Acute aortic syndrome explained

Specialty:Vascular surgery

Acute aortic syndrome (AAS) describes a range of severe, painful, potentially life-threatening abnormalities of the aorta.[1] These include aortic dissection, intramural thrombus, and penetrating atherosclerotic aortic ulcer.[2] AAS can be caused by a lesion on the wall of the aorta that involves the tunica media, often in the descending aorta.[3] It is possible for AAS to lead to acute coronary syndrome.[4] The term was introduced in 2001.[5] [6]

Signs and symptoms

The most common symptom of AAS is sudden and severe chest pain. However, other variants of chest pain and back pain have been described.[7]

Causes

Causes can include aortic dissection (which is the most common type),[8] intramural hematoma, penetrating atherosclerotic ulcer or a thoracic aneurysm that has become unstable.[9] The potential causes of AAS are life-threatening and present with similar symptoms, making it difficult to distinguish the ultimate cause, though high resolution, high contrast computerised tomography can be used.[9] [10]

Diagnosis

The condition can be mimicked by a ruptured cyst of the pericardium,[11] ruptured aortic aneurysm[10] and acute coronary syndrome.[12]

Misdiagnosis is estimated at 39% and is associated with delays correct diagnosis and improper treatment with anticoagulants producing excessive bleeding and extended hospital stays.[12]

Management

AAS is life-threatening, with a high mortality rate if appearing acutely, reduced only when diagnosed early and treated by a surgeon with considerable expertise.[3] If patients survive acute presentation, within three to five years 30% will develop complications and require close follow-up.[3] Early diagnosis is essential for survival and management is challenging though greater awareness of the syndrome and improving management strategies are improving patient outcomes.[13]

Notes and References

  1. Ahmad F, Cheshire N, Hamady M . Acute aortic syndrome: pathology and therapeutic strategies . Postgrad Med J . 82 . 967 . 305–12 . May 2006 . 16679467 . 10.1136/pgmj.2005.043083 . 2563796.
  2. Macura . KJ . Corl FM. Fishman EK. Bluemke DA . Pathogenesis in acute aortic syndromes: aortic dissection, intramural hematoma, and penetrating atherosclerotic aortic ulcer . American Journal of Roentgenology . 181 . 2 . 309–316 . 1 August 2003 . 12876003 . 10.2214/ajr.181.2.1810309.
  3. Evangelista Masip A . [Progress in the acute aortic syndrome] . es . Revista Espanola de Cardiologia. 60 . 4 . 428–39 . April 2007 . 17521551 . 10.1157/13101646.
  4. Manghat NE, Morgan-Hughes GJ, Roobottom CA . Multi-detector row computed tomography: imaging in acute aortic syndrome . Clin Radiol . 60 . 12 . 1256–67 . December 2005 . 16291307 . 10.1016/j.crad.2005.06.011 .
  5. van der Loo B, Jenni R . Acute aortic syndrome: proposal for a novel classification . Heart . 89 . 8 . 928 . August 2003 . 12860875 . 10.1136/heart.89.8.928. 1767786.
  6. Vilacosta I, Román JA . Acute aortic syndrome . Heart . 85 . 4 . 365–8 . April 2001 . 11250953 . 10.1136/heart.85.4.365. 1729697.
  7. Murphy . Michael C. . Castner . Catherine F. . Kouchoukos . Nicholas T. . 2017 . Acute Aortic Syndromes: Diagnosis and Treatment . Missouri Medicine . 114 . 6 . 458–463 . 0026-6620 . 6139964 . 30228665.
  8. Gregory. Stephen H.. Yalamuri. Suraj M.. Bishawi. Muath. Swaminathan. Madhav. December 2018. The Perioperative Management of Ascending Aortic Dissection. Anesthesia & Analgesia. en. 127. 6. 1302–1313. 10.1213/ANE.0000000000003747. 30211773. 52195386. 0003-2999. free.
  9. Smith AD, Schoenhagen P . CT imaging for acute aortic syndrome . Cleve Clin J Med . 75 . 1 . 7–9, 12, 15–7 passim . January 2008 . 18236724 . 10.3949/ccjm.75.1.7.
  10. Marijon E, Vilanculos A, Tivane A . Thoracic aortic aneurysm: direct sign of rupture . Cardiovasc J Afr . 18 . 3 . 180–1 . 2007 . 17612751 . etal.
  11. Nishigami K, Hirayama T, Kamio T . Pericardial cyst rupture mimicking acute aortic syndrome . Eur. Heart J. . 29. 14. 1752. February 2008 . 18296680 . 10.1093/eurheartj/ehn038 .
  12. Hansen MS, Nogareda GJ, Hutchison SJ . Frequency of and inappropriate treatment of misdiagnosis of acute aortic dissection . Am. J. Cardiol. . 99 . 6 . 852–6 . March 2007 . 17350381 . 10.1016/j.amjcard.2006.10.055 .
  13. Ince H, Nienaber CA . [Management of acute aortic syndromes] . es . Revista Española de Cardiología (English Edition). 60 . 5 . 526–41 . May 2007 . 17535765 . 10.1016/S1885-5857(07)60194-7.

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