Thoracic Aorta

  • Peter I. Ellman
  • Irving L. Kron


An 18-year-old woman who just recently received her driver’s license is involved in a head-on collision. Upon arrival to the trauma bay, she is alert and complaining of chest pain. The patient is hemodynamically stable. Physical examination is unremarkable with the exception of precordial tenderness. Diagnostic workup confirms a traumatic aortic rupture. Which of the following would be the most appropriate management approach?
  1. (A)


  2. (B)

    Intraaortic balloon pump

  3. (C)

    Endovascular stenting

  4. (D)

    Antihypertensive therapy and monitoring

  5. (E)

    Observation only



Aortic Dissection Thoracic Aorta Marfan Syndrome False Lumen Compute Tomog 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Smith RS, Chang FC. Traumatic rupture of the aorta: still a lethal injury. Am J Surg 1986; 152(6):660–663.PubMedCrossRefGoogle Scholar
  2. 2.
    Fabian TC, Richardson JD, Croce MA, et al. Prospective study of blunt aortic injury: multicenter trial of the American Association for the Surgery of Trauma. J Trauma 1997; 42(3):374–383.PubMedCrossRefGoogle Scholar
  3. 3.
    Gavant ML, Flick P, Menke P, Gold RE. CT aortography of thoracic aortic rupture. AJR Am J Roentgenol 1996; 166(4):955–961.PubMedGoogle Scholar
  4. 4.
    Parmley LF, Mattingly TW, Manion WC, Jahnke EJ Jr. Nonpenetrating traumatic injury of the aorta. Circulation 1958; 17(6):1086–1101.PubMedGoogle Scholar
  5. 5.
    Steinberg I. Chronic traumatic aneurysm of the thoracic aorta: report of five cases, with a plea for conservative treatment. N Engl J Med 1957; 257(19):913–918.PubMedGoogle Scholar
  6. 6.
    Passaro E Jr, Pace WG. Traumatic rupture of the aorta. Surgery 1959; 46:787–791.PubMedGoogle Scholar
  7. 7.
    Mattox KL. Fact and fiction about management of aortic transection. Ann Thorac Surg 1989; 48(1):1–2.PubMedCrossRefGoogle Scholar
  8. 8.
    Duhaylongsod FG, Glower DD, Wolfe WG. Acute traumatic aortic aneurysm: the Duke experience from 1970 to 1990. J Vasc Surg 1992; 15(2):331–343.PubMedCrossRefGoogle Scholar
  9. 9.
    Brown DK, Roe EJ, Henry TE. A fatality associated with the deployment of an automobile airbag. J Trauma 1995; 39(6):1204–1206.PubMedCrossRefGoogle Scholar
  10. 10.
    Pillgram-Larsen J, Geiran O. [Air bags influence the pattern of injury in severe thoracic trauma.] Tidsskr Nor Laegeforen 1997; 117(17):2437–2439.PubMedGoogle Scholar
  11. 11.
    Dunn JA, Williams MG. Occult ascending aortic rupture in the presence of an air bag. Ann Thorac Surg 1996; 62(2):577–578.PubMedCrossRefGoogle Scholar
  12. 12.
    Sevitt S. Traumatic ruptures of the aorta: a clinico-pathological study. Injury 1977; 8(3):159–173.PubMedCrossRefGoogle Scholar
  13. 13.
    Greendyke RM. Traumatic rupture of aorta; special reference to automobile accidents. JAMA 1966; 195(7):527–530.PubMedCrossRefGoogle Scholar
  14. 14.
    Butcher HR Jr, Jaffe BM. Treatment of aortoiliac arterial occlusive disease by endarterectomy. Ann Surg 1971; 173(6):925–932.PubMedCrossRefGoogle Scholar
  15. 15.
    Butcher HR Jr. The elastic properties of human aortic intima, media and adventitia: the initial effect of thromboendarterectomy. Ann Surg 1960; 151:480–489.PubMedCrossRefGoogle Scholar
  16. 16.
    Stapp JP. Human tolerance to deceleration. Am J Surg 1957; 93(4):734–740.PubMedCrossRefGoogle Scholar
  17. 17.
    Jackson FR, Berkas EM, Roberts VL. Traumatic aortic rupture after blunt trauma. Dis Chest 1968; 53(5):577–583.PubMedCrossRefGoogle Scholar
  18. 18.
