{ "schemaVersion": 2, "eyebrow": "Cardiovascular emergency", "title": "Aortic Dissection", "summary": "Aortic dissection requires rapid anatomic diagnosis, immediate anti-impulse therapy, and disposition determined by ascending-aortic involvement, rupture, malperfusion, and persistent symptoms. Computed tomographic angiography is first-line in most stable patients; type A disease requires emergency surgical evaluation, whereas uncomplicated type B disease begins with medical therapy.", "seoDescription": "Point-of-care review of aortic dissection diagnosis, anti-impulse therapy, surgery, TEVAR selection, surveillance, and family screening.", "clinicalQuestion": "How should physicians rapidly diagnose, stabilize, classify, treat, and surveil patients with acute aortic dissection?", "specialty": "Cardiology and cardiovascular surgery", "audience": "U.S. physicians and medical trainees", "tags": [ "aortic dissection", "acute aortic syndrome", "Stanford type A", "Stanford type B", "anti-impulse therapy", "TEVAR", "aortic malperfusion" ], "keyTakeaways": [ "Obtain urgent CTA for suspected acute aortic syndrome; TEE or MRI are reasonable alternatives when CTA is unsuitable. A low aortic-dissection risk score plus D-dimer <500 ng/mL can help exclude acute aortic syndrome only in low-pretest-probability patients. [6]", "Initial treatment is ICU-level anti-impulse therapy with an arterial line, IV beta blockade unless contraindicated, target heart rate 60 to 80 beats/min, and systolic pressure <120 mm Hg or the lowest pressure preserving end-organ perfusion. [6]", "Acute type A dissection warrants immediate surgical consultation and operative repair; stable transfer to a high-volume aortic center is reasonable when it does not compromise timely care. [6]", "Uncomplicated acute type B dissection is initially managed medically. Rupture, malperfusion, extension, progressive enlargement, refractory pain, or uncontrolled hypertension requires intervention; TEVAR is preferred over open repair when anatomy is suitable. [6]", "After acute dissection or intramural hematoma, obtain CT or MRI at 1, 6, and 12 months, then annually if stable; residual chronic thoracic aortic disease reaching 5.5 cm warrants elective repair. [6]" ], "sections": [ { "id": "initial-recognition-and-diagnosis", "eyebrow": "Emergency evaluation", "heading": "Recognize high-risk presentations and obtain definitive imaging", "intro": "Do not rely on chest radiography, ECG, or biomarkers alone to exclude acute aortic syndrome.", "paragraphs": [ "Acute aortic syndrome should be considered with abrupt severe chest, back, or abdominal pain, especially with pulse deficit, limb blood-pressure differential, neurologic deficit, new aortic regurgitation murmur, syncope, hypotension, known thoracic aortic disease, recent aortic manipulation, or heritable aortopathy. Measure blood pressure in both arms and lower extremities and assess for coronary, cerebral, visceral, renal, spinal, and limb malperfusion. [6]", "CTA is the recommended initial diagnostic study because it is rapid, widely available, and delineates the dissection extent, entry tear when visible, branch-vessel involvement, malperfusion, hemopericardium, mediastinal hemorrhage, and pleural effusion. For suspected acute aortic syndrome, obtain noncontrast images first when feasible to identify intramural hematoma, followed by arterial-phase CTA from the thoracic inlet through the femoral arteries. ECG-gated acquisition improves assessment of the root and ascending aorta. [6]", "TEE is a useful bedside alternative in unstable patients or when iodinated contrast is unsuitable; it also defines aortic regurgitation, pericardial effusion, and true-versus-false lumen flow. MRI is highly accurate but is generally reserved for stable patients when CT is contraindicated or uncertainty persists because acquisition and monitoring are less practical in unstable patients. [6]" ], "bullets": [ "Use the Aortic Dissection Detection Risk Score: one point each for high-risk condition, pain feature, and examination feature; 0 is low risk, 1 intermediate risk, and 2 to 3 high risk. [6]", "In low-pretest-probability presentations, D-dimer <500 ng/mL plus a low risk score may help exclude acute aortic syndrome; it is not a stand-alone exclusion test in higher-risk presentations. [6]", "A chest radiograph may show mediastinal widening, abnormal aortic contour, or a calcium sign, but lacks sufficient sensitivity and specificity to rule out disease. [6]" ], "subsections": [], "table": { "caption": "Immediate diagnostic strategy for suspected acute aortic syndrome. [6]", "columns": [ "Clinical context", "Preferred next