IR Playbook pp 209-218 | Cite as

Aortic Dissection

  • William M. Sherk
  • Minhaj S. Khaja
  • David M. WilliamsEmail author


The spectrum of acute aortic syndrome includes aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. All three are amenable to endovascular treatment in select cases. The following chapter introduces the pathophysiology and clinical presentation of aortic dissection, indications for traditional (medical or open surgical) versus endovascular repair, and techniques of both TEVAR (thoracic endovascular aortic repair) and fenestration with or without stenting.


Aortic dissection Acute aortic syndrome Intramural hematoma Static obstruction Dynamic obstruction Fenestration TEVAR (thoracic endovascular aortic repair) 


  1. 1.
    Anagnostopoulos CE, Prabhakar MJ, Kittle CF. Aortic dissections and dissecting aneurysms. Am J Cardiol. 1972;30(3):263–73.CrossRefPubMedGoogle Scholar
  2. 2.
    De Bakey ME, Cooley DA, Creech O Jr. Surgical considerations of dissecting aneurysm of the aorta. Ann Surg. 1955;142(4):586.CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Wheat MW Jr, Palmer RF, Bartley TD, Seelman RC. Treatment of dissecting aneurysms of the aorta without surgery. J Thorac Cardiovasc Surg. 1965;50:364–73.PubMedGoogle Scholar
  4. 4.
    Khan IA, Nair CK. Clinical, diagnostic, and management perspectives of aortic dissection. Chest J. 2002;122(1):311–28.CrossRefGoogle Scholar
  5. 5.
    Williams DM, Lee DY, Hamilton BH, Marx MV, Narasimham DL, Kazanjian SN, et al. The dissected aorta: part III. Anatomy and radiologic diagnosis of branch-vessel compromise. Radiology. 1997;203(1):37–44.CrossRefPubMedGoogle Scholar
  6. 6.
    Hiratzka L, Bakris G, Beckman J, Bersin RM, Carr VF, Casey DE Jr, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. J Am Coll Cardiol. 2010;121:e266–369.Google Scholar
  7. 7.
    Monnin-Bares V, Thony F, Rodiere M, Bach V, Hacini R, Blin D, et al. Endovascular stent-graft management of aortic intramural hematomas. J Vasc Interv Radiol. 2009;20:713–21.CrossRefPubMedGoogle Scholar
  8. 8.
    Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection: perspectives from the International Registry of Acute Aortic Dissection (IRAD). Eur J Vasc Endovasc Surg. 2009;37(2):149–59.CrossRefPubMedGoogle Scholar
  9. 9.
    De Bakey ME. Surgical management of dissecting aneurysm of the aorta. J Thorac Cardiovasc Surg. 1965;49:130–49.Google Scholar
  10. 10.
    Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE. Management of acute aortic dissections. Ann Thorac Surg. 1970;10(3):237–47.CrossRefPubMedGoogle Scholar
  11. 11.
    Booher AM, Isselbacher EM, Nienaber CA, Trimarchi S, Evangelista A, Montgomery DG, et al. The IRAD classification system for characterizing survival after aortic dissection. Am J Med. 2013;126(8):730–e19.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Trimarchi S, Nienaber CA, Rampoldi V, Myrmel T, Suzuki T, Bossone E, et al. Role and results of surgery in acute type B aortic dissection insights from the International Registry of Acute Aortic Dissection (IRAD). Circulation. 2006;114(1 suppl):I-357.Google Scholar
  13. 13.
    von Kodolitsch Y, Schwartz AG, Nienaber CA. Clinical prediction of acute aortic dissection. Arch Intern Med. 2000;160(19):2977–82.CrossRefGoogle Scholar
  14. 14.
    Deeb GM, Williams DM, Bolling SF, Quint LE, Monaghan H, Sievers J, et al. Surgical delay for acute type a dissection with malperfusion. Ann Thorac Surg. 1997;64:1669–75. discussion 1675-7.CrossRefPubMedGoogle Scholar
  15. 15.
    Patel HJ, Williams DM, Dasika NL, Suzuki Y, Deeb GM. Operative delay for peripheral malperfusion syndrome in acute type A aortic dissection: a long-term analysis. J Thorac Cardiovasc Surg. 2008;135:1288–95. discussion 1295-6.CrossRefPubMedGoogle Scholar
  16. 16.