    Sevitt S. The mechanisms of traumatic rupture of the thoracic aorta. Br J Surg 1977; 64(3):166–173.PubMedCrossRefGoogle Scholar
  19. 19.
    Coermann R, Dotzauer G, Lange W, Voigt GE. The effects of the design of the steering assembly and the instrument panel on injuries (especially aortic rupture) sustained by car drivers in head-on collision. J Trauma 1972; 12(8): 715–724.PubMedCrossRefGoogle Scholar
  20. 20.
    Crass JR, Cohen AM, Motta AO, Tomashefski JF Jr, Wiesen EJ. A proposed new mechanism of traumatic aortic rupture: the osseous pinch. Radiology 1990; 176(3): 645–649.PubMedGoogle Scholar
  21. 21.
    Cohen AM, Crass JR, Thomas HA, Fisher RG, Jacobs DG. CT evidence for the “osseous pinch” mechanism of traumatic aortic injury. AJR Am J Roentgenol 1992; 159(2): 271–274.PubMedGoogle Scholar
  22. 22.
    Cohen AM, Crass JR. Traumatic aortic injuries: current concepts. Semin Ultrasound CT MR 1993; 14(2):71–84.PubMedCrossRefGoogle Scholar
  23. 23.
    Feczko JD, Lynch L, Pless JE, Clark MA, McClain J, Hawley DA. An autopsy case review of 142 nonpenetrating (blunt) injuries of the aorta. J Trauma 1992; 33(6): 846–849.PubMedCrossRefGoogle Scholar
  24. 24.
    Arajarvi E, Santavirta S, Tolonen J. Aortic ruptures in seat belt wearers. J Thorac Cardiovasc Surg 1989; 98(3):355–361.PubMedGoogle Scholar
  25. 25.
    Rabinsky I, Sidhu GS, Wagner RB. Mid-descending aortic traumatic aneurysms. Ann Thorac Surg 1990; 50(1):155–160.PubMedCrossRefGoogle Scholar
  26. 26.
    Razzouk AJ, Gundry SR, Wang N, del Rio MJ, Varnell D, Bailey LL. Repair of traumatic aortic rupture: a 25-year experience. Arch Surg 2000; 135(8):913–919.PubMedCrossRefGoogle Scholar
  27. 27.
    Sweeney MS, Young DJ, Frazier OH, Adams PR, Kapusta MO, Macris MP. Traumatic aortic transections: eight-year experience with the “clamp-sew” technique. Ann Thorac Surg 1997; 64(2):384–389.PubMedCrossRefGoogle Scholar
  28. 28.
    Hilgenberg AD, Logan DL, Akins CW, et al. Blunt injuries of the thoracic aorta. Ann Thorac Surg 1992; 53(2):233–239.PubMedCrossRefGoogle Scholar
  29. 29.
    Kieny R, Charpentier A. Traumatic lesions of the thoracic aorta. A report of 73 cases. J Cardiovasc Surg (Torino) 1991; 32(5):613–619.Google Scholar
  30. 30.
    Cowley RA, Turney SZ, Hankins JR, Rodriguez A, Attar S, Shankar BS. Rupture of thoracic aorta caused by blunt trauma. A fifteen-year experience. J Thorac Cardiovasc Surg 1990; 100(5):652–661.PubMedGoogle Scholar
  31. 31.
    von Oppell UO, Dunne TT, De Groot MK, Zilla P. Traumatic aortic rupture: twenty-year metaanalysis of mortality and risk of paraplegia. Ann Thorac Surg 1994; 58(2): 585–593.CrossRefGoogle Scholar
  32. 32.
    McBride LR, Tidik S, Stothert JC, et al. Primary repair of traumatic aortic disruption. Ann Thorac Surg 1987; 43(1):65–67.PubMedCrossRefGoogle Scholar
  33. 33.
    Schmidt CA, Wood MN, Razzouk AJ, Killeen JD, Gan KA. Primary repair of traumatic aortic rupture: a preferred approach. J Trauma 1992; 32(5):588–592.PubMedCrossRefGoogle Scholar
  34. 34.
    Kirsh MM, Behrendt DM, Orringer MB, et al. The treatment of acute traumatic rupture of the aorta: a 10-year experience. Ann Surg 1976; 184(3):308–316.PubMedCrossRefGoogle Scholar
  35. 35.
