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World J Hypertens. May 23, 2015; 5(2): 79-84
Published online May 23, 2015. doi: 10.5494/wjh.v5.i2.79
Diagnosis and management of thoracic aortic dissection: An update
Ruth A Benson, Ben O Patterson, Ian M Loftus
Ruth A Benson, Ben O Patterson, Ian M Loftus, St George’s Vascular Institute, St George’s Healthcare NHS Trust, London SW170 QT, United Kingdom
Author contributions: Benson RA, Patterson BO and Loftus IM contributed to this paper.
Conflict-of-interest: None declared.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ruth A Benson, BSc, MBChB, MRCS, Vascular Research Fellow, St George’s Vascular Institute, St George’s Healthcare NHS Trust, Blackshaw Road, London SW170 QT, United Kingdom. ruth.benson@gmail.com
Telephone: +44-20-87253205 Fax: +44-20-87253495
Received: September 29, 2014
Peer-review started: October 1, 2014
First decision: October 28, 2014
Revised: November 11, 2014
Accepted: February 4, 2015
Article in press: February 6, 2015
Published online: May 23, 2015
Processing time: 234 Days and 11.4 Hours
Abstract

Acute thoracic aortic dissection is part of the acute aortic syndrome triad. Caused by an intimal tear in the lumen of the aorta, it leads to the creation and propagation of a false lumen. In the acute setting this can lead to malignant hypertension, pain and end organ malperfusion. In the chronic setting it can lead to aneurysm formation and rupture. It remains the most common aortic emergency, affecting up to 4 per 100000 people per year in the United Kingdom and United States. Despite advances in treatment and centralisation of vascular services, it continues to be associated with a high pre-admission and in-hospital mortality. Dissection is classified in several ways according to anatomical extent, timing and underlying pathology, all of which guides clinical management. Traditionally, medical management has been the mainstay of treatment in patients with uncomplicated disease. Surgery has been used in symptomatic patients. With published information now available from several prospective international registries, we are beginning to see the advantages of newer surgical treatment options such as endovascular repair, in the acute setting. This review provides an update on diagnosis and management of aortic dissection, including new information that has become available in recent years.

Keywords: Aortic dissection; Endovascular; Acute aortic syndrome; Aneurysm; Dissecting; Endovascular procedures; Hypertension, Malignant; Registries

Core tip: Aortic dissection remains the most common aortic emergency, affecting up to 4 per 100000 people per year in the United Kingdom and United States. Surgical management is indicated in dissection complicated by uncontrolled pain and hypertension, end-organ malperfusion and aneurysmal dilatation with risk of rupture. This update discusses results of thoracic stenting from more recently published prospective international registries, including risks and benefits to treated patients affected by this incredibly high risk condition.