test", "Actionable result" ], "rows": [ [ "Hemodynamically stable; acute aortic syndrome suspected", "CTA with noncontrast and arterial-phase imaging", "Define type A versus type B involvement, branch-vessel compromise, rupture, and operative/endovascular anatomy. [6]" ], [ "Too unstable for CT transfer or iodinated contrast unsuitable", "TEE", "Assess proximal dissection, aortic regurgitation, tamponade, and proximal false-lumen anatomy; involve aortic surgery urgently if type A is identified. [6]" ], [ "Stable patient with contraindication to iodinated contrast or unresolved diagnostic uncertainty", "MRI", "Use when acquisition and monitoring are feasible; do not delay urgent management of probable type A disease. [6]" ] ] } }, { "id": "classification-and-immediate-stabilization", "eyebrow": "First hour", "heading": "Classify anatomy and initiate anti-impulse therapy before definitive repair", "intro": "Stabilization and surgical/endovascular consultation proceed in parallel with imaging.", "paragraphs": [ "Stanford type A includes any dissection involving the ascending aorta; type B spares the ascending aorta. The current SVS/STS temporal classification defines hyperacute disease as <24 hours, acute as 1 to 14 days, subacute as 15 to 90 days, and chronic as >90 days after symptom onset. [6]", "All acute aortic syndromes require prompt ICU care with invasive arterial pressure monitoring and anti-impulse therapy. Begin an IV beta blocker unless contraindicated; the guideline identifies esmolol, metoprolol, and labetalol as commonly used agents. If beta blockade is contraindicated or not tolerated, IV verapamil or diltiazem is a reasonable alternative for heart-rate control. The supplied sources support targets but do not provide regimen-specific dosing; use institutional protocols and product labeling. [6]", "After heart-rate control, add an IV vasodilator if blood pressure remains above goal; commonly used agents include nicardipine, clevidipine, and sodium nitroprusside. Avoid initiating a vasodilator before rate control because reflex tachycardia can increase aortic wall stress. Treat pain, generally with IV opioids, because pain-driven sympathetic activation impairs hemodynamic control. [6]" ], "bullets": [ "Target heart rate: 60 to 80 beats/min. [6]", "Target systolic blood pressure: <120 mm Hg or the lowest pressure that preserves end-organ perfusion. [6]", "Use particular caution with beta blockers in acute severe aortic regurgitation, heart block, or bradycardia. [6]" ], "subsections": [], "table": { "caption": "Anti-impulse therapy sequence in acute aortic syndrome. [6]", "columns": [ "Step", "Intervention", "Purpose and caution" ], "rows": [ [ "1", "ICU admission and arterial line", "Continuous hemodynamic monitoring while definitive treatment is arranged. [6]" ], [ "2", "IV beta blocker; IV diltiazem or verapamil if beta blockade is unsuitable", "Reduce heart rate and dP/dt before vasodilation. [6]" ], [ "3", "IV vasodilator if pressure remains uncontrolled after rate control", "Lower systolic pressure; do not use first because compensatory tachycardia may occur. [6]" ], [ "4", "Analgesia and serial malperfusion assessment", "Reduce sympathetic activation and identify evolving coronary, neurologic, visceral, renal, spinal, or limb ischemia. [6]" ] ] } }, { "id": "type-a-dissection", "eyebrow": "Ascending aorta involvement", "heading": "Treat acute type A dissection as a surgical emergency", "intro": "The principal immediate threat is rupture, tamponade, acute regurgitation, coronary compromise, or malperfusion.", "paragraphs": [ "Acute type A dissection requires emergency surgical consultation and immediate operative intervention because medical management alone carries substantially higher mortality. In IRAD, medical mortality was 57% compared with 18% surgical mortality in contemporary cohorts; untreated symptomatic ascending dissection has early mortality of approximately 1% to 2% per hour after symptom onset. [6]", "If the patient is stable enough for transfer, management at a high-volume aortic center is reasonable. High-volume multidisciplinary teams have lower mortality, and guideline-supported aortic centers integrate cardiac surgery, vascular/endovascular expertise, advanced imaging, anesthesiology, and critical care. [6]", "Neurologic injury alone should not reflexively preclude surgery. In patients with nonhemorrhagic stroke complicating type A dissection, surgery is reasonable over medical therapy; reported mortality with surgical versus medical treatment was approximately 25% to 27% versus 76%. Complete internal carotid occlusion with cerebral edema risk is a particularly poor-prognosis