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Acute Aortic Syndrome

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Dominik Fleischmann – One of the best experts on this subject based on the ideXlab platform.

  • A pictorial review of Acute Aortic Syndrome: discriminating and overlapping features as revealed by ECG-gated multidetector-row CT angiography
    Insights into Imaging, 2012
    Co-Authors: Takuya Ueda, Anne Chin, Ivan Petrovitch, Dominik Fleischmann

    Abstract:

    Background The term “Acute Aortic Syndrome” (AAS) encompasses a spectrum of life-threatening conditions characterized by Acute Aortic pain. AAS traditionally embraces three abnormalities including classic Aortic dissection, intramural haematoma, and penetrating atherosclerotic ulcer. Although the underlying etiologies and conditions predisposing to AAS are diverse, the clinical features are indistinguishable. Methods Multidetector-row computed tomography (CT) with electrocardiographic gating (ECG-gated MDCT) has greatly improved imaging of Acute thoracic Aortic diseases by virtually eliminating pulsation artifacts transmitted from cardiac motion and reveals subtle Aortic abnormalities, which have been difficult to recognize by conventional non-gated CT. Results While these advances in imaging technology provide additional discriminating features of Acute Aortic diseases, they also reveal a range of overlapping features of these life-threatening conditions that not uncommonly are dynamic and evolving. These overlapping and transitional features may be a major source of misunderstanding, confusion, and controversy for diseases that cause AAS. Conclusion In this pictorial review, we describe the discriminating and typical imaging features as revealed by modern ECG-gated MDCT angiography. In addition to the discriminating features, recognition of the overlapping and transitional features in AAS will allow a more comprehensive understanding of their underlying pathophysiologic conditions and their natural history, and may improve therapeutic management. Main Messages • The superior visualization of ECG-gated CTA improves the diagnostic accuracy of Acute Aortic Syndrome. • ECG-gated CTA provides discriminating features of underlying pathophysiologic conditions of AAS. • Also, recognition of the overlapping features in AAS will allow a more comprehensive understanding.

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  • a pictorial review of Acute Aortic Syndrome discriminating and overlapping features as revealed by ecg gated multidetector row ct angiography
    Insights Into Imaging, 2012
    Co-Authors: Takuya Ueda, Anne Chin, Ivan Petrovitch, Dominik Fleischmann

    Abstract:

    Background
    The term “Acute Aortic Syndrome” (AAS) encompasses a spectrum of life-threatening conditions characterized by Acute Aortic pain. AAS traditionally embraces three abnormalities including classic Aortic dissection, intramural haematoma, and penetrating atherosclerotic ulcer. Although the underlying etiologies and conditions predisposing to AAS are diverse, the clinical features are indistinguishable.

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  • State-of-the-art computed tomography angiography of Acute Aortic Syndrome.
    Seminars in ultrasound CT and MR, 2012
    Co-Authors: Anne S. Chin, Dominik Fleischmann

    Abstract:

    Acute Aortic Syndrome refers to a spectrum of Acute life-threatening Aortic abnormalities requiring prompt recognition and treatment. Although underlying pathologies are diverse, presenting signs and symptoms are often indistinguishable clinically, underscoring the role of imaging to make the correct diagnosis. Computed tomography (CT) angiography, a safe and accessible imaging modality, is paramount in accurately confirming or excluding critical Aortic lesions, defining location and extent, and describing associated complications. Electrocardiographic gating further improves diagnostic precision of CT, providing motion-free 3- and 4-dimensional imaging of the entire aorta. This article reviews the imaging spectrum and state-of-the-art CT for patients presenting with Acute Aortic Syndrome.

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Ferco H Berger – One of the best experts on this subject based on the ideXlab platform.

  • Acute Aortic Syndrome and blunt traumatic Aortic injury pictorial review of mdct imaging
    European Journal of Radiology, 2010
    Co-Authors: Ferco H Berger, Krijn P Van Lienden, Robin Smithuis, Savvas Nicolaou, Otto M Van Delden

    Abstract:

    Thoracic Aortic emergencies have high mortality and morbidity and should be diagnosed accurately and treated promptly. Advances in treatment options have increased survival and management choices heavily depend on imaging findings. Speed, accuracy and availability have made Multi Detector Computer Tomography (MDCT) the first line modality in evaluating thoracic Aortic emergencies and radiologists should be familiar with findings in these conditions. In this paper a pictorial review of the Acute Aortic Syndrome and Blunt Traumatic Aortic Injury will be given.