    Sturm JT, Billiar TR, Dorsey JS, Luxenberg MG, Perry JF Jr. Risk factors for survival following surgical treatment of traumatic aortic rupture. Ann Thorac Surg 1985; 39(5): 418–421.PubMedCrossRefGoogle Scholar
  36. 36.
    Clark DE, Zeiger MA, Wallace KL, Packard AB, Nowicki ER. Blunt aortic trauma: signs of high risk. J Trauma 1990; 30(6):701–705.PubMedCrossRefGoogle Scholar
  37. 37.
    Gundry SR, Williams S, Burney RE, Cho KJ, Mackenzie JR. Indications for aortography in blunt thoracic trauma: a reassessment. J Trauma 1982; 22(8):664–671.PubMedCrossRefGoogle Scholar
  38. 38.
    Kram HB, Wohlmuth DA, Appel PL, Shoemaker WC. Clinical and radiographic indications for aortography in blunt chest trauma. J Vasc Surg 1987; 6(2):168–176.PubMedCrossRefGoogle Scholar
  39. 39.
    Sturm JT, Perry JF Jr, Olson FR, Cicero JJ. Significance of symptoms and signs in patients with traumatic aortic rupture. Ann Emerg Med 1984; 13(10):876–878.PubMedCrossRefGoogle Scholar
  40. 40.
    Trachiotis GD, Sell JE, Pearson GD, Martin GR, Midgley FM. Traumatic thoracic aortic rupture in the pediatric patient. Ann Thorac Surg 1996; 62(3):724–732.PubMedCrossRefGoogle Scholar
  41. 41.
    Vlahakes GJ, Warren RL. Traumatic rupture of the aorta. N Engl J Med 1995; 332(6):389–390.PubMedCrossRefGoogle Scholar
  42. 42.
    Cook AD, Klein JS, Rogers FB, Osler TM, Shackford SR. Chest radiographs of limited utility in the diagnosis of blunt traumatic aortic laceration. J Trauma 2001; 50(5): 843–847.PubMedCrossRefGoogle Scholar
  43. 43.
    Fabian TC, Davis KA, Gavant ML, et al. Prospective study of blunt aortic injury: helical CT is diagnostic and antihypertensive therapy reduces rupture. Ann Surg 1998; 227(5):666–677.PubMedCrossRefGoogle Scholar
  44. 44.
    Gavant ML. Helical CT grading of traumatic aortic injuries. Impact on clinical guidelines for medical and surgical management. Radiol Clin North Am 1999; 37(3):553–574, vi.PubMedCrossRefGoogle Scholar
  45. 45.
    Demetriades D, Gomez H, Velmahos GC, et al. Routine helical computed tomographic evaluation of the mediastinum in high-risk blunt trauma patients. Arch Surg 1998; 133(10):1084–1088.PubMedCrossRefGoogle Scholar
  46. 46.
    Sturm JT, Hankins DG, Young G. Thoracic aortography following blunt chest trauma. Am J Emerg Med 1990; 8(2):92–96.PubMedCrossRefGoogle Scholar
  47. 47.
    Eddy AC, Nance DR, Goldman MA, et al. Rapid diagnosis of thoracic aortic transection using intravenous digital subtraction angiography. Am J Surg 1990; 159(5):500–503.PubMedCrossRefGoogle Scholar
  48. 48.
    LaBerge JM, Jeffrey RB. Aortic lacerations: fatal complications of thoracic aortography. Radiology 1987; 165(2): 367–369.PubMedGoogle Scholar
  49. 49.
    Wilson D, Voystock JF, Sariego J, Kerstein MD. Role of computed tomography scan in evaluating the widened mediastinum. Am Surg 1994; 60(6):421–423.PubMedGoogle Scholar
  50. 50.
    Mirvis SE, Shanmuganathan K, Buell J, Rodriguez A. Use of spiral computed tomography for the assessment of blunt trauma patients with potential aortic injury. J Trauma 1998; 45(5):922–930.PubMedCrossRefGoogle Scholar
  51. 51.
    Melton SM, Kerby JD, McGiffin D, et al. The evolution of chest computed tomography for the definitive diagnosis of blunt aortic injury: a single-center experience. J Trauma 2004; 56(2):243–250.PubMedCrossRefGoogle Scholar
  52. 52.
