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Acute Aortic Dissection and Intramural Hematoma: A Systematic Review
Firas F Mussa1, Joshua D Horton2, Rameen Moridzadeh3
1Division of Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, New York.
JAMA
|August 18, 2016
Summary
Acute aortic syndrome (AAS) requires prompt diagnosis and treatment for its high mortality. Imaging like CT and MRI are key, with surgery often necessary for ascending aorta cases, while endovascular repair shows promise for descending aorta AAS.
Area of Science:
- Cardiovascular Medicine
- Diagnostic Imaging
- Surgical Innovation
Background:
- Acute Aortic Syndrome (AAS) is a life-threatening condition involving the aortic wall, often presenting as severe chest pain and hypertension.
- AAS encompasses aortic dissection and intramural hematoma, with potential complications including impaired perfusion and aneurysm formation.
- Despite its rarity (3.5-6.0 per 100,000 patient-years), rapid diagnosis is critical due to the frequent need for emergency surgery.
Purpose of the Study:
- To conduct a systematic review of existing evidence regarding the diagnosis and treatment of Acute Aortic Syndrome.
- To synthesize findings from clinical trials and observational studies to inform clinical practice.
Main Methods:
- Searched MEDLINE, EMBASE, and Cochrane Register of Controlled Trials for studies on AAS diagnosis and treatment (June 1994-January 2016).
- Included clinical trials and prospective observational studies with at least 10 patients.
- Reviewed 82 studies involving 57,311 patients, including 2 randomized clinical trials and 80 observational studies.
Main Results:
- Chest or back pain (61.6%-84.8%) and hypertension (45%-100%) were common symptoms in patients aged 60-70, predominantly male.
- High diagnostic sensitivities were reported for CT (100%), MRI (95%-100%), and transesophageal echocardiography (86%-100%).
- Open surgical repair is recommended for Type A AAS due to high mortality (26%-58%), while endovascular repair showed superior outcomes for Type B AAS in one RCT.
Conclusions:
- Prompt recognition and diagnosis of AAS are crucial given its high mortality, especially in patients with acute chest/back pain and hypertension.
- CT, MRI, and transesophageal echocardiography are reliable diagnostic modalities for AAS.
- While open surgery is favored for Type A AAS and endovascular repair for Type B AAS, evidence is limited by a lack of randomized trials.
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