subgroup requiring individualized multidisciplinary assessment. [6]" ], "bullets": [ "For renal, lower-extremity, or uncomplicated visceral malperfusion, proceed with immediate central aortic repair and reassess residual malperfusion afterward. [6]", "Clinically significant mesenteric malperfusion is a major exception with genuine management variation: either immediate central repair or expert endovascular/open mesenteric reperfusion before central repair is reasonable. [6]", "If tamponade causes critical shock while awaiting surgery, controlled drainage of very small amounts of hemopericardium may temporize selected patients, but definitive treatment remains immediate aortic repair; rapid aggressive pericardiocentesis may worsen bleeding. [23]" ], "subsections": [], "table": { "caption": "Operative principles for acute type A dissection. [6]", "columns": [ "Finding or operative issue", "Preferred approach", "Rationale" ], "rows": [ [ "Partially dissected root without major leaflet pathology", "Aortic valve resuspension rather than valve replacement", "Preserves the native valve with acceptable durability. [6]" ], [ "Root destruction, root aneurysm, or known genetic aortopathy", "Root replacement with mechanical or biologic valved conduit", "Reduces risk from persistent root disease. [6]" ], [ "No arch entry tear or major arch aneurysm", "Hemiarch rather than total arch replacement", "More extensive arch repair has higher operative risk without consistent late reoperation benefit. [6]" ], [ "Distal repair", "Open distal anastomosis", "Associated with better survival and greater false-lumen thrombosis than clamp-on distal techniques. [6]" ], [ "Cannulation when feasible", "Axillary rather than femoral cannulation", "Reduces stroke or retrograde malperfusion risk. [6]" ] ] } }, { "id": "type-b-dissection", "eyebrow": "Descending aorta involvement", "heading": "Use medical therapy first for uncomplicated acute type B dissection", "intro": "Intervene for rupture, malperfusion, progression, refractory symptoms, or high-risk anatomy.", "paragraphs": [ "Initial management of uncomplicated acute type B dissection is medical anti-impulse therapy. This remains the guideline-recommended strategy despite substantial late risk of aneurysmal degeneration, because prophylactic TEVAR has remodeling benefits but uncertain universal early clinical benefit. [6]", "Complicated acute type B dissection requires urgent intervention. Complications include rupture, branch-vessel occlusion or malperfusion, dissection extension, progressive enlargement, intractable pain, and uncontrolled hypertension. With suitable anatomy, TEVAR is recommended for rupture and is reasonable over open repair for other complications. Persistent static malperfusion may require adjunctive fenestration or branch-vessel stenting after TEVAR. [6]", "In selected uncomplicated patients with high-risk imaging features, TEVAR may be considered. These features include maximal aortic diameter >40 mm, false-lumen diameter >20 to 22 mm, entry tear >10 mm, entry tear on the lesser curvature, interval total-aortic-diameter increase >5 mm, bloody pleural effusion, or imaging-only malperfusion. Refractory hypertension despite more than three maximally tolerated antihypertensive classes, persistent pain >12 hours despite maximal therapy, and readmission are additional high-risk clinical features. [6]" ], "bullets": [ "Discuss prophylactic TEVAR as an individualized decision, not default care, balancing aortic remodeling against procedural stroke, spinal cord ischemia, retrograde type A dissection, endoleak, reintervention, anatomy, age, and life expectancy. [6][9]", "For TEVAR requiring planned left subclavian coverage, revascularize the left subclavian artery before TEVAR to reduce spinal cord injury and potentially stroke; this is especially important with a patent left internal mammary graft or left-arm dialysis access. [6]", "Patients with Marfan syndrome, Loeys-Dietz syndrome, or vascular Ehlers-Danlos syndrome generally favor open repair for intact descending thoracic aneurysm when intervention is required, because endovascular durability is less established in native connective-tissue aorta. [6]" ], "subsections": [], "table": { "caption": "Acute type B dissection: disposition by complication status. [6]", "columns": [ "Status", "Management", "Key triggers" ], "rows": [ [ "Uncomplicated", "Medical therapy initially", "No rupture, malperfusion, extension, progressive enlargement, refractory pain, or uncontrolled hypertension. [6]" ], [ "Complicated with rupture", "Urgent TEVAR if suitable anatomy", "Free or contained rupture, hemothorax, increasing periaortic/mediastinal