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Chronic aortic dissection: still a challenge

Giuseppe Giugliano1, Lucrezia Spadera, Mario De Laurentis

  • 1Department of Clinical Medicine and Cardiovascular and Immunological Sciences, University of Naples Federico II, Naples, Italy. a.giugliano@inwind.it

Acta Cardiologica
|January 12, 2010
PubMed

Insights

Stable chronic aortic dissections are managed medically, primarily with antihypertensive therapy. Surgical or endovascular repair is reserved for complications like rupture, malperfusion, or rapid aneurysm growth, with endovascular approaches showing future promise.

Area of Science:

  • Cardiovascular Medicine
  • Vascular Surgery
  • Medical Imaging

Background:

  • Chronic aortic dissections (CAD) present complex challenges with predictable natural histories influenced by factors like aortic diameter and hypertension.
  • Current management guidelines prioritize medical therapy for stable CAD, emphasizing antihypertensive treatments, including beta-blockers.

Purpose of the Study:

  • To outline the management strategies for chronic aortic dissections.
  • To define criteria for intervention in stable versus complicated CAD.
  • To highlight the role of serial imaging in monitoring disease progression and guiding treatment decisions.

Main Methods:

  • Review of natural history factors influencing CAD progression.
  • Analysis of indications for medical versus interventional management.
  • Emphasis on serial aortic imaging for surveillance.

Main Results:

  • Medical management is the cornerstone for stable chronic aortic dissections.
  • Intervention is necessitated by specific complications: rupture, malperfusion, symptoms, significant aneurysmal change, or rapid growth.
  • Serial imaging is critical for timely detection of high-risk lesions.

Conclusions:

  • Stable chronic aortic dissections require ongoing medical management, focusing on blood pressure control.
  • Surgical or endovascular repair is indicated for complications, with evolving endograft technology potentially shifting future treatment paradigms.
  • Continuous surveillance via imaging is essential for optimizing patient outcomes in chronic aortic dissection.

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