Acute aortic syndrome

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Acute aortic syndrome Microchapters

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Patient Information

Overview

Classification

• Aortic dissection
• Aortic intramural hematoma
• Penetrating atherosclerotic aortic ulcer

Differentiating Acute Aortic Syndrome from other Diseases

Causes

Guidelines

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]

Overview

Acute aortic syndrome (AAS) describes a constellation of emergency conditions with a similar clinical feature that involves the aorta.[1] These include aortic dissection, intramural thrombus, and penetrating atherosclerotic aortic ulcer.[2] It is possible for AAS to lead to acute coronary syndrome.[3] The term was introduced in 2001.[4][5]

Classification

Acute aortic syndromes is classified into 5 entities as follows:[6][7]

  • 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

Differentiating Acute Aortic Syndrome from other Diseases

Causes

Guidelines

2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases (DO NOT EDIT)[10]

Clinical Assessment of Patients Suspicious of Aortic Dissection

Class I
"In all patients with suspected AAS, pre-test probability assessment is recommended, according to the patient’s condition, symptoms, and clinical features.[11](Level of Evidence: B)"
Class IIb
" Chest X-ray may be considered in cases of low clinical probability of AAS. (Level of Evidence: C)"

Diagnostic Work-up of Patients Suspicious of Acute Aortic Syndrome

Class I
"In unstabled patients with a suspicion of AAS, the following imaging modalities are recommended according to local availability and expertise:transoesophageal echocardiography; CT scan.(Level of Evidence: 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 scan; MRI.(Level of Evidence: C)"

Diagnostic Value of Echocardiography in the Diagnosis of Aortic Dissection

Class I
"Initial recommended imaging study for the diagnosis of acute aortic syndrome is transthoracic echocardiography. (Level of Evidence: C)"
Class IIa
"In stable patients, transoesophageal echocardiography is the recommended imaging study. (Level of Evidence: C)"

Follow-up Imaging study

Class I
"In case of initially negative imaging with persistence of suspicion of AAS, repetitive imaging (CT or MRI) is recommended.(Level of Evidence: C)"
"In case of uncomplicated Type B AD treated medically, repeated imaging (CT or MRI) during the first days is recommended. (Level of Evidence: C)"

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. Retrieved 2008-05-28.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ "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.
  8. ↑ 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. ↑ 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.
  10. ↑ Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RS, Vrints CJ (November 2014). "2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC)". Eur. Heart J. 35 (41): 2873–926. doi:10.1093/eurheartj/ehu281. PMID 25173340.
  11. ↑ 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.


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