hematoma. [6]" ], [ "Complicated with malperfusion or other progression", "TEVAR preferred when anatomy is suitable; add branch-vessel interventions if needed", "Visceral, renal, spinal, or limb ischemia; extension; aortic enlargement; refractory pain or hypertension. [6]" ], [ "Uncomplicated but high risk", "Consider TEVAR in selected patients", "Aortic diameter >40 mm, false lumen >20 to 22 mm, entry tear >10 mm, interval enlargement, bloody effusion, or imaging-only malperfusion. [6]" ] ] } }, { "id": "long-term-management", "eyebrow": "After discharge", "heading": "Maintain lifelong blood-pressure control, surveillance, and family assessment", "intro": "Survival after the index event does not eliminate risk from residual dissection or distal aneurysm formation.", "paragraphs": [ "Long-term therapy after acute aortic syndrome should include beta blockers unless contraindicated; add ACE inhibitors or ARBs as needed to control blood pressure. Long-term calcium-channel blocker therapy may be best avoided in Marfan syndrome when alternatives can achieve blood-pressure control because adverse signals have been reported in experimental and registry data. [6]", "For dissection or intramural hematoma managed medically or treated with open or endovascular repair with residual disease, perform CT or MRI at 1, 6, and 12 months and then annually if stable. TTE complements cross-sectional imaging by following root anatomy and aortic valve function. [6]", "Screen first-degree relatives of patients with aortic root or ascending aortic aneurysm or aortic dissection with aortic imaging. Obtain a multigenerational history of thoracic aortic disease, unexplained sudden death, and peripheral or intracranial aneurysms. Genetic testing is recommended when risk factors for heritable thoracic aortic disease are present, including syndromic features, age <60 years, or relevant family history. [6]" ], "bullets": [ "Use reproducible orthogonal measurements at defined landmarks; report the technique and compare directly with prior studies. [6]", "For CT/MRI, use ECG-gated inner-edge-to-inner-edge root and ascending measurements; use outer-edge measurements for segments with wall thickening, intramural hematoma, or significant atherosclerotic wall abnormality. [6]", "Advise against intense isometric exertion, Valsalva-associated heavy lifting, burst exertion, and collision sports; with controlled blood pressure, mild-to-moderate aerobic activity for 30 to 60 minutes at least 3 to 4 days weekly is reasonable. [6]" ], "subsections": [], "table": { "caption": "Surveillance after acute dissection or intramural hematoma. [6]", "columns": [ "Clinical state", "Imaging schedule", "Management consequence" ], "rows": [ [ "Residual disease after open or endovascular repair", "CT or MRI at 1, 6, and 12 months; annually if stable", "Identify false-lumen enlargement, endoleak, graft complication, or new aneurysm requiring reintervention. [6]" ], [ "Medical management alone", "CT or MRI at 1, 6, and 12 months; annually if stable", "Detect delayed expansion, which occurs in 20% to 50% of medically managed uncomplicated type B dissections over 4 years. [6]" ], [ "Chronic residual thoracic aortic aneurysm", "Elective repair at total diameter ≥5.5 cm", "Threshold applies after prior acute dissection or intramural hematoma. [6]" ] ] } } ], "faq": [ { "question": "What is the first-line imaging study for suspected acute aortic dissection?", "answer": "CTA is first-line in most patients because of speed, availability, and complete anatomic assessment. TEE is useful at bedside in unstable patients; MRI is best reserved for stable patients when CTA is unsuitable. [6]" }, { "question": "What hemodynamic targets should be used initially in acute aortic dissection?", "answer": "Treat to heart rate 60 to 80 beats/min and systolic pressure <120 mm Hg, or the lowest pressure that preserves end-organ perfusion. Start IV beta blockade before adding vasodilators. [6]" }, { "question": "When is TEVAR indicated in type B aortic dissection?", "answer": "TEVAR is indicated for rupture and is preferred when anatomy is suitable for complicated type B dissection with malperfusion, extension, enlargement, refractory pain, or uncontrolled hypertension. Selected uncomplicated patients with high-risk anatomy may also be considered. [6]" }, { "question": "Should first-degree relatives undergo screening after aortic dissection?", "answer": "Yes. First-degree relatives of patients with aortic root or ascending aneurysm or aortic dissection should receive screening aortic imaging, even if no pathogenic genetic variant is identified. [6]" } ], "references": [ { "number": 