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[Management of patients with closing aortic dissection]
Y Moriyama1, H Toyohira, M Koga
1Second Department of Surgery, Kagoshima University, Faculty of Medicine, Japan.
Insights
Closing aortic dissection (CAD) is a serious condition. Early diagnosis and consistent antihypertensive therapy are crucial for managing CAD patients and improving survival rates.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Diagnostic Imaging
Context:
- Acute aortic dissection is a life-threatening emergency.
- Clinical features of closing aortic dissection (CAD) are not well-documented.
- This study investigates the characteristics and management of CAD.
Purpose:
- To describe the clinical presentation, diagnosis, and outcomes of patients with closing aortic dissection.
- To evaluate the effectiveness of conservative medical management versus surgical intervention.
- To identify factors influencing survival in CAD patients.
Summary:
- Twenty-four patients with CAD were managed between 1991 and 1994.
- All presented with sudden chest and back pain; hypertension was common.
- Diagnosis was confirmed by CT scans, with no patent false lumen.
- Seventeen patients had descending thoracic aorta involvement, and 5 had ascending.
- Initial management was conservative, with 7 patients requiring surgery.
- Two patients died, and 3-year survival was 74%.
Impact:
- Highlights the importance of antihypertensive therapy for CAD.
- Emphasizes the need for frequent follow-up imaging to monitor aortic status.
- Provides insights into the natural history and management strategies for CAD.
Abstract:
Acute aortic dissection is a catastrophic event requiring immediate diagnosis and definitive treatment, while the clinical characteristics of closing aortic dissection are not well known. From Jan. 1991 through Dec. 1994 a total of 24 patients with closing aortic dissection (CAD) was managed at our institution. There were 19 men and 5 women, ranging in age from 49 to 74 years with a mean of 65 years. All patients presented with a sudden onset of severe chest and back pain. Twenty patients had a history of hypertension with a wide mediastinal silhouette on chest X-ray. The diagnosis of CAD was established by contrast computed tomographic (CT) scans in all patients with no evidence of patent false lumen. The descending thoracic aorta was involved in 17 patients and the ascending in 5. Conservative medical management was initially attempted for all. Seven patients (Stanford type A/B: 2/5) ultimately required surgical intervention, and 2 patients died. The follow-up was 100% complete with a mean term of 14.6 months. The overall survival rate was 74% at 3 years after the initial presentation. Based on our clinical experience, all patients with CAD need careful antihypertensive therapy and frequent follow-up studies to assess the aorta.