J Korean Med Assoc.  2008 Apr;51(4):347-356. 10.5124/jkma.2008.51.4.347.

Current Status of Acute Aortic Disease Treatment

• Park KH

• KMID: 2185743
• DOI: http://doi.org/10.5124/jkma.2008.51.4.347

Abstract

About 1,000 patients undergo aortic surgery annually in Korea. Unlike Western countries, emergency surgery for dissection or ruptured aneurysm is more frequent than elective cases. Because timely diagnosis and intervention are essential for improving the treatment outcome, medical professionals should be provided with accurate knowledge about the nature of the diseases and currently available treatment modalities along with their results. Aortic dissection is the most frequent among the acute aortic diseases. Although there is a wide variation in surgical results between hospitals, experienced centers are reporting early survival rates higher than 90% after a surgery for acute type A dissection. The majority of the patients with acute type B dissection can be treated medically. For those who have serious complications such as rupture or malperfusion, catheter-based intervention became a promising alternative to surgery. Aortic intramural hematoma and penetrating atherosclerotic ulcer are known to have better prognosis than dissection. However, treatment plans should be decided individually, because many of such lesions can progress into dissection or rupture. Because the result of surgery for ruptured degenerative aneurysm is poor, surveillance and timely intervention is of utmost importance. The mortality rate after elective aortic surgery has come into a satisfactory range; <10% for the thoracic and <5% for the abdominal aorta. Endovascular repair has been established as an effective treatment for the abdominal aortic aneurysm. However, its effectiveness and proper indications for thoracic aortic diseases are not fully determined. Refinement of device and combination with surgical repair (hybrid technique) will widen the indication of stent-grafting.

Keyword

Aorta; Aortic dissection; Aortic aneurysm

MeSH Terms

Aneurysm
Aneurysm, Ruptured
Aorta
Aorta, Abdominal
Aortic Aneurysm
Aortic Aneurysm, Abdominal
Aortic Diseases
Emergencies
Hematoma
Humans
Korea
Prognosis
Rupture
Survival Rate
Treatment Outcome
Ulcer

Figure

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  Figure 1 Trend in annual number of aortic surgery in Korea.

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  Figure 2 Extent of aortic replacement for acute type A dissection.

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  Figure 3 Computed tomographic scan images of various malperfusion syndrome caused by aortic dissection. (A) True lumen compression in right common carotid artery causing stroke. (B) Obstruction of arch branches by mobile intimal flap causing cerebral ischemia and arm ischemia. (C), (D) Malperfusion of left main coronary artery causing acute myocardial infarction. (E), (F) Occlusion of superior mesenteric artery causing bowel infarction.

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  Figure 4 Extended replacement of the aorta and open insertion of stent-graft for acute type A dissection.

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  Figure 5 Rationale of fenestration for acute type B aortic dissection.

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  Figure 6 Aortic intramural hematoma (A, B) and penetrating ulcer (C, D).

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  Figure 7 Spontaneous absorption of intramural hematoma seen in serial CT scans.

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  Figure 8 Aortic intramural hematoma accompanied by an intimal defect.

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  Figure 9 Stent-graft for the thoracic aorta.

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