1, "title": "Zenith® Dissection - accessdata.fda.gov", "detail": "www.accessdata.fda.gov", "url": "https://www.accessdata.fda.gov/cdrh_docs/pdf18/P180001C.pdf", "authors": "www.accessdata.fda.gov", "host": "www.accessdata.fda.gov" }, { "number": 2, "title": "ENDOVASCULAR TREATMENT OF THE THORACIC AORTA", "detail": "www.accessdata.fda.gov", "url": "https://www.accessdata.fda.gov/cdrh_docs/pdf21/P210032D.pdf", "authors": "www.accessdata.fda.gov", "host": "www.accessdata.fda.gov" }, { "number": 3, "title": "Acute aortic dissection", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/article/S0140673622019705/pdf", "authors": "www.thelancet.com", "host": "www.thelancet.com" }, { "number": 4, "title": "The Diagnosis and Management of Aortic Dissection", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jama/fullarticle/383986", "authors": "jamanetwork.com", "host": "jamanetwork.com" }, { "number": 5, "title": "Interval or Permanent Nonoperative Management of Acute ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamasurgery/fullarticle/390261", "authors": "jamanetwork.com", "host": "jamanetwork.com" }, { "number": 6, "title": "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacc.2022.08.004", "authors": "www.jacc.org", "host": "www.jacc.org" }, { "number": 7, "title": "2022 Aortic Disease Guideline-at-a-Glance", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacc.2022.10.001", "authors": "www.jacc.org", "host": "www.jacc.org" }, { "number": 8, "title": "Thoracic Aortic Aneurysm and Dissection", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacc.2014.08.025", "authors": "www.jacc.org", "host": "www.jacc.org" }, { 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"https://www.escardio.org/communities/councils/cardiology-practice/scientific-documents-and-publications/ejournal/volume-15/Cardiac-tamponade-due-to-aortic-dissection-clinical-picture-and-treatment-with-focus-on-pericardiocentesis", "authors": "www.escardio.org", "host": "www.escardio.org" }, { "number": 24, "title": "Aortic valve diseases in pregnancy", "detail": "www.escardio.org", "url": "https://www.escardio.org/communities/councils/cardiology-practice/scientific-documents-and-publications/ejournal/volume-18/aortic-valve-diseases-in-pregnancy", "authors": "www.escardio.org", "host": "www.escardio.org" } ], "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Zenith® Dissection - accessdata.fda.gov", "detail": "www.accessdata.fda.gov", "url": "https://www.accessdata.fda.gov/cdrh_docs/pdf18/P180001C.pdf", "authors": "www.accessdata.fda.gov", "host": "www.accessdata.fda.gov", "snippet": "your doctor may recommend periodic checks. The checks could include a physical exam and possibly a CT scan or MRI. 6 Treatment of Aortic Dissection How do doctors treat a thoracic aortic dissection? Once diagnosed, thoracic aortic dissection should be treated promptly. The two main complications are", "score": 0.53750324 }, { "number": 2, "title": "ENDOVASCULAR TREATMENT OF THE THORACIC AORTA", "detail": "www.accessdata.fda.gov", "url": "https://www.accessdata.fda.gov/cdrh_docs/pdf21/P210032D.pdf", "authors": "www.accessdata.fda.gov", "host": "www.accessdata.fda.gov", "snippet": "Diagnosis of transections is often not based on symptoms, but rather on the fact that the patient was in an accident. An acute aortic dissection may involve a sudden onset of symptoms, which may include chest pain often described as severe and tearing along with cold sweats. The pain may be localize", "score": 0.3367895 }, { "number": 3, "title": "Acute aortic dissection", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/article/S0140673622019705/pdf", "authors": "www.thelancet.com", "host": "www.thelancet.com", "snippet": "by T Carrel · 2023 · Cited by 295 — Large penetrating aortic ulcers might be best treated by endovascular stent-grafts while conservative treatment is justified for small lesions.7", "score": 0.1728413 }, { "number": 4, "title": "The Diagnosis and Management of Aortic Dissection", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jama/fullarticle/383986", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "by ES Crawford · 1990 · Cited by 384 — diligent follow-up includes controlling blood pressure, decreasing the velocity of left ventricular contraction, monitoring the size of the", "score": 0.56661874 }, { "number": 5, "title": "Interval or Permanent Nonoperative Management of Acute ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamasurgery/fullarticle/390261", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "by FG Scholl · 1999 · Cited by 90 — Immediate surgical therapy is still recommended for acceptable operative candidates with acute type A aortic dissection who seek immediate treatment.", "score": 0.37188962 }, { "number": 6, "title": "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacc.2022.08.004", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "1.