journal |author=Manghat NE, Morgan-Hughes GJ, Roobottom CA |title=Multi-detector row computed tomography: imaging in acute aortic syndrome |journal=Clin Radiol |volume=60 |issue=12 |pages=1256–67 |date=December 2005 |pmid=16291307 |doi=10.1016/j.crad.2005.06.011 |url=}}</ref> The term was introduced in 2001.<ref name="pmid12860875">{{cite journal |author=van der Loo B, Jenni R |title=Acute aortic syndrome: proposal for a novel classification |journal=Heart |volume=89 |issue=8 |pages=928 |date=August 2003 |pmid=12860875 |doi= 10.1136/heart.89.8.928|url=http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=12860875 |pmc=1767786}}</ref><ref name="pmid11250953">{{cite journal |author=Vilacosta I, Román JA |title=Acute aortic syndrome |journal=Heart |volume=85 |issue=4 |pages=365–8 |date=April 2001 |pmid=11250953 |doi= 10.1136/heart.85.4.365|url=http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=11250953 |pmc=1729697}}</ref> | '''Acute aortic syndrome''' ('''AAS''') describes a range of severe, [[pain]]ful, potentially life-threatening abnormalities of the [[aorta]].<ref name="pmid16679467">{{cite journal |author=Ahmad F, Cheshire N, Hamady M |title=Acute aortic syndrome: pathology and therapeutic strategies |journal=Postgrad Med J |volume=82 |issue=967 |pages=305–12 |date=May 2006 |pmid=16679467 |doi=10.1136/pgmj.2005.043083 |url=http://pmj.bmjjournals.com/cgi/pmidlookup?view=long&pmid=16679467 |pmc=2563796}}</ref> These include [[aortic dissection]], intramural [[thrombus]], and [[penetrating atherosclerotic ulcer|penetrating atherosclerotic aortic ulcer]].<ref name="Macura">{{cite journal | last=Macura | first=KJ |author2=Corl FM|author3=Fishman EK|author4=Bluemke DA | title=Pathogenesis in acute aortic syndromes: aortic dissection, intramural hematoma, and penetrating atherosclerotic aortic ulcer | journal=American Journal of Roentgenology | volume=181 | issue=2 | pages=309–316 | date=1 August 2003 | pmid=12876003 | url=http://www.ajronline.org/cgi/content/full/181/2/309 | accessdate=2008-05-28 | doi=10.2214/ajr.181.2.1810309}}</ref> AAS can be caused by a [[lesion]] on the wall of the [[aorta]] that involves the [[tunica media]], often in the [[descending aorta]].<ref name="pmid17521551">{{cite journal |author=Evangelista Masip A |title=[Progress in the acute aortic syndrome] |language=Spanish; Castilian |journal=Rev Esp Cardiol |volume=60 |issue=4 |pages=428–39 |date=April 2007 |pmid=17521551 | url=http://www.revespcardiol.org/cgi-bin/wdbcgi.exe/cardio/mrevista_cardio.pubmed_full?inctrl=05ZI0113&vol=60&num=4&pag=428 |doi=10.1157/13101646}}</ref> It is possible for AAS to lead to [[acute coronary syndrome]].<ref name="pmid16291307">{{cite journal |author=Manghat NE, Morgan-Hughes GJ, Roobottom CA |title=Multi-detector row computed tomography: imaging in acute aortic syndrome |journal=Clin Radiol |volume=60 |issue=12 |pages=1256–67 |date=December 2005 |pmid=16291307 |doi=10.1016/j.crad.2005.06.011 |url=}}</ref> The term was introduced in 2001.<ref name="pmid12860875">{{cite journal |author=van der Loo B, Jenni R |title=Acute aortic syndrome: proposal for a novel classification |journal=Heart |volume=89 |issue=8 |pages=928 |date=August 2003 |pmid=12860875 |doi= 10.1136/heart.89.8.928|url=http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=12860875 |pmc=1767786}}</ref><ref name="pmid11250953">{{cite journal |author=Vilacosta I, Román JA |title=Acute aortic syndrome |journal=Heart |volume=85 |issue=4 |pages=365–8 |date=April 2001 |pmid=11250953 |doi= 10.1136/heart.85.4.365|url=http://heart.bmj.com/cgi/pmidlookup?view=long&pmid=11250953 |pmc=1729697}}</ref> | ||
==Classification== | |||
< | Acute aortic syndromes is classified into 5 entities as follows:<ref name="Erbel2001">{{cite journal|last1=Erbel|first1=R|title=Diagnosis and management of aortic dissection Task Force on Aortic Dissection, European Society of Cardiology|journal=European Heart Journal|volume=22|issue=18|year=2001|pages=1642–1681|issn=0195668X|doi=10.1053/euhj.2001.2782}}</ref><ref>{{cite journal|title=2014 ESC Guidelines on the diagnosis and treatment of aortic diseases|journal=European Heart Journal|volume=35|issue=41|year=2014|pages=2873–2926|issn=0195-668X|doi=10.1093/eurheartj/ehu281}}</ref> | ||
* Type I: classic aortic dissection involving an [[intimal]] layer between the true and false lumen (with no communication between the two lumen) | |||
* Type II: aortic dissection with medial rupture and the subsequent [[intramural]] [[hematoma]] formation | |||
* Type III: Subtle aortic dissection with bulging of the aortic wall | |||
