Sandbox:Sahar
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Recomendacations | Class | Level | References |
---|---|---|---|
History and clinical assessment | |||
In all patients with suspected
AAS, pre-test probability assessment is recommended, according to the patient’s condition, symptoms, and clinical features. |
I | B | [1] |
Laboratory testing | |||
In case of suspicion of AAS,
the interpretation of biomarkers should always be considered along with the pretest clinical probability. |
IIa | B | |
In case of low clinical
probability of AAS, negative D-dimer levels should be considered as ruling out the diagnosis. |
IIa | C | [2][3][4][5] |
In case of intermediate clinical
probability of AAS with a positive (point-of-care) D-dimer test, further imaging tests should be considered. |
IIa | B | [2][3] |
In patients with high probability
(risk score 2 or 3) of AD, testing of D-dimers is not recommended. |
III | C | |
Imaging | |||
TTE is recommended as an
initial imaging investigation. |
I | C | |
In unstabled patients with a
suspicion of AAS, the following imaging modalities are recommended according to local availability and expertise: |
|||
TOE | I | C | |
CT | I | C | |
In stable patients with a
suspicion of AAS, the following imaging modalities are recommended (or should be considered) according to local availability and expertise: |
|||
CT | I | C | |
MRI | I | C | |
TOE | IIa | C | |
In case of initially negative
imaging with the persistence of suspicion of AAS, repetitive imaging (CT or MRI) is recommended. |
I | C | |
Chest X-ray maybe
considered in cases of low clinical probability of AAS. |
IIb | C | |
In case of uncomplicated
Type B AD treated medically, repeated imaging (CT or MRI)e during the first days is recommended. |
I | C |
- ↑ Evangelista, Arturo; Isselbacher, Eric M.; Bossone, Eduardo; Gleason, Thomas G.; Eusanio, Marco Di; Sechtem, Udo; Ehrlich, Marek P.; Trimarchi, Santi; Braverman, Alan C.; Myrmel, Truls; Harris, Kevin M.; Hutchinson, Stuart; O’Gara, Patrick; Suzuki, Toru; Nienaber, Christoph A.; Eagle, Kim A. (2018). "Insights From the International Registry of Acute Aortic Dissection". Circulation. 137 (17): 1846–1860. doi:10.1161/CIRCULATIONAHA.117.031264. ISSN 0009-7322.
- ↑ 2.0 2.1 Eggebrecht, Holger; Mehta, Rajendra H.; Metozounve, Huguette; Huptas, Sebastian; Herold, Ulf; Jakob, Heinz G.; Erbel, Raimund (2008). "Clinical Implications of Systemic Inflammatory Response Syndrome Following Thoracic Aortic Stent-Graft Placement". Journal of Endovascular Therapy. 15 (2): 135–143. doi:10.1583/07-2284.1. ISSN 1526-6028.
- ↑ 3.0 3.1 Sutherland, Alexander; Escano, Jude; Coon, Troy P. (2008). "D-dimer as the Sole Screening Test for Acute Aortic Dissection: A Review of the Literature". Annals of Emergency Medicine. 52 (4): 339–343. doi:10.1016/j.annemergmed.2007.12.026. ISSN 0196-0644.
- ↑ Suzuki, Toru; Bossone, Eduardo; Sawaki, Daigo; Jánosi, Rolf Alexander; Erbel, Raimund; Eagle, Kim; Nagai, Ryozo (2013). "Biomarkers of aortic diseases". American Heart Journal. 165 (1): 15–25. doi:10.1016/j.ahj.2012.10.006. ISSN 0002-8703.
- ↑ Taylor, R. Andrew; Iyer, Neel S. (2013). "A decision analysis to determine a testing threshold for computed tomographic angiography and d-dimer in the evaluation of aortic dissection". The American Journal of Emergency Medicine. 31 (7): 1047–1055. doi:10.1016/j.ajem.2013.03.039. ISSN 0735-6757.