    Vignon P, Boncoeur MP, Francois B, Rambaud G, Maubon A, Gastinne H. Comparison of multiplane transesophageal echocardiography and contrast-enhanced helical CT in the diagnosis of blunt traumatic cardiovascular injuries. Anesthesiology 2001; 94(4):615–622.PubMedCrossRefGoogle Scholar
  53. 53.
    Parker MS, Matheson TL, Rao AV, et al. Making the transition: the role of helical CT in the evaluation of potentially acute thoracic aortic injuries. AJR Am J Roentgenol 2001; 176(5):1267–1272.PubMedGoogle Scholar
  54. 54.
    Smith MD, Cassidy JM, Souther S, et al. Transesophageal echocardiography in the diagnosis of traumatic rupture of the aorta. N Engl J Med 1995; 332(6):356–362.PubMedCrossRefGoogle Scholar
  55. 55.
    Kearney PA, Smith DW, Johnson SB, Barker DE, Smith MD, Sapin PM. Use of transesophageal echocardiography in the evaluation of traumatic aortic injury. J Trauma 1993; 34(5):696–703.PubMedCrossRefGoogle Scholar
  56. 56.
    Saletta S, Lederman E, Fein S, Singh A, Kuehler DH, Fortune JB. Transesophageal echocardiography for the initial evaluation of the widened mediastinum in trauma patients. J Trauma 1995; 39(1):137–142.PubMedCrossRefGoogle Scholar
  57. 57.
    Orford VP, Atkinson NR, Thomson K, et al. Blunt traumatic aortic transection: the endovascular experience. Ann Thorac Surg 2003; 75(1):106–112.PubMedCrossRefGoogle Scholar
  58. 58.
    Ahn SH, Cutry A, Murphy TP, Slaiby JM. Traumatic thoracic aortic rupture: treatment with endovascular graft in the acute setting. J Trauma 2001; 50(5):949–951.PubMedCrossRefGoogle Scholar
  59. 59.
    Ott MC, Stewart TC, Lawlor DK, Gray DK, Forbes TL. Management of blunt thoracic aortic injuries: endovascular stents versus open repair. J Trauma 2004; 56(3):565–570.PubMedCrossRefGoogle Scholar
  60. 60.
    Fujikawa T, Yukioka T, Ishimaru S, et al. Endovascular stent grafting for the treatment of blunt thoracic aortic injury. J Trauma 2001; 50(2):223–229.PubMedCrossRefGoogle Scholar
  61. 61.
    von Oppell UO, Dunne TT, De Groot KM, Zilla P. Spinal cord protection in the absence of collateral circulation: meta-analysis of mortality and paraplegia. J Cardiol Surg 1994; 9(6):685–691.CrossRefGoogle Scholar
  62. 62.
    Katz NM, Blackstone EH, Kirklin JW, Karp RB. Incremental risk factors for spinal cord injury following operation for acute traumatic aortic transection. J Thorac Cardiovasc Surg 1981; 81(5):669–674.PubMedGoogle Scholar
  63. 63.
    Pate JW, Gavant ML, Weiman DS, Fabian TC. Traumatic rupture of the aortic isthmus: program of selective management. World J Surg 1999; 23(1):59–63.PubMedCrossRefGoogle Scholar
  64. 64.
    Szwerc MF, Benckart DH, Lin JC, et al. Recent clinical experience with left heart bypass using a centrifugal pump for repair of traumatic aortic transection. Ann Surg 1999; 230(4):484–492.PubMedCrossRefGoogle Scholar
  65. 65.
    Fullerton DA. Simplified technique for left heart bypass to repair aortic transection. Ann Thorac Surg 1993; 56(3): 579–580.PubMedCrossRefGoogle Scholar
  66. 66.
    Read RA, Moore EE, Moore FA, Haenel JB. Partial left heart bypass for thoracic aorta repair. Survival without paraplegia. Arch Surg 1993; 128(7):746–752.PubMedGoogle Scholar
  67. 67.
    Plume S, DeWeese JA. Traumatic rupture of the thoracic aorta. Arch Surg 1979; 114(3):240–243.PubMedGoogle Scholar
  68. 68.
    Turney SZ, Attar S, Ayella R, Cowley RA, McLaughlin J. Traumatic rupture of the aorta. A five-year experience. J Thorac Cardiovasc Surg 1976; 72(5):727–734.PubMedGoogle Scholar
  69. 69.