* Type IV: aortic dissection due to [[plaque rupture]] and subsequent [[ulceration]] | |||
* Type V: [[iatrogenic]]/traumatic dissection | |||
==Causes== | ==Causes== | ||
Causes can include [[aortic dissection]], [[intramural hematoma]], [[penetrating atherosclerotic ulcer]] or a [[thoracic aneurysm]] that has become unstable.<ref name="pmid18236724">{{cite journal |author=Smith AD, Schoenhagen P |title=CT imaging for acute aortic syndrome |journal=Cleve Clin J Med |volume=75 |issue=1 |pages=7–9, 12, 15–7 passim |date=January 2008 |pmid=18236724 |doi= 10.3949/ccjm.75.1.7|url=}}</ref> 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.<ref name="pmid18236724"/><ref name="pmid17612751">{{cite journal |author=Marijon E, Vilanculos A, Tivane A, ''et al.'' |title=Thoracic aortic aneurysm: direct sign of rupture |journal=Cardiovasc J Afr |volume=18 |issue=3 |pages=180–1 |year=2007 |pmid=17612751 |doi= | format = pdf |url=http://blues.sabinet.co.za/WebZ/Authorize?sessionid=0:autho=pubmed:password=pubmed2004&/AdvancedQuery?&format=F&next=images/ejour/cardio/cardio_v18_n3_a10.pdf}}</ref> | Causes can include [[aortic dissection]], [[intramural hematoma]], [[penetrating atherosclerotic ulcer]] or a [[thoracic aneurysm]] that has become unstable.<ref name="pmid18236724">{{cite journal |author=Smith AD, Schoenhagen P |title=CT imaging for acute aortic syndrome |journal=Cleve Clin J Med |volume=75 |issue=1 |pages=7–9, 12, 15–7 passim |date=January 2008 |pmid=18236724 |doi= 10.3949/ccjm.75.1.7|url=}}</ref> 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.<ref name="pmid18236724"/><ref name="pmid17612751">{{cite journal |author=Marijon E, Vilanculos A, Tivane A, ''et al.'' |title=Thoracic aortic aneurysm: direct sign of rupture |journal=Cardiovasc J Afr |volume=18 |issue=3 |pages=180–1 |year=2007 |pmid=17612751 |doi= | format = pdf |url=http://blues.sabinet.co.za/WebZ/Authorize?sessionid=0:autho=pubmed:password=pubmed2004&/AdvancedQuery?&format=F&next=images/ejour/cardio/cardio_v18_n3_a10.pdf}}</ref> | ||
Revision as of 20:03, 19 December 2019
|
Acute aortic syndrome Microchapters |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief:
Overview
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]
Classification
Acute aortic syndromes is classified into 5 entities as follows:[7][8]
- Type I: classic aortic dissection involving an intimal layer between the true and false lumen (with no communication between the two lumen)
- Type II: aortic dissection with medial rupture and the subsequent intramural hematoma formation
- Type III: Subtle aortic dissection with bulging of the aortic wall
- Type IV: aortic dissection due to plaque rupture and subsequent ulceration
- Type V: iatrogenic/traumatic dissection
Causes
Causes can include aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer or a thoracic aneurysm that has become unstable.[9] 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.[9][10]
Diagnosis
The condition can be mimicked by a ruptured cyst of the pericardium,[11] ruptured aortic aneurysm[10] and acute coronary syndrome.[12]
Misdiagnosis is estimated at 39% and is associated with delays correct diagnosis and improper treatment with anticoagulants producing excessive bleeding and extended hospital stay.[12]
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.[13]
References
- ↑ 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.
- ↑ 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. Retrieved 2008-05-28.
- ↑ 3.0 3.1 3.2 Evangelista Masip A (April 2007). "[Progress in the acute aortic syndrome]". Rev Esp Cardiol (in Spanish; Castilian). 60 (4): 428–39. doi:10.1157/13101646. PMID 17521551.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Erbel, R (2001). "Diagnosis and management of aortic dissection Task Force on Aortic Dissection, European Society of Cardiology". European Heart Journal. 22 (18): 1642–1681. doi:10.1053/euhj.2001.2782. ISSN 0195-668X.
- ↑ "2014 ESC Guidelines on the diagnosis and treatment of aortic diseases". European Heart Journal. 35 (41): 2873–2926. 2014. doi:10.1093/eurheartj/ehu281. ISSN 0195-668X.
- ↑ 9.0 9.1 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.
- ↑ 10.0 10.1 Marijon E, Vilanculos A, Tivane A; et al. (2007). "Thoracic aortic aneurysm: direct sign of rupture" (pdf). Cardiovasc J Afr. 18 (3): 180–1. PMID 17612751.
- ↑ 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.
- ↑ 12.0 12.1 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.
- ↑ Ince H, Nienaber CA (May 2007). "[Management of acute aortic syndromes]". Rev Esp Cardiol (in Spanish; Castilian). 60 (5): 526–41. doi:10.1016/S1885-5857(07)60194-7. PMID 17535765.