Acute Aortic Syndrome

  • Cynthia M. Wells
  • Kathirvel Subramaniam


Acute aortic syndrome is a modern term that describes the acute presentation of patients with characteristic “aortic” pain caused by one of the life-threatening thoracic aortic conditions including aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer (Fig. 2.1). This entity involves acute lesions of the aorta involving the tunica media and can be distinguished by their etiopathogenesis and characteristic appearance using various diagnostic imaging modalities. Recent advances in imaging techniques and therapeutic interventions have increased awareness of these pathological conditions and emphasized the importance of early diagnosis and treatment.


Aortic Dissection Aortic Wall False Lumen Acute Aortic Dissection True Lumen 
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.


  1. 1.
    Svensson LG, Labib SB, Eisenhauer AC, Butterly JR. Intimal tear without hematoma: an important variant of aortic dissection that can elude current imaging techniques. Circulation. 1999;99:1331–1336.PubMedGoogle Scholar
  2. 2.
    Tsai TT, Nienaber CA, Eagle KA. Acute aortic syndromes. Circulation. 2005;112:3802–3813.CrossRefPubMedGoogle Scholar
  3. 3.
    Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000;283:897–903.CrossRefPubMedGoogle Scholar
  4. 4.
    Evangelista A, Gonzalez-Alujas T. Pathophysiology of aortic dissection. In: Rousseau H, Verhoye JP, Heautot JF, eds. Thoracic aortic Diseases. 1st ed. Berlin Heidelberg, Germany: Springer; 2006:33–53.Google Scholar
  5. 5.
    Fleck T, Ehrlich M, Czerny M, et al. Intraoperative iatrogenic type A aortic dissection and perioperative outcome. Interact Cardiovasc Thorac Surg. 2006;5:11–14.CrossRefPubMedGoogle Scholar
  6. 6.
    Elitz T, Kawohl M, Fritzsche D, et al. Aortic dissection after previous coronary artery bypass grafting. J Card Surg. 2003;18:519–523.CrossRefGoogle Scholar
  7. 7.
    De Smet JM, Stefanidis C. Acute aortic dissection after off pump coronary artery surgery. Eur J Cardiothorac Surg. 2003;24:315–317.CrossRefPubMedGoogle Scholar
  8. 8.
    Okamoto R, Makino K, Saito K, et al. Aorto-coronary dissection during angioplasty in a patient with myxedema. Jpn Circ J. 2000 Apr;64(4):316–320.CrossRefPubMedGoogle Scholar
  9. 9.
    Wyss CA, Steffel J, Lüscher TF. Isolated acute iatrogenic aortic dissection during percutaneous coronaryintervention without involvement of the coronary arteries. J Invasive Cardiol. 2008 Jul;20(7):380–382.PubMedGoogle Scholar
  10. 10.
    Kpodonu J, Preventza O, Ramaiah VG, et al. Retrograde type A dissection after endovascular stenting of the descendingthoracic aorta. Is the risk real? Eur J Cardiothorac Surg. 2008 Jun;33(6):1014–1018. Epub 2008 Apr 21.CrossRefPubMedGoogle Scholar
  11. 11.
    Panten RR, Harrison JK, Warner J, Grocott HP. Aortic dissection after angioplasty and stenting of an aortic coarctation:detection by intravascular ultrasonography but not transesophageal echocardiography. J Am Soc Echocardiogr. 2001 Jan;14(1):73–76.CrossRefPubMedGoogle Scholar
  12. 12.
    Sheldon WS, Vandervoort PM, Black IW, Grimm RA, Stewart WJ. Aortic intramural hematoma in patients evaluated for aortic dissection: clinical, ­echocardiographic, radiologic and pathologic ­findings. Circulation. 1994;90(Suppl I):I385.Google Scholar
  13. 13.
    Vilacosta I, de Dios RM, Pinto AG. Aortic intramural hematoma during coronary angioplasty: insights into the pathogenesis of intramedial hemorrhage. J Am Soc Echocardiogr. 2000;13:403–406.PubMedGoogle Scholar
  14. 14.
    Ganaha F, Miller DC, Sugimoto K, et al. Prognosis of aortic intramural hematoma with and without penetrating atherosclerotic ulcer: a clinical and radiological analysis. Circulation. 2002 Jul 16;106(3):342–348.CrossRefPubMedGoogle Scholar
  15. 15.
    Nienaber CA, Sievers HH. Intramural hematoma in acute aortic syndrome: more than on variant of dissection? Circulation. 2002;106:284–285.CrossRefPubMedGoogle Scholar
  16. 16.
    Kaji S, Nishigami K, Akasaka T, et al. Prediction of progression or regression of type A aortic intramural hematoma bycomputed tomography. Circulation. 1999 Nov 9;100(19 Suppl):II281–II286.PubMedGoogle Scholar
  17. 17.
    Von Kodolitsch Y, Csösz SK, Koschyk DH, et al. Intramural hematoma of the aorta: predictors of progression to dissection and rupture. Circulation. 2003 Mar 4;107(8):1158–1163.CrossRefGoogle Scholar
  18. 18.
    Hayashi J, Matsuoka Y, Sakamoto I, et al. Penetrating atherosclerotic ulcer of the aortoa: imaging features and disease concept. RadioGraphics. 2000;20:995–1005.PubMedGoogle Scholar
  19. 19.
    Stanson AW, Kazmier FJ, Hollier LH, et al. Penetrating atherosclerotic ulcers of the thoracic aorta: natural history and clinicopathologic correlations. Ann Vasc Surg. 1986;1:15–23.PubMedGoogle Scholar
  20. 20.
    Vilacosta I, San Román JA, Aragoncillo P, et al. Penetrating atherosclerotic aortic ulcer: documentation by transesophagealechocardiography. J Am Coll Cardiol. 1998;32:83–89.CrossRefPubMedGoogle Scholar
  21. 21.
    Ando Y, Minami H, Muramoto H, Narita M, Sakai S. Rupture of thoracic aorta caused by penetrating aortic ulcer. Chest. 1994;106:624–626.CrossRefPubMedGoogle Scholar
  22. 22.
    Nienaber CA. Pathophysiology of acute aortic syndromes. In: Baliga RR, Nienaber CA, Isselbacher EM, Eagle KA, eds. Aortic Dissection and Related Syndromes. 1st ed. NewYork: Springer Science; 2007:17–44.CrossRefGoogle Scholar
  23. 23.
    Botta DM, Elefteriades JA. Matrix metalloproteinases in aortic aneurysm and dissection. In: Elefteriades JA, ed. Acute Aortic Disease. 1st ed. NewYork: Informa Healthcare; 2007:131–146.Google Scholar
  24. 24.
    Wooley CF, Sparks EH, Boudoulas H. Aortic pain. Prog Cardiovasc Dis. 1998;40:563–589.CrossRefPubMedGoogle Scholar
  25. 25.
    Ahmad F, Cheshire N, Hamady M. Acute aortic syndrome: pathology and therapeutic strategies. Postgrad Med J. 2006;82:305–312.CrossRefPubMedGoogle Scholar
  26. 26.
    Shiga T, Wajima Z, Apfel CC, Inoue T, Ohe Y. Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis. Arch Intern Med. 2006;166:1350–1356.CrossRefPubMedGoogle Scholar
  27. 27.
    Kapustin AJ, Litt HI. Diagnostic imaging for aortic dissection. Semin Thorac Cardiovasc Surg. 2005;17:214–223.CrossRefPubMedGoogle Scholar
  28. 28.
    Von Kodolitsch Y, Nienbar CA, Dieckmann C, et al. Chest radiography for the diagnosis of acute aortic syndrome. Am J Med. 2004;116:73–77.CrossRefGoogle Scholar
  29. 29.
    Smith AD, Schoenhagen P. CT imaging for acute ­aortic syndrome. Cleve Clin J Med. 2008;75:7–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Berger F, Smithuis R, van Delden O. Thoracic Aorta – the Acute Aortic Syndrome. Accessed May 25, 2009.
  31. 31.
    Reddy GP. Multidetector CT of acute aortic syndrome. Imag Decision. 2006;2:22–26.CrossRefGoogle Scholar
  32. 32.
    Manghat NE, Morgan-Hughes GJ, Roobottom CA. Multi-detector row computed tomography: imaging in acute aortic syndrome. Clin Radiol. 2005;60:1256–1267.CrossRefPubMedGoogle Scholar
  33. 33.
    Svensson LG. Acute aortic syndromes: time to talk of many things. Cleve Clin J Med. 2008;75:25–29.CrossRefPubMedGoogle Scholar
  34. 34.
    Meredith EL, Masani ND. Echocardiography in the emergency assessment of acute aortic syndromes. Eur J Echocardiogr. 2009;10:i31–i39.CrossRefPubMedGoogle Scholar
  35. 35.
    Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000;283:897–903.CrossRefPubMedGoogle Scholar
  36. 36.
    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;40:685–692.CrossRefPubMedGoogle Scholar
  37. 37.
    Mehta RH, Suzuki T, Hagan PG, et al. Predicting death in patients with acute type A aortic dissection. Circulation. 2002;105:200–206.CrossRefPubMedGoogle Scholar
  38. 38.
