Acute dissections of the aorta. Current surgical treatment

Tremendous progress has been made in the treatment of acute aortic dissections as a result of advances in surgical, medical, and diagnostic modalities. Rapid clinical diagnosis should be followed by aggressive monitoring, pharmacologic manipulation, and definitive elucidation of the anatomy of the disorder. Ultrasonography and CT scanning may provide valuable information on the anatomy of the dissection, but contrast arteriography remains the preferred method for demonstrating the anatomy. Surgical correction is now recommended for both type A and type B dissections during the acute stage. The exact approach is dictated by the location of the intimal tear and the extent of the dissection. The complexity of the operation may extend from interposing an intraluminal graft to full cardiopulmonary bypass with profound hypothermia, circulatory arrest, and replacement of the ascending aorta, aortic arch, or aortic valve apparatus. The rapid advancement of management techniques for acute aortic dissections now offers patients a reasonable expectation of survival without complications. Future improvements in early, noninvasive, and rapid diagnostic methods, as well as increased utilization of invasive monitoring and nonporous graft materials, promise to increase survival for a patient afflicted with acute aortic dissection.