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Imaging and Surveillance of Chronic Aortic Dissection: A Scientific Statement From the American Heart Association
Insights
Lifelong imaging surveillance is crucial for patients with chronic aortic dissection to monitor aorta changes and prevent rupture. Standardized measurements and advanced techniques can improve risk assessment and guide future treatments.
Area of Science:
- Cardiovascular Imaging
- Medical Device Technology
- Biomedical Engineering
Background:
- Patients surviving acute aortic dissection need lifelong aorta surveillance.
- Chronic false lumen degeneration and aneurysm formation are common late complications.
- Imaging is vital for medical decision-making in chronic aortic dissection.
Purpose of the Study:
- To present state-of-the-art imaging and measurement techniques for chronic aortic dissection surveillance.
- To highlight the need for standardized measurements and reporting in lifelong surveillance.
- To examine the role of imaging and simulations in predicting aortic degeneration and failure.
Main Methods:
- Review of current imaging and measurement techniques for chronic aortic dissection.
- Analysis of challenges in accurate aortic diameter measurement and documentation.
- Exploration of emerging imaging and computational simulation methods.
Main Results:
- Current imaging surveillance lacks standardized guidelines.
- Accurate and systematic aortic diameter measurement presents practical challenges.
- Advanced imaging and simulations show promise for predicting aortic complications.
Conclusions:
- Standardized imaging surveillance is essential for managing chronic aortic dissection.
- Improved risk stratification and individualized treatment may result from advanced imaging insights.
- Novel treatment strategies may emerge from a better understanding of aortic degeneration and biomechanics.
Abstract:
All patients surviving an acute aortic dissection require continued lifelong surveillance of their diseased aorta. Late complications, driven predominantly by chronic false lumen degeneration and aneurysm formation, often require surgical, endovascular, or hybrid interventions to treat or prevent aortic rupture. Imaging plays a central role in the medical decision-making of patients with chronic aortic dissection. Accurate aortic diameter measurements and rigorous, systematic documentation of diameter changes over time with different imaging equipment and modalities pose a range of practical challenges in these complex patients. Currently, no guidelines or recommendations for imaging surveillance in patients with chronic aortic dissection exist. In this document, we present state-of-the-art imaging and measurement techniques for patients with chronic aortic dissection and clarify the need for standardized measurements and reporting for lifelong surveillance. We also examine the emerging role of imaging and computer simulations to predict aortic false lumen degeneration, remodeling, and biomechanical failure from morphological and hemodynamic features. These insights may improve risk stratification, individualize contemporary treatment options, and potentially aid in the conception of novel treatment strategies in the future.