    Zeiger MA, Clark DE, Morton JR. Reappraisal of surgical treatment of traumatic transection of the thoracic aorta. J Cardiovasc Surg (Torino) 1990; 31(5):607–610.Google Scholar
  70. 70.
    Wallenhaupt SL, Hudspeth AS, Mills SA, Tucker WY, Dobbins JE, Cordell AR. Current treatment of traumatic aortic disruptions. Am Surg 1989; 55(5):316–320.PubMedGoogle Scholar
  71. 71.
    Hunt JP, Baker CC, Lentz CW, et al. Thoracic aorta injuries: management and outcome of 144 patients. J Trauma 1996; 40(4):547–556.PubMedCrossRefGoogle Scholar
  72. 72.
    von Kodolitsch Y, Schwartz AG, Nienaber CA, et al. Clinical prediction of acute aortic dissection. Arch Intern Med 2000 160(19):2977–2982.CrossRefGoogle Scholar
  73. 73.
    Kodali S, Jamieson WR, Leia-Stephens M, Miyagishima RT, Janusz MT, Tyers GF. Traumatic rupture of the thoracic aorta. A 20-year review: 1969–1989. Circulation 1991; 84(5 Suppl):III-40–46.Google Scholar
  74. 74.
    Sennertus D. Cap. 42. Op Omn Lib 1650; 5:306.Google Scholar
  75. 75.
    Morgagni G. De dedibus et causis moroborum. Venetiis, 1761.Google Scholar
  76. 76.
    Maunoir J. Memoires Physiologiques et Pratiques sur L’aneurysme et la Ligature des Arteres. Geneva: J. J. Pashoud, 1802.Google Scholar
  77. 77.
    Gurin D. Dissecting aneurysms of the aorta: diagnosis and operative relief of acute arterial obstruction due to this cause. NY State J Med 1935; 35:1200.Google Scholar
  78. 78.
    DeBakey ME, Cooley DA, Creech O, Jr. Surgical considerations of dissecting aneurysm of the aorta. Ann Surg 1955; 142(4):586–612.CrossRefGoogle Scholar
  79. 79.
    Hufnagel CA, Conrad PW. Direct repair of dissecting aneurysms of the aorta. Circulation 1962; 25:568–572.PubMedGoogle Scholar
  80. 80.
    Ponraj P, Pepper J. Aortic dissection. Br J Clin Pract 1992; 46(2):127–131.PubMedGoogle Scholar
  81. 81.
    Kouchoukos NT, Dougenis D. Surgery of the thoracic aorta. N Engl J Med 1997; 336(26):1876–1888.PubMedCrossRefGoogle Scholar
  82. 82.
    Pate JW, Richardson RL, Eastridge CE. Acute aortic dissections. Am Surg 1976; 42(6):395–404.PubMedGoogle Scholar
  83. 83.
    Coady MA, Rizzo JA, Goldstein LJ, Elefteriades JA. Natural history, pathogenesis, and etiology of thoracic aortic aneurysms and dissections. Cardiol Clin 1999; 17(4): 615–635, vii.PubMedCrossRefGoogle Scholar
  84. 84.
    Khan IA, Nair CK. Clinical, diagnostic, and management perspectives of aortic dissection. Chest 2002; 122(1):311–328.PubMedCrossRefGoogle Scholar
  85. 85.
    Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA 2000; 283(7):897–903.PubMedCrossRefGoogle Scholar
  86. 86.
    Hirst AE Jr, Johns VJ Jr, Kime SW Jr. Dissecting aneurysm of the aorta: a review of 505 cases. Medicine (Baltimore) 1958; 37(3):217–279.Google Scholar
  87. 87.
    Wilson SK, Hutchins GM. Aortic dissecting aneurysms: causative factors in 204 subjects. Arch Pathol Lab Med 1982; 106(4):175–180.PubMedGoogle Scholar
  88. 88.
    DeBakey ME, McCollum CH, Crawford ES, et al. Dissection and dissecting aneurysms of the aorta: twenty-year follow-up of five hundred twenty-seven patients treated surgically. Surgery 1982; 92(6):1118–1134.PubMedGoogle Scholar
  89. 89.
    Spittell PC, Spittell JA Jr, Joyce JW, et al. Clinical features and differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990). Mayo Clin Proc 1993; 68(7):642–651.PubMedGoogle Scholar
  90. 90.
    Lesauskaite V, Tanganelli P, Sassi C, et al. Smooth muscle cells of the media in the dilatative pathology of ascending thoracic aorta: morphology, immunoreactivity for osteopontin, matrix metalloproteinases, and their inhibitors. Hum Pathol 2001; 32(9):1003–1011.PubMedCrossRefGoogle Scholar
  91. 91.
    Segura AM, Luna RE, Horiba K, et al. Immunohistochemistry of matrix metalloproteinases and their inhibitors in thoracic aortic aneurysms and aortic valves of patients with Marfan’s syndrome. Circulation 1998; 98(19 Suppl):II-331–338.Google Scholar
  92. 92.
    Larson EW, Edwards WD. Risk factors for aortic dissection: a necropsy study of 161 cases. Am J Cardiol 1984; 53(6):849–855.PubMedCrossRefGoogle Scholar
  93. 93.
    Germain DP. Clinical and genetic features of vascular Ehlers-Danlos syndrome. Ann Vasc Surg 2002; 16(3):391–397.PubMedCrossRefGoogle Scholar
  94. 94.
    Mattar SG, Kumar AG, Lumsden AB. Vascular complications in Ehlers-Danlos syndrome. Am Surg 1994; 60(11): 827–831.PubMedGoogle Scholar
  95. 95.
    Lauwers G, Nevelsteen A, Daenen G, Lacroix H, Suy R, Frijns JP. Ehlers-Danlos syndrome type IV: a heterogeneous disease. Ann Vasc Surg 1997; 11(2):178–182.PubMedCrossRefGoogle Scholar
  96. 96.
    Freeman RK, Swegle J, Sise MJ. The surgical complications of Ehlers-Danlos syndrome. Am Surg 1996; 62(10):869–873.PubMedGoogle Scholar
  97. 97.
    Cikrit DF, Miles JH, Silver D. Spontaneous arterial perforation: the Ehlers-Danlos specter. J Vasc Surg 1987; 5(2): 248–255.PubMedCrossRefGoogle Scholar
  98. 98.
    Beighton P, Horan FT. Surgical aspects of the Ehlers-Danlos syndrome. A survey of 100 cases. Br J Surg 1969; 56(4):255–259.PubMedCrossRefGoogle Scholar
  99. 99.
    Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: Part I: from etiology to diagnostic strategies. Circulation 2003; 108(5):628–635.PubMedCrossRefGoogle Scholar
  100. 100.
    Stefanadis CI, Karayannacos PE, Boudoulas HK, et al. Medial necrosis and acute alterations in aortic distensibility following removal of the vasa vasorum of canine ascending aorta. Cardiovasc Res 1993; 27(6):951–956.PubMedCrossRefGoogle Scholar
  101. 101.
    Januzzi JL, Sabatine MS, Eagle KA, et al. Iatrogenic aortic dissection. Am J Cardiol 2002; 89(5):623–626.PubMedCrossRefGoogle Scholar
  102. 102.
    von Kodolitsch Y, Simic O, Schwartz A, et al. Predictors of proximal aortic dissection at the time of aortic valve replacement. Circulation 1999; 100(19 Suppl):II-287–294.Google Scholar
  103. 103.
    Pieters FA, Widdershoven JW, Gerardy AC, Geskes G, Cheriex EC, Wellens HJ. Risk of aortic dissection after aortic valve replacement. Am J Cardiol 1993; 72(14):1043–1047.PubMedCrossRefGoogle Scholar
  104. 104.
    Nienaber CA, von Kodolitsch Y, Petersen B, et al. Intramural hemorrhage of the thoracic aorta. Diagnostic and therapeutic implications. Circulation 1995; 92(6):1465–1472.PubMedGoogle Scholar
  105. 105.
    O’Gara PT, DeSanctis RW. Acute aortic dissection and its variants. Toward a common diagnostic and therapeutic approach. Circulation 1995; 92(6):1376–1378.PubMedGoogle Scholar
  106. 106.
    von Kodolitsch Y, Csosz SK, Koschyk DH, et al. Intramural hematoma of the aorta: predictors of progression to dissection and rupture. Circulation 2003; 107(8):1158–1163.CrossRefGoogle Scholar
  107. 107.
    Ide K, Uchida H, Otsuji H, et al. Acute aortic dissection with intramural hematoma: possibility of transition to classic dissection or aneurysm. J Thorac Imaging 1996; 11(1):46–52.PubMedCrossRefGoogle Scholar
  108. 108.