    Ergin MA, O’Connor J, Guinto R, Griepp RB. Experience with profound hypothermia and circulatory arrest in the treatment of aneurysms of the aortic arch. Aortic arch replacement for acute arch dissections. J Thorac Cardiovasc Surg. 1982;84:649–655.PubMedGoogle Scholar
  39. 39.
    Nguyen B, Müller M, Kipfer B, et al. Different techniques of distal aortic repair in acute type A dissection: impacton late aortic morphology and reoperation. Eur J Cardiothorac Surg. 1999;15:496–500.CrossRefPubMedGoogle Scholar
  40. 40.
    Borst HG, Walterbusch G, Schaps D. Extensive aortic replacement using elephant trunk prosthesis. Thorac Cardiovasc Surg. 1983;31:37–40.CrossRefPubMedGoogle Scholar
  41. 41.
    Isselbacher EM. Dissection of the descending thoracic aorta: looking into the future. J Am Coll Cardiol. 2007;50:805–807.CrossRefPubMedGoogle Scholar
  42. 42.
    Heinemann MK, Buehner B, Schaefers HJ, Jurmann MJ, Laas J, Borst HG. Malperfusion of the thoracoabdominal vasculature in aortic dissection. J Card Surg. 1994;9:748–755.CrossRefPubMedGoogle Scholar
  43. 43.
    Borst HG, Laas J, Heinemann M. Type A aortic dissection: diagnosis and management of malperfusion phenomena. Semin Thorac Cardiovasc Surg. 1991;3:238–241.PubMedGoogle Scholar
  44. 44.
    Ince H, Nienaber CA. The concept of interventional therapy in acute aortic syndrome. J Card Surg. 2002;17:135–142.CrossRefPubMedGoogle Scholar
  45. 45.
    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;117:1118–1126.CrossRefPubMedGoogle Scholar
  46. 46.
    Slonim SM, Nyman UR, Semba CP, Miller DC, Mitchell RS, Dake MD. True lumen obliteration in complicated aortic dissection: endovascular treatment. Radiology. 1996;201:161–166.PubMedGoogle Scholar
  47. 47.
    Kato N, Shimono T, Hirano T, Ishida M, Yada I, Takeda K. Transluminal placement of endovascular stent-grafts for the treatment of type A aortic dissection with an entry tear in the descending thoracic aorta. J Vasc Surg. 2001;34:1023–1028.CrossRefPubMedGoogle Scholar
  48. 48.
    Tittle SL, Lynch RJ, Cole PE, et al. Midterm follow-up of penetrating ulcer and intramural hematoma of the aorta. J Thorac Cardiovasc Surg. 2002;123:1051–1059.CrossRefPubMedGoogle Scholar
  49. 49.
    Eggebrecht H, Baumgart D, Schmermund A, et al. Penetrating atherosclerotic ulcer of the aorta: treatment by endovascular stent-graft placement. Curr Opin Cardiol. 2003;18:431–435.CrossRefPubMedGoogle Scholar
  50. 50.
    Song JK, Kang SJ, Song JM, et al. Factors associated with in-hospital mortality in patients with acute aortic syndrome involving the ascending aorta. Int J Cardiol. 2007;115:14–18.CrossRefPubMedGoogle Scholar
  51. 51.
    Nienaber CA, Eagle KA. Aortic dissection:new ­frontiers in diagnosis and management. Circulation. 2003;108:628–635.CrossRefPubMedGoogle Scholar
  52. 52.
    Sueyoshi E, Sakamoto I, Hayashi K, Yamaguchi T, Imada T. Growth rate of aortic diameter in patients with type B aortic dissection during the chronic phase. Circulation. 2004;110(11 Suppl 1):II256–II261.PubMedGoogle Scholar
  53. 53.
    Junoven T, Ergin MA, Galla JD, et al. Risk factors for rupture of chronic type B dissections. J Thoac Cardiovasc Surg. 1999;117:776–786.CrossRefGoogle Scholar
  54. 54.
    Kaji S, Akasaka T, Boribata Y, et al. Long term prognosis of patients with type A intramural hematoma. Circulation. 2002;106:248–252.Google Scholar
  55. 55.
    Kaji S, Akasaka T, Katayama M, et al. Long term prognosis of patients with type B intramural hematoma. Circulation. 2003;108:307–331.Google Scholar
  56. 56.
    Erbel R, Alfonso F, Boileau C, et al. Diagnosis and management of aortic dissection: task force on aortic dissection, European society of cardiology. Eur Heart J. 2001;22:1642–1681.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of AnesthesiologyUniversity of Pittsburgh Medical Center – Presbyterian HospitalPittsburghUSA

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