    Czerny M, Schoenhoff F, Etz C, Englberger L, Englberger L, Khaladj N, Zierer A, et al. The impact of pre-operative malperfusion on outcome in acute type A aortic dissection: results from the GERAADA registry. J Am Coll Cardiol. 2015;65(24):2628–35.CrossRefPubMedGoogle Scholar
  17. 17.
    Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet. 2015;385(9970):800–11.CrossRefPubMedGoogle Scholar
  18. 18.
    Gysi J, Schaffner T, Mohacsi P, Aeschbacher B, Althaus U, Carrel T. Early and late outcome of operated and non-operated acute dissection of the descending aorta. Eur J Cardiothorac Surg. 1997;11(6):1163–70.CrossRefPubMedGoogle Scholar
  19. 19.
    Glower DD, Speier RH, White WD, Smith LR, Rankin JS, Wolfe WG. Management and long-term outcome of aortic dissection. Ann Surg. 1991;214(1):31.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Akutsu K, Nejima J, Kiuchi K, Sasaki K, Ochi M, Tanaka K, et al. Effects of the patent false lumen on the long-term outcome of type B acute aortic dissection. Eur J Cardiothorac Surg. 2004;26(2):359–66.CrossRefPubMedGoogle Scholar
  21. 21.
    Gurin D, Bulmer JW, Derby R. Dissecting aneurysm of the aorta: diagnosis and operative relief of acute arterial obstruction due to this cause. NY State J Med. 1935;35:1200–2.Google Scholar
  22. 22.
    Bavaria JE, Brinster DR, Gorman RC, Woo YJ, Gleason T, Pochettino A, et al. Advances in the treatment of acute type A dissection: an integrated approach. Ann Thorac Surg. 2002;74(5):S1848–52.CrossRefPubMedGoogle Scholar
  23. 23.
    Jonker FH, Patel HJ, Upchurch GR, Williams DM, Montgomery DG, Gleason TG, et al. Acute type B aortic dissection complicated by visceral ischemia. J Thorac Cardiovasc Surg. 2015;149(4):1081–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Suzuki T, Mehta RH, Ince H, Mehta RH, Ince H, Nagai R, Sakomura Y, Weber F, et al. Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD). Circulation. 2003;108(10 suppl 1):II-312.Google Scholar
  25. 25.
    Dake MD, Kato N, Mitchell RS, Semba CP, Razavi MK, Shimono T, et al. Endovascular stent–graft placement for the treatment of acute aortic dissection. N Engl J Med. 1999;340(20):1546–52.CrossRefPubMedGoogle Scholar
  26. 26.
    Williams DM, Lee DY, Hamilton BH, Marx MV, Narasimham DL, Kazanjian SN, et al. The dissected aorta: percutaneous treatment of ischemic complications–principles and results. J Vasc Interv Radiol. 1997;8:605–25.CrossRefPubMedGoogle Scholar
  27. 27.
    Coady MA, Ikonomidis JS, Cheung AT, Matsumoto AH, Dake MD, Chaikof EL, et al. Surgical management of descending thoracic aortic disease: open and endovascular approaches a scientific statement from the American heart association. Circulation. 2010;121(25):2780–804.CrossRefPubMedGoogle Scholar
  28. 28.
    Svensson LG, Kouchoukos NT, Miller DC, Bavaria JE, Coselli JS, Curi MA, et al. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Ann Thorac Surg. 2008;85(1):S1–41.CrossRefPubMedGoogle Scholar
  29. 29.
    Fattori R, Cao P, De Rango P, Czerny M, Evangelista A, Nienaber C, et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J Am Coll Cardiol. 2013;61(16):1661–78.CrossRefPubMedGoogle Scholar
  30. 30.
    Brunkwall J, Kasprzak P, Verhoeven E, Heijmen R, Taylor P, Trialists ADSORB, et al. Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial. Eur J Vasc Endovasc Surg. 2014;48(3):285–91.CrossRefPubMedGoogle Scholar
  31. 31.
    Nienaber CA, Kische S, Rousseau H, Eggebrecht H, Rehders TC, Kundt G, et al. Endovascular repair of type B aortic dissection long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv. 2013;6(4):407–16.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • William M. Sherk
    • 1
  • Minhaj S. Khaja
    • 2
  • David M. Williams
    • 2
    Email author
  1. 1.Department of RadiologyUniversity of Michigan Health SystemAnn ArborUSA
  2. 2.Department of RadiologyUniversity of Michigan Hospital and Health SystemsAnn ArborUSA

Personalised recommendations