Sandbox:Sahar: Difference between revisions
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| style="padding: 5px 5px; background: #90EE90;" align="center" |'''I''' | | style="padding: 5px 5px; background: #90EE90;" align="center" |'''I''' | ||
| style="padding: 5px 5px; background: #0000CD;" align="center" |'''B''' | | style="padding: 5px 5px; background: #0000CD;" align="center" |'''B''' | ||
| | |" align="center" |<ref name="EvangelistaIsselbacher2018">{{cite journal|last1=Evangelista|first1=Arturo|last2=Isselbacher|first2=Eric M.|last3=Bossone|first3=Eduardo|last4=Gleason|first4=Thomas G.|last5=Eusanio|first5=Marco Di|last6=Sechtem|first6=Udo|last7=Ehrlich|first7=Marek P.|last8=Trimarchi|first8=Santi|last9=Braverman|first9=Alan C.|last10=Myrmel|first10=Truls|last11=Harris|first11=Kevin M.|last12=Hutchinson|first12=Stuart|last13=O’Gara|first13=Patrick|last14=Suzuki|first14=Toru|last15=Nienaber|first15=Christoph A.|last16=Eagle|first16=Kim A.|title=Insights From the International Registry of Acute Aortic Dissection|journal=Circulation|volume=137|issue=17|year=2018|pages=1846–1860|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.117.031264}}</ref> | ||
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! colspan="4" align="left" | Laboratory testing | ! colspan="4" align="left" | Laboratory testing | ||
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| style="padding: 5px 5px; background: #FFFACD;" align="center" |'''IIa''' | | style="padding: 5px 5px; background: #FFFACD;" align="center" |'''IIa''' | ||
| style="padding: 5px 5px; background: #6495ED;" align="center" |'''C''' | | style="padding: 5px 5px; background: #6495ED;" align="center" |'''C''' | ||
| | | align="center" |<ref name="EggebrechtMehta2008">{{cite journal|last1=Eggebrecht|first1=Holger|last2=Mehta|first2=Rajendra H.|last3=Metozounve|first3=Huguette|last4=Huptas|first4=Sebastian|last5=Herold|first5=Ulf|last6=Jakob|first6=Heinz G.|last7=Erbel|first7=Raimund|title=Clinical Implications of Systemic Inflammatory Response Syndrome Following Thoracic Aortic Stent-Graft Placement|journal=Journal of Endovascular Therapy|volume=15|issue=2|year=2008|pages=135–143|issn=1526-6028|doi=10.1583/07-2284.1}}</ref><ref name="SutherlandEscano2008">{{cite journal|last1=Sutherland|first1=Alexander|last2=Escano|first2=Jude|last3=Coon|first3=Troy P.|title=D-dimer as the Sole Screening Test for Acute Aortic Dissection: A Review of the Literature|journal=Annals of Emergency Medicine|volume=52|issue=4|year=2008|pages=339–343|issn=01960644|doi=10.1016/j.annemergmed.2007.12.026}}</ref><ref name="SuzukiBossone2013">{{cite journal|last1=Suzuki|first1=Toru|last2=Bossone|first2=Eduardo|last3=Sawaki|first3=Daigo|last4=Jánosi|first4=Rolf Alexander|last5=Erbel|first5=Raimund|last6=Eagle|first6=Kim|last7=Nagai|first7=Ryozo|title=Biomarkers of aortic diseases|journal=American Heart Journal|volume=165|issue=1|year=2013|pages=15–25|issn=00028703|doi=10.1016/j.ahj.2012.10.006}}</ref><ref name="TaylorIyer2013">{{cite journal|last1=Taylor|first1=R. Andrew|last2=Iyer|first2=Neel S.|title=A decision analysis to determine a testing threshold for computed tomographic angiography and d-dimer in the evaluation of aortic dissection|journal=The American Journal of Emergency Medicine|volume=31|issue=7|year=2013|pages=1047–1055|issn=07356757|doi=10.1016/j.ajem.2013.03.039}}</ref> | ||
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! style="padding: 5px 5px; background: #FFFFE0; " align="left" |In case of intermediate clinical | ! style="padding: 5px 5px; background: #FFFFE0; " align="left" |In case of intermediate clinical | ||
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| style="padding: 5px 5px; background: #FFFACD;" align="center" |'''IIa''' | | style="padding: 5px 5px; background: #FFFACD;" align="center" |'''IIa''' | ||
| style="padding: 5px 5px; background: #0000CD;" align="center" |'''B''' | | style="padding: 5px 5px; background: #0000CD;" align="center" |'''B''' | ||
| | | align="center" |<ref name="EggebrechtMehta2008">{{cite journal|last1=Eggebrecht|first1=Holger|last2=Mehta|first2=Rajendra H.|last3=Metozounve|first3=Huguette|last4=Huptas|first4=Sebastian|last5=Herold|first5=Ulf|last6=Jakob|first6=Heinz G.|last7=Erbel|first7=Raimund|title=Clinical Implications of Systemic Inflammatory Response Syndrome Following Thoracic Aortic Stent-Graft Placement|journal=Journal of Endovascular Therapy|volume=15|issue=2|year=2008|pages=135–143|issn=1526-6028|doi=10.1583/07-2284.1}}</ref><ref name="SutherlandEscano2008">{{cite journal|last1=Sutherland|first1=Alexander|last2=Escano|first2=Jude|last3=Coon|first3=Troy P.|title=D-dimer as the Sole Screening Test for Acute Aortic Dissection: A Review of the Literature|journal=Annals of Emergency Medicine|volume=52|issue=4|year=2008|pages=339–343|issn=01960644|doi=10.1016/j.annemergmed.2007.12.026}}</ref> | ||
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! style="padding: 5px 5px;" align="left" |In patients with high probability | ! style="padding: 5px 5px;" align="left" |In patients with high probability | ||
Revision as of 04:13, 25 December 2019
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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.