    Svensson LG, Hess KR, Coselli JS, Safi HJ, Crawford ES. A prospective study of respiratory failure after high-risk surgery on the thoracoabdominal aorta. J Vasc Surg 1991; 14(3):271–282.PubMedCrossRefGoogle Scholar
  109. 109.
    Suzuki T, Mehta RH, Ince H, 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(Suppl 1):II-312–317.Google Scholar
  110. 110.
    Mehta RH, O’Gara PT, Bossone E, et al. Acute type A aortic dissection in the elderly: clinical characteristics, management, and outcomes in the current era. J Am Coll Cardiol 2002; 40(4):685–692.PubMedCrossRefGoogle Scholar
  111. 111.
    Mehta RH, Bossone E, Evangelista A, et al. Acute type B aortic dissection in elderly patients: clinical features, outcomes, and simple risk stratification rule. Ann Thorac Surg 2004; 77(5):1622–1628.PubMedCrossRefGoogle Scholar
  112. 112.
    Januzzi JL, Isselbacher EM, Fattori R, et al. Characterizing the young patient with aortic dissection: results from the International Registry of Aortic Dissection (IRAD). J Am Coll Cardiol 2004; 43(4):665–669.PubMedCrossRefGoogle Scholar
  113. 113.
    Bossone E, Rampoldi V, Nienaber CA, et al. Usefulness of pulse deficit to predict in-hospital complications and mortality in patients with acute type A aortic dissection. Am J Cardiol 2002; 89(7):851–855.PubMedCrossRefGoogle Scholar
  114. 114.
    Eagle KA. Current management in aortic dissection: data from the International Registry for Aortic Dissection (IRAD). Eur Heart J 1999; 20(Suppl):A3827.Google Scholar
  115. 115.
    Yoshida S, Akiba H, Tamakawa M, et al. Thoracic involvement of type A aortic dissection and intramural hematoma: diagnostic accuracy—comparison of emergency helical CT and surgical findings. Radiology 2003; 228(2):430–435.PubMedCrossRefGoogle Scholar
  116. 116.
    Sebastia C, Pallisa E, Quiroga S, Alvarez-Castells A, Dominguez R, Evangelista A. Aortic dissection: diagnosis and follow-up with helical CT. Radiographics 1999; 19(1):45–60, 149–150.PubMedGoogle Scholar
  117. 117.
    Erbel R, Engberding R, Daniel W, Roelandt J, Visser C, Rennollet H. Echocardiography in diagnosis of aortic dissection. Lancet 1989; 1(8636):457–461.PubMedCrossRefGoogle Scholar
  118. 118.
    Anagnostopoulos CE PM, Kittle CF. Aortic dissections and dissecting aneurysms. Am J Cardiol 1972; 30: 263.PubMedCrossRefGoogle Scholar
  119. 119.
    von Kodolitsch Y, Schwartz AG, Nienaber CA. Clinical prediction of acute aortic dissection. Arch Intern Med 2000; 160(19):2977–2982.CrossRefGoogle Scholar
  120. 120.
    Elefteriades JA, Lovoulos CJ, Coady MA, Tellides G, Kopf GS, Rizzo JA. Management of descending aortic dissection. Ann Thorac Surg 1999; 67(6):2002–2009.PubMedCrossRefGoogle Scholar
  121. 121.
    Miller DC. The continuing dilemma concerning medical versus surgical management of patients with acute type B dissections. Semin Thorac Cardiovasc Surg 1993; 5(1):33–46.PubMedGoogle Scholar
  122. 122.
    Slonim SM, Miller DC, Mitchell RS, Semba CP, Razavi MK, Dake MD. Percutaneous balloon fenestration and stenting for life-threatening ischemic complications in patients with acute aortic dissection. J Thorac Cardiovasc Surg 1999; 117(6):1118–1126.PubMedCrossRefGoogle Scholar
  123. 123.
    Iannelli G, Piscione F, Di Tommaso L, Monaco M, Chiariello M, Spampinato N. Thoracic aortic emergencies: impact of endovascular surgery. Ann Thorac Surg 2004; 77(2):591–596.PubMedCrossRefGoogle Scholar
  124. 124.
    Ince H, Neinaber, CA. The concept of interventional therapy in acute aortic syndrome. J Card Surg 2002; 17:135–142.PubMedCrossRefGoogle Scholar
  125. 125.