\n\nThose patients with type B aortic dissection generally have better survival than those with type A aortic dissection. In the acute uncomplicated setting, medical management is the first mode of therapy for type B aortic dissection. A review of the IRAD database showed overall in-hospital mortali", "score": 0.77096564 }, { "number": 7, "title": "2022 Aortic Disease Guideline-at-a-Glance", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacc.2022.10.001", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "8.\n\nPatients with acute type A aortic dissection, if clinically stable, should be considered for transfer to a high-volume aortic center to improve survival. The operative repair of type A aortic dissection should entail at least an open distal anastomosis rather than just a simple supracoronary int", "score": 0.60133666 }, { "number": 8, "title": "Thoracic Aortic Aneurysm and Dissection", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacc.2014.08.025", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "Aortic dissection is the most devastating complication of thoracic aortic disease. In the more than 250 years since thoracic aortic dissection was first described, much has been learned about diseases of the thoracic aorta. In this review, we describe normal thoracic aortic size; risk factors for di", "score": 0.4617697 }, { "number": 9, "title": "Optimal Treatment of Uncomplicated Type B Aortic Dissection: JACC Review Topic of the Week", "detail": "www.jacc.org", "url": "https://www.jacc.org/doi/10.1016/j.jacc.2019.07.063", "authors": "www.jacc.org", "host": "www.jacc.org", "snippet": "View all articles by David H. Adams\n\n#### Notes\n\n∗\n\nAddress for correspondence: Dr. Rami O. Tadros, Department of Surgery, Division of Vascular Surgery, The Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 4th Floor, New York, New York 10029.\n\n## Metrics & Citations\n\nMetrics Citations\n\n", "score": 0.4398682 }, { "number": 10, "title": "Aortic Dissection | Circulation", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/circulationaha.108.799908", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "by D Juang · 2008 · Cited by 74 — The most frequently performed tests to diagnose aortic dissection and its complications include computed tomography (CT) scan, transesophageal", "score": 0.5863576 }, { "number": 11, "title": "Diagnosis of Acute Aortic Dissection by D-Dimer | Circulation", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/circulationaha.108.833004", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "the widely used cutoff level of 500 ng/mL for ruling out pulmonary embolism also can reliably rule out aortic dissection, with a", "score": 0.48279548 }, { "number": 12, "title": "Aortic Dissection: New Frontiers in Diagnosis and ...", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/01.cir.0000087009.16755.e4", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "by CA Nienaber · 2003 · Cited by 1041 — Acute aortic dissection of the ascending aorta is highly lethal, with a mortality rate of 1% to 2% per hour early after symptom onset. ... Instantaneous onset of", "score": 0.4767995 }, { "number": 13, "title": "Acute Aortic Dissection | Circulation", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/circulationaha.110.958975", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "by AC Braverman · 2010 · Cited by 324 — Short- and long-term survival in acute type A dissection has ranged between 52% and 94% at 1 year and 45% and 88% at 5 years. The 10-year", "score": 0.41620392 }, { "number": 14, "title": "Clinical Examination for Acute Aortic Dissection: A ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1111/acem.13360", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "this review confirms recommendations made by the American College of Emergency Physicians 2015 guideline for the diagnosis of acute aortic", "score": 0.72559077 }, { "number": 15, "title": "2014 ESC Guidelines on the diagnosis and treatment of aortic ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/eurheartj/article/35/41/2873/407693", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by Authors/Task Force members · 2014 · Cited by 5841 — 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta", "score": 0.31849626 }, { "number": 16, "title": "Diagnosing aortic dissection: A review of this elusive, lethal ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/full/10.1002/emp2.13225", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "by B Briggs · 2024 · Cited by 19 — The aim of this article is to review the available literature on AD, discussing the diversity in presentations and the prevalence of historical", "score": 0.299915 }, { "number": 17, "title": "The incidence and mortality of acute thoracic aortic dissection", "detail": "academic.oup.com", "url": "https://academic.oup.com/ejcts/article/50/6/1111/2726579", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by IH Melvinsdottir · 2016 · Cited by 320 — The 30-day mortality rate for patients operated for type A dissection was 28.6% and did not change significantly throughout the study period. Of the 34 non-", "score": 0.10503621 }, { "number": 18, "title": "2024 ESC Guidelines for the management of peripheral ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/eurheartj/article/45/36/3538/7738955", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by L Mazzolai · 2024 · Cited by 1286 — Guidelines evaluate and summarize available evidence with the aim of assisting health professionals in proposing the best diagnostic or", "score": 0.060713034 }, { "number": 19, "title": "Surgical management for Stanford type A aortic dissection ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/icvts/article/7/6/1107/655538", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by L Göbölös · 2008 · Cited by 24 — Surgical therapy consists mainly in replacing the ascending aorta, and as extended procedure also removing the arch up to the proximal descending region. A", "score": 0.39824316 }, { "number": 20, "title": "American Society for Clinical Pharmacology and Therapeutics", "detail": "ascpt.onlinelibrary.wiley.com", "url": "https://ascpt.onlinelibrary.wiley.com/doi/10.1002/cpt.3167", "authors": "ascpt.onlinelibrary.wiley.com", "host": "ascpt.onlinelibrary.wiley.com", "snippet": "The analysis supports a body-weight based dosing approach and no starting dose adjustments in mild to moderate renal or hepatic impairment.", "score": 0.2443003 }, { "number": 21, "title": "2022 ACC/AHA Guideline for the Diagnosis and ...", "detail": "www.ccjm.org", "url": "https://www.ccjm.org/lookup/external-ref?access_num=10.1161%2FCIR.0000000000001106&link_type=DOI", "authors": "www.ccjm.org", "host": "www.ccjm.org", "snippet": "by EM Isselbacher · 2022 · Cited by 3066 — The “2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease” provides recommendations to guide clinicians in the diagnosis,", "score": 0.5125224 }, { "number": 22, "title": "Thoracic aortic aneurysm: Optimal surveillance and treatment", "detail": "www.ccjm.org", "url": "https://www.ccjm.org/content/87/9/557", "authors": "www.ccjm.org", "host": "www.ccjm.org", "snippet": "Type A aortic dissection (ie, originating in the ascending aorta) is a fatal condition with dismal in-hospital mortality rates of 57% without emergency surgery and 17% to 25% with emergency surgery in national and international registries despite advances in management.3,4 The mortality rate is much", "score": 0.5114976 }, { "number": 23, "title": "Cardiac tamponade due to aortic dissection: clinical picture and treatment with focus on pericardiocentesis", "detail": "www.escardio.org", "url": "https://www.escardio.org/communities/councils/cardiology-practice/scientific-documents-and-publications/ejournal/volume-15/Cardiac-tamponade-due-to-aortic-dissection-clinical-picture-and-treatment-with-focus-on-pericardiocentesis", "authors": "www.escardio.org", "host": "www.escardio.org", "snippet": "study . As a result, the elevation of systolic blood pressure was about 30 mmHg . In addition, systolic blood pressure after drainage was around 95 mmHg in their patients, and was achieved without inducing fatal bleeding from the aorta . Based on this report, 2015 ESC Guidelines for the diagnosis an", "score": 0.5003668 }, { "number": 24, "title": "Aortic valve diseases in pregnancy", "detail": "www.escardio.org", "url": "https://www.escardio.org/communities/councils/cardiology-practice/scientific-documents-and-publications/ejournal/volume-18/aortic-valve-diseases-in-pregnancy", "authors": "www.escardio.org", "host": "www.escardio.org", "snippet": "8. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomstrom-Lundqvist C, Cifkova R, De Bonis M, Iung B, Johnson MR, Kintscher U, Kranke P, Lang IM, Morais J, Pieper PG, Presbitero P, Price S, Rosano GMC, Seeland U, Simoncini T, Swan L, Warnes CA; ESC Scientific Document Group. 2018 ESC Guidelin", "score": 0.44160134 } ], "publishedAt": "2026-08-20T23:44:02.416673Z", "updatedAt": "2026-08-20T23:44:02.416673Z", "readingMinutes": 6, "slug": "aortic-dissection" }