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Christoph A. Nienaber – One of the best experts on this subject based on the ideXlab platform.

  • impact of a streamlined rotational system for the management of Acute Aortic Syndrome sharing is caring
    European Journal of Cardio-Thoracic Surgery, 2019
    Co-Authors: Ricky Vaja, Christoph A. Nienaber, Shagorika Talukder, Mindaugas Norkunas, Ross Hoffman, John Pepper, Ulrich Rosendahl, George Asimakopoulos, Cesare Quarto

    Abstract:

    Objectives Acute type A Aortic dissection is an emergency associated with up to 30% of hospital mortality. It has been established that outcomes are improved with specialist Aortic team care in high-volume centres. Most centres are limited to a small number of Aortic specialists, thus making it logistically impractical to have a dedicated 24/7 single-centre service. In 2011, a rotational 24/7 service between 3 centres covering a geographical location was introduced including 24/7 access to a dissection ‘Hotline’. Methods We analysed data since 2003 from a prospectively collected database. A total of 227 patients underwent surgery for Acute Aortic Syndrome between 2003 and 2017. The results on outcomes were compared before and after the initiation of the dissection hotline and 24/7 dedicated service. Results We identified 128 patients from the pre-rotational group and 99 patients from the post-rotational group. Both groups were well matched in terms of demographics and comorbidities. In the post-rotational group, there was an increase in arch surgery (11.8% vs 20.2%, P: 0.07). The introduction of the rotational service reduced 30-day mortality (20% vs 8%, P: 0.010). The introduction of the service improved the overall long-term survival [P: 0.04, hazard ratio 1.86; confidence interval (1.03-3.38)] in the multivariable analysis. There was no difference between the groups in postoperative complications. There was an increase in the median length of hospital stay in the post-rotational group (13 days vs 20 days, P: 0.014). Conclusions A streamlined Aortic dissection service allows for centralized care. This provides the referring centres with 24/7 access to an experienced Aortic team and may improve patient outcomes.

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  • Endovascular “neobranching” to manage Acute Aortic Syndrome
    Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 2016
    Co-Authors: Isabelle L. Vandormael, Mohammad Yousuf Salmasi, James S‐m Yeh, Christoph A. Nienaber

    Abstract:

    Acute Aortic Syndrome was coined in 2001 to describe a spectrum of Acute Aortic wall pathologies. The Syndrome represents a cluster of Aortic conditions such as Aortic dissection, intramural hematoma and penetrating atherosclerotic ulcer. Acute Aortic dissection is more common than the latter two pathologies with an incidence of up to 6 cases per 100,000 per year. The following report focuses on an unusual case presentation emphasizing the newest management techniques including “neobranching” whilst dealing with challenging patient anatomy and refractory hypertension. We believe this case report eventually broadens our understanding of Acute Aortic Syndrome whilst addressing an entry tear outside the aorta by placing “neobranches”. © 2016 Wiley Periodicals, Inc.

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  • Acute Aortic Syndrome
    Deutsche medizinische Wochenschrift (1946), 2016
    Co-Authors: Christoph A. Nienaber

    Abstract:

    Acute Aortic Syndrome is the common denominator for Acute events to the Aortic wall and encompasses dissection of the aorta, intramural hematoma, formation of Aortic ulcers and trauma to the aorta with an annual incidence of up to 35 cases/100.000 between 65 and 75 years of age. Both, inflammation and/or microtrauma at the level of the Aortic media layer, and a genetic disposition are promoting elements of AAS, while the extent and anatomic involvement of the ascending aorta call for either surgical resection/repair in the proximal part of the aorta, or an endovascular solution for pathologies in the distal aorta; in all cases of dissection (regardless of location) reconstruction/realignment has been proven to portend better long-term outcomes (in addition to medical management of blood pressure).

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