    Nienaber CA, Fattori R, Lund G, et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med 1999; 340(20):1539–1545.PubMedCrossRefGoogle Scholar
  126. 126.
    Dake MD, Kato N, Mitchell RS, et al. Endovascular stentgraft placement for the treatment of acute aortic dissection. N Engl J Med 1999; 340(20):1546–1552.PubMedCrossRefGoogle Scholar
  127. 127.
    Sabik JF, Nemeh H, Lytle BW, et al. Cannulation of the axillary artery with a side graft reduces morbidity. Ann Thorac Surg 2004; 77(4):1315–1320.PubMedCrossRefGoogle Scholar
  128. 128.
    McCullough JN, Zhang N, Reich DL, et al. Cerebral metabolic suppression during hypothermic circulatory arrest in humans. Ann Thorac Surg 1999; 67(6):1895–1921.PubMedCrossRefGoogle Scholar
  129. 129.
    Coselli MD JS, LeMaire MD SA, Poli de Figueiredo MD P, Luiz, Kirby MD RP. Paraplegia after thoracoabdominal aortic aneurysm repair: is dissection a risk factor? Ann Thorac Surg 1997; 63(1):28–36.PubMedCrossRefGoogle Scholar
  130. 130.
    Mehta RH, O’Gara PT, Bossone E, et al. Acute type A aortic dissection in the elderly: clinical characteristics, management, and outcomes in the current era. J Am Coll Cardiol 2002; 40(4):685–692.PubMedCrossRefGoogle Scholar
  131. 131.
    Long SM, Tribble CG, Raymond DP, et al. Preoperative shock determines outcome for acute type A aortic dissection. Ann Thorac Surg 2003; 75(2):520–524.PubMedCrossRefGoogle Scholar
  132. 132.
    Borst HG, Laas J, Heinemann M. Type A aortic dissection: diagnosis and management of malperfusion phenomena. Semin Thorac Cardiovasc Surg 1991; 3(3):238–241.PubMedGoogle Scholar
  133. 133.
    Fann JI, Sarris GE, Mitchell RS, et al. Treatment of patients with aortic dissection presenting with peripheral vascular complications. Ann Surg 1990; 212(6):705–713.PubMedCrossRefGoogle Scholar
  134. 134.
    Lauterbach SR, Cambria RP, Brewster DC, et al. Contemporary management of aortic branch compromise resulting from acute aortic dissection. J Vasc Surg 2001; 33(6):1185–1192.PubMedCrossRefGoogle Scholar
  135. 135.
    Cambria RP, Brewster DC, Gertler J, et al. Vascular complications associated with spontaneous aortic dissection. J Vasc Surg 1988; 7(2):199–209.PubMedCrossRefGoogle Scholar
  136. 136.
    Girardi LN, Krieger KH, Lee LY, Mack CA, Tortolani AJ, Isom OW. Management strategies for type A dissection complicated by peripheral vascular malperfusion. Ann Thorac Surg 2004; 77(4):1309–1314.PubMedCrossRefGoogle Scholar
  137. 137.
    Deeb GM, Williams DM, Bolling SF, et al. Surgical delay for acute type A dissection with malperfusion. Ann Thorac Surg 1997; 64(6):1669–1677.PubMedCrossRefGoogle Scholar
  138. 138.
    Fann JI, Smith JA, Miller DC, et al. Surgical management of aortic dissection during a 30-year period. Circulation 1995; 92(9):113–121.Google Scholar
  139. 139.
    Haverich A, Miller DC, Scott WC, et al. Acute and chronic aortic dissections—determinants of long-term outcome for operative survivors. Circulation 1985; 72(3 Pt 2):II-22–34.Google Scholar
  140. 140.
    Fann JI, Smith JA, Miller DC, et al. Surgical management of aortic dissection during a 30-year period. Circulation 1995; 92(9 Suppl):II-113-121.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Peter I. Ellman
    • 1
  • Irving L. Kron
    • 2
  1. 1.Department of General Surgery, University of VirginiaUniversity of Virginia Health Sciences CenterCharlottesvilleUSA
  2. 2.Departments of Surgery and Thoracic and Cardiovascular Surgery, University of VirginiaUniversity of Virginia Health Sciences CenterCharlottesvilleUSA

Personalised recommendations