Aortic dissections: new perspectives and treatment paradigms

Area of Science:

• Cardiovascular Medicine
• Vascular Surgery
• Medical Pathophysiology

Background:

• Aortic dissection involves complex arterial wall disease, with severity influenced by tear characteristics, location, and patient physiology.
• Understanding pathophysiology has lagged behind treatment evaluations, focusing on success and failure of interventions.
• Historical indications for intervention include rupture, pain, hypertension, ischemia, and aneurysm formation.

Purpose of the Study:

• To review the current understanding of aortic dissection pathophysiology.
• To outline the evolving treatment strategies for acute and chronic aortic dissections.
• To discuss the role of endovascular and open surgical approaches in managing aortic dissections.

Main Methods:

• Review of existing literature on aortic dissection pathophysiology and treatment modalities.
• Analysis of indications for intervention based on patient presentation and anatomy.
• Categorization of endovascular techniques (stentgrafts, branch stenting, fenestrations) and open surgical approaches.

Main Results:

• Acute aortic dissections with ischemia are increasingly managed with endovascular techniques.
• Endovascular treatments include stentgrafts, branch vessel stenting, and aortic fenestrations.
• Chronic dissections predominantly utilize open surgical techniques, with combined approaches for specific thoracoabdominal cases.

Conclusions:

• Management decisions for aortic dissections are guided by anatomy, acuity, and patient physiology.
• Endovascular approaches offer targeted solutions for acute ischemic dissections.
• Combined open and endovascular strategies provide options for complex chronic thoracoabdominal aortic dissections.