Vascular complications associated with spontaneous aortic dissection

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Presentation transcript:

Vascular complications associated with spontaneous aortic dissection Richard P. Cambria, M.D., David C. Brewster, M.D., Jonathan Gertler, M.D., Ashby C. Moncure, M.D., Richard Gusberg, M.D., M.David Tilson, M.D., R.Clement Darling, M.D., Grahme Hammond, M.D., Joseph Megerman, Ph.D., William M. Abbott, M.D. Journal of Vascular Surgery Volume 7, Issue 2, Pages 199-209 (February 1988) DOI: 10.1016/0741-5214(88)90137-1 Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Schematic representation of the classification of DeBakey et al. with demographic features, incidence of hypertension (HBP), and vascular complications (VC) for each type of dissection. Numbers in parentheses are percentage. Journal of Vascular Surgery 1988 7, 199-209DOI: (10.1016/0741-5214(88)90137-1) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Sites and distribution of peripheral (not involving the ascending aorta) vascular complications and related clinical events. Disparity between occlusions and clinical events reflects asymptomatic occlusions. HBP = incidence of hypertension, ABD = abdominal. Journal of Vascular Surgery 1988 7, 199-209DOI: (10.1016/0741-5214(88)90137-1) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Influence of aortic rupture and vascular complications on mortality in patients with aortic dissection. Mortality was excessive with rupture. Too few patients with types II and IIIA dissection experienced rupture or vascular complications to make meaningful comparisons. In the absence of rupture, patients with vascular complications experienced significantly increased mortality. Numbers in parentheses are percentage. PVC = peripheral vascular complications. Journal of Vascular Surgery 1988 7, 199-209DOI: (10.1016/0741-5214(88)90137-1) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Aortogram in patient with chronic type I dissection. Note absence of left common carotid artery (arrow) and saccular aneurysm. Patient sustained recurrent left hemispheric watershed infarcts and was treated with a right-to-left carotid-to-carotid bypass before aneurysm resection. Journal of Vascular Surgery 1988 7, 199-209DOI: (10.1016/0741-5214(88)90137-1) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Mechanism of aortic branch obstruction in acute dissection. Bulging of the false lumen can produce occlusion at the branch orifice (A) and subsequent thrombosis distally (B) may occur. Intimal detachment at the branch orifice may occur with perfusion largely via the false channel (C). The dissection process may also proceed into the branch such that the actual obstruction occurs beyond the branch orifice (D). Similar mechanisms can produce distal aortic obstruction, which may be complicated by distal thrombosis or relieved by spontaneous (or surgical) reentry. Journal of Vascular Surgery 1988 7, 199-209DOI: (10.1016/0741-5214(88)90137-1) Copyright © 1988 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions