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PubMedDate not supplied

[Spontaneous dissection of carotid and vertebral arteries. II. Vertebral arteries and their branches].

Dissection of the extra- and ntracranial portions of vertebral arteries, as well as basilar artery and their branches are discussed based on the up-to-date literature. Formerly, arterial dissections were found exclusively at necropsy, yet they have currently arisen to the field of interest of not only neurologists but also radiologists, neurosurgeons, and vascular surgeons. Ischemic strokes frequently result from arterial dissection, in particular subintimal dissection (most often in the extracranial portion of vertebral artery), by formation of emboli or reduced perfusion. Conversely, subadventitial and transmedial dissections produce aneurysms (most often in the intracranial portion of vertebral arteries and basilar artery) which may result in subarachnoid or intracerebral hemorrhages. The other possible mechanism of focal lesions is the compression of adjacent structures by dissected artery, most frequently by dolichoectasia of basilar artery which originates from its multiple intramural lesions. The dissections may present with cranial nerve palsies, symptoms of ischemia of cervical spine, cerebellum, and cerebral trunk, as well as occipital lobe syndromes. Arterial dissection may occur in adolescents and young adults. The clinical symptom that should be stressed is headache which precedes the occurrence of stroke for several days. The right diagnosis gives a chance for proper treatment, including operative procedures, and improved prognosis.

Adult↗

PubMedDate not supplied

[Aortic dissection: role of the general surgeon in diagnostic-therapeutic procedure].

Aortic dissection occurs when there is a tear or separation of the aortic intima from the media; flow of blood into the intima-media space allows the tear to develop into a dissecting hematoma. Aortic dissection is a rare condition which represents an acute cardiovascular emergency for which the appropriate therapy is immediate surgical correction. Patients with aortic dissection show a heterogeneous constellation of symptoms; hence, clinical suspicion is often difficult. Only a minority of patients has "classic" symptomatology, the electrocardiogram is often misleading and the chest radiogram is almost always non-specific. In Italy, the usual "hospital routine practice" assigns the key-role in the emergency diagnostic procedure for these patients to the general surgeon. In view of the necessity of immediate cardiac surgery and the overwhelming likelihood of adverse events when surgery is delayed, techniques for diagnosis must be accurate, widely available and easily and quickly used. The present study consists of four case-reports of aortic dissection thoroughly examined and confronted with the literature. Management strategy based on emergency echocardiography is a reliable, feasible and successful technique for evaluating patients with aortic dissection. It allows a rapid accurate diagnosis with a single examination that can also be performed in the emergency room and provides information of sufficient diagnostic value to allow immediate cardiovascular surgery. CT scan and/or MRI are also valid tools for the emergency diagnosis of aortic dissection. However, a major problem still exists: the range of symptoms is sufficiently broad that a high index of "personal suspicion" of aortic dissection is required on the part of the general surgeon when he performs the role of "emergency-team leader".

Adult↗

PubMed1999

Dissecting aneurysm of the infrarenal abdominal aorta.

The aim of this study was to report the case of a patient with chronic dissecting infrarenal abdominal aortic aneurysm (AAA) and to review the literature for this rare vascular disorder. The preoperative assessment, surgical treatment, and postoperative course of a patient with a dissecting AAA and associated left iliac artery dissection were analyzed. The literature is reviewed with respect to etiology and pathogenesis as well as diagnostic and therapeutic management of infrarenal dissecting AAA. The preoperative diagnosis of dissecting infrarenal AAA was made by computed tomography and aortography and confirmed during surgery. Successful repair was accomplished by use of a bifurcated aortobiiliacal Dacron graft. A review of the literature demonstrates the rarity of dissecting aneurysm exclusively involving the infrarenal aortic segment. Primary dissecting aneurysm of the infrarenal abdominal aorta is a rare morphologic finding. Principles of diagnostic and therapeutic management of common atherosclerotic AAA also apply to dissecting AAA.

Aortic Dissection↗

PubMed2000

[Atherosclerosis-related aortic dissection].

Penetrating atherosclerotic aortic ulcers (PAU) can cause aortic dissection. Of 38 autopsy cases with aortic dissection, 6 (15.8%) had severe atherosclerotic changes, resembling those of PAU, at the site of entry (SE). Clinicopathological data on these patients were compared with those on 32 cases with nonatheromatous dissection (5 with Marfan syndrome or its forme fruste and 27 without Marfan syndrome) and 13 with atherosclerotic saccular aneurysms. For control study, the aorta of a 44-year-old woman who died of pulmonary cancer was used. Compare to nonatheromatous dissection, atherosclerosis-related aortic dissections were found in older women. Four cases were complicated by saccular aneurysms of the aorta. The SE was located in the ascending aorta in 1 and the descending aorta in 5. These sites usually were ulcerated atheromatous plaques or longitudinal fissures rather than transverse tears. Immunohistochemical examination of the SE revealed that MMP-1, 2, 9 and TIMP-2 were expressed in macrophages and/or interstitium, similar to the findings in atheromatous plaque or PAU. We propose that atherosclerosis-related aortic dissection differs from the usual classical aortic dissection. Patients with this lesion have a high risk of re-dissection from the new SE in the same lesion.

Adult↗

PubMed2000

[An arterial dissection of the distal anterior inferior cerebellar artery treated by endovascular therapy].

A rare case of a dissection of the distal anterior inferior cerebellar artery (AICA) is presented. A 68-year-old woman with sudden onset of headache was admitted. Computed tomographic (CT) scan demonstrated no subarachnoid hemorrhage. Seven days later, CT scan revealed subarachnoid and intraventricular hemorrhage. Left vertebral angiogram showed an aneurysmal dilatation on the distal AICA with a diagnosis of suspected arterial dissection. At that time, we chose delayed craniotomy to observe the lesion directly. However, rebleeding causing aggravation of the patient's systemic condition delayed radical treatment. 19 days after rebleeding, by a superselective angiogram, endovascular treatment was selected to prevent further bleeding. The lesion was diagnosed as dissection of the AICA. The parent AICA was occluded with a Guglielmi detachable coil and fibered platinum coils. Dissection of the distal portion of the cerebellar artery is rare. Only six cases have been reported in the posterior inferior cerebellar artery (PICA) and two cases in the superior cerebellar artery (SCA). However, to our knowledge, no such case has been reported in the AICA. Ruptured dissection of distal PICA or SCA is reported to require early treatment to prevent further bleeding. Ruptured dissection of the distal AICA also requires early treatment. Two cases of distal dissection of PICA and SCA successfully treated by endovascular treatment are reported. Endovascular treatment has some benefits in that it does not always require general anesthesia and in that it can follow diagnostic angiography. On the other hand, saccular aneurysms of the distal AICA do not always require early treatment, such as removal of hematoma because of low incidence of vasospasm. So, to decide the treatment, precise diagnosis of the dissection is very important.

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PubMed2002

[A dissecting aneurysm of the posterior inferior cerebellar artery was reduced spontaneously during conservative therapy: case report].

We report here a case of a patient with a dissecting aneurysm of the anterior medullary segment of the posterior inferior cerebellar artery (PICA) which presented with Wallenberg's syndrome. A 32-year-male presented with an unusual case of Wallenberg's syndrome due to a dissecting aneurysm of the PICA manifesting as a sensation of heaviness in the occipital region and vertigo. The occipital symptoms persisted and vertigo and vomiting developed after 6 days. Numbness developed on the left side of the patient's face, and hyperalgesia on the right side of the body. The diagnosis of Wallenberg's syndrome was based on the above findings. MRI revealed infarction of the lateral aspect of the medulla oblongata and MR angiography revealed dilatation in the proximal portion of the left PICA. Digital subtraction angiography revealed that the left vertebral artery was essentially normal, but there was a spindle-shaped dilatation in the proximal portion of the left PICA. We carried out conservative therapy at the patient's request and 3D-CTA revealed that the dissecting aneurysm was markedly reduced in size seven months after the onset. Dissecting aneurysms of the intracranial posterior circulation have been shown to be less uncommon than previously thought. However, those involving the PICA without involvement of the vertebral artery at all are extremely rare. The natural history of the dissecting PICA aneurysm was unknown, and the indication for surgical treatment of such aneurysms remains controversial. Management options are conservative treatment, open surgical treatment including wrapping, trapping, and resection with reconstruction, but almost all of the patients underwent radical treatment to prevent rupture of the aneurysm. However we had no knowledge of the risk of rupture of a PICA dissecting aneurysm presenting with ischemic symptoms. We have reviewed the well-documented 15 cases of dissecting aneurysms of the PICA reported in the literature and we discuss the management of the dissecting PICA aneurysm presenting with ischemic symptoms.

Adult↗

PubMed2002

[Neurologic complications of aortic dissection].

INTRODUCTION: Beside the damages of the cardiovascular system the lesions of the the nervous system are the most common complications of aortic dissection. This is usually an early event, therefore the dissection of the aorta may manifest itself as an acute primary neurologic disease. The aim of this study is to describe the frequency and distribution of acute neurologic symptoms occurring in aortic dissection and the distribution of their clinico-pathologic features and to establish correlations between these and the acute in-hospital mortality as well as to discuss available diagnostic and therapeutic possibilities. PATIENTS AND METHODS: The study was based of 95 cases of acute dissection of aorta (with additional three later events of redissection), observed in a longitudinal study over a period of 29.5 years, in a population of 106,000 (in Western Hungary). RESULTS: Of the 95 patients 20 (21%) died before admission. Neurological complications were observed in 30 of the 75 patients admitted to hospital (40%). Symptoms involving the central nervous system were found in 24 patients, affecting the spinal cord in two and the peripheral nervous system in four cases. The dissection of the aorta was diagnosed in vivo only in 22 out of the 75 patients who died in hospital (29%). 53 patients (71%) without correct diagnosis received supportive therapy only. The average survival time of the 21 patients with proximal dissection of aorta was 48.5 hours. The survival time of 23 patients with the same type of dissection involving the vessels of the aortic arch was 22.2 hours. This difference in survival time was significant (p = 0.0152). 20 of 23 patients (87%) in this group showed signs of neurologic damage confirming earlier experience that neurological complications can seriously worsen the otherwise already catastrophic prognosis of aortic dissection. CONCLUSIONS: The study brought compelling evidence for the need for early diagnosis and rapid transfer of patients to appropriate cardiac surgery centers for definitive diagnosis and therapy.

Acute Disease↗

PubMed2002

Surgical management for type A aortic dissection: 38 cases experience in King Chulalongkorn Memorial Hospital: early result and longterm follow-up.

OBJECTIVE: The objective of the present study was to evaluate the outcome of operative treatment for type A aortic dissection during the past 8 year period. PATIENTS AND METHOD: From January 1992 to March 2000, 38 patients (24 men and 14 women) underwent operations for acute (n = 26) and chronic (n = 12) type A aortic dissection. Patient's age ranged from 24 to 82 years (mean age 56 years). Surgical procedures included supracoronary ascending aortic graft for normal sinuses and valve (n = 34) with valve resuspension for commissural detatchment (n = 2), composite valve and ascending aortic graft for abnormal sinuses and valve (n = 1), and valve replacement and supracoronary ascending aortic graft for normal sinuses and abnormal valve (n = 1). Resection was extended into the arch and descending aorta in chronic dissection if there was excessive dilatation of the arch and descending aorta (n = 3). In 28 patients, aortic graft replacement was accomplished by proximal and distal anastomoses during aortic cross-clamping just proximal to the innominate artery. In 10 patients, deep hypothermia and circulatory arrest was used for open distal anastomosis or for arch replacement. Simultaneous coronary artery bypass grafting was performed in 4 patients. Pre-operative risk factors and the condition of the patients were defined and post-operative morbidity and mortality were followed in the early and long term period. RESULTS: There were 2 post-operative deaths (5.2%); one patient died of acute renal failure, the other patient had intra-operative rupture of the heart chamber; both were operated on in the acute phase of dissection. Complications included sternal wound infection in one case, neurological complication in two cases, respiratory problems in three cases, pericardial effusion in one case and post-operative bleeding that required re-operation in five cases. There was no hospital mortality in the group that were operated on in the chronic phase of dissection. Patient follow-up ranged 2 months to 8 years, there were two late mortalities, both, from acute myocardial infarction (at 33 days and 2 years after surgery). Survival rate was 92 per cent and 86 per cent at 30 days and 2 years, respectively. CONCLUSION: The result of repair of type A dissection in both phases was good in our center. The operative mortality was 5.2 per cent. Predictive factors of mortality were pre-operative shock (p=0.021), tamponade (p=0.021) and operation in the acute phase of dissection (p=0.042). In chronic type A dissection, the operative mortality was zero. Coronary artery disease was the most common cause of late deaths. Intermediate term survival in the present series was satisfactory.

Acute Disease↗

PubMed2002

Transluminal stent-graft placements for the treatments of acute onset and chronic aortic dissections.

BACKGROUND: Transluminal stent-graft placement (TSGP) for aortic dissection is a relatively new procedure. We performed TSGPs to seal the primary entry site to treat and prevent complications of aortic dissection. The early to mid-term outcomes were analyzed. METHODS AND RESULTS: Thirty-seven patients with a primary intimal tear in descending aorta underwent TSPG. TSGP was performed in 16 acute onset dissections (AOD) with dissection-related complications instead of emergency surgery. Eight AOD without complications were treated to prevent aneurysmal enlargement. Thirteen chronic dissections were treated to prevent rupture. TSGP was technically successful in all cases. One patient with prehospital rupture died. The hospital mortality rate was of 2.7% overall, 6.3% in AOD with complications, 0% in AOD without complications and in chronic dissections. One persistent endoleak required open surgery, and 1 intimal tear was caused by the stent-graft, necessitating an additional TSGP. The primary success rate was 94.4% overall. After hospital discharge, no patient died or suffered aortic rupture during an average follow-up of 24.5 months. New intimal tears caused by the stent-grafts and a secondary endoleak developed in 3 AOD patients. One open procedure and 2 additional TSGPs were performed. Actuarial survival rate and cardiovascular event-free rate at 2 years are 97.3% and 78.3% overall, 93.8% and 48.0% in AOD with complications, 100% and 87.5% in AOD without complications, and both 100% in chronic dissections. CONCLUSIONS: TSGP is a reasonable treatment option for aortic dissection. However, delayed intimal tear formations caused by the stent-graft is a problem that requires further investigation.

Acute Disease↗

PubMed2003

Potential pitfalls in the diagnosis of aortic dissection.

STUDY OBJECTIVES: The primary objective of our study was to identify clinical issues contributing to delay in the diagnosis of nontraumatic aortic dissection. DESIGN: Retrospective observational study. SETTING: A 425-bed community based, university-affiliated teaching hospital. PATIENTS: Medical records were analyzed for physiologic, clinical, and outcome variables in 32 consecutive patients who presented to our hospital with non-traumatic aortic dissection over a three-year period (1995-1997). MEASUREMENTS AND RESULTS: The mean time to diagnosis was 10.7 hours (range 0.5-72 hours). The time to diagnosis and clinical variables did not differ between type A and type B aortic dissections (8.7 vs 11.4 hours; P = 0.54). The diagnosis of aortic dissection was not entertained initially in 44% (14/32) of patients, leading to a significant delay in diagnosis compared to patients with suspected aortic dissection on admission (15.0 vs 4.5 hours; P = 0.008). Lack of a widened mediastinum on chest roentgenography (18.7 vs 6.6 hours; P = 0.026) and lack of hypertension (< 140/90 mmHg) at presentation (14.9 vs 7.1 hours; P = 0.03) were associated with a delayed diagnosis of aortic dissection as compared to presence of either finding. The presence or absence of chest or back pain, resting ECG changes, and a past medical history of hypertension did not correlate with time to diagnosis. There was a trend toward earlier diagnosis when the initial diagnostic modality was transesophageal echocardiography as compared to computed axial tomography (CAT) scan (7.7 vs 10.1 hours; P = 0.20). CONCLUSIONS: Patients with aortic dissection are frequently normotensive and may lack typical chest roentgenographic findings at presentation. A high index of clinical suspicion for aortic dissection is essential to avoid potentially fatal delays in its diagnosis.

Aortic Dissection↗

PubMed2003

[Familial aortic dissection; cases involving a father, mother, and son].

The occurrence of familial aortic dissection is rare in cases that are not linked to Marfan syndrome. We report the 3 cases of acute aortic dissection, involving both parents and their son. Case 1 (father case): 79-year-old male visited a nearby doctor complaining of severe chest and back pain. He was diagnosed as acute aortic dissection (Stanford type A). An emergency operation was carried out and he had an artificial vascular replacement of ascending aorta and arch portion. Case 2 (mother case): 73-year-old female was treated for hypertension. Suddenly, she had a terrible epigastralgia and back pain. The contrast enhanced chest computed tomography (CT) revealed an acute aortic dissection (Stanford type A). The ascending aortic aneurysm ruptured in the ambulance while she was transferred to our hospital. She arrived at our hospital after cardiac and respiratory arrest. We attempted to perform cardiac massage, but we could not bring her back to life. Case 3 (son case): 48-year-old male was transferred to our hospital diagnosed with acute aortic dissection (Stanford type A). The ascending aorta replacement was performed on the same day. We were able to save cases 1 and 3 by performing surgery. Aortic dissection is thought to be the disease of medial degeneration. Hereditary links to aortic dissection are not well understood, with the exception of Marfan syndrome cases. The investigation of genetic mechanisms related to aortic dissection will be expected in the future.

Acute Disease↗

PubMedDate not supplied

The discovery of the body: human dissection and its cultural contexts in ancient Greece.

In the first half of the third century B.C, two Greeks, Herophilus of Chalcedon and his younger contemporary Erasistratus of Ceos, became the first and last ancient scientists to perform systematic dissections of human cadavers. In all probability, they also conducted vivisections of condemned criminals. Their anatomical and physiological discoveries were extraordinary. The uniqueness of these events presents an intriguing historical puzzle. Animals had been dissected by Aristotle in the preceding century (and partly dissected by other Greeks in earlier centuries), and, later, Galen (second century A.D.) and others again systematically dissected numerous animals. But no ancient scientists ever seem to have resumed systematic human dissection. This paper explores, first, the cultural factors--including traditional Greek attitudes to the corpse and to the skin, also as manifested in Greek sacred laws--that may have prevented systematic human dissection during almost all of Greek antiquity, from the Pre-Socratic philosopher-scientists of the sixth and fifth centuries B.C. to distinguished Greek physicians of the later Roman Empire. Second, the exceptional constellation of cultural, political, and social circumstances in early Alexandria that might have emboldened Herophilus to overcome the pressures of cultural traditions and to initiate systematic human dissection, is analyzed. Finally, the paper explores possible reasons for the mysteriously abrupt disappearance of systematic human dissection from Greek science after the death of Erasistratus and Herophilus.

Animals↗

PubMed2003

[Left renal infarction due to dissecting aneurysm of the renal arterial branch].

Primary renal artery dissection is a rare condition that causes renal infarction and renovascular hypertension. We describe a case of a 48-year-old man who was admitted for left renal infarction due to a primary dissecting aneurysm of renal artery. He was diagnosed by a contrast enhanced abdominal CT scan and a renal angiography demonstrating a dissection at the branch of the left renal artery. He was treated with conservative medical management, including anticoagulation therapy. Forty-five primary renal artery dissections in 38 patients from previous reports were analyzed. Based on this analysis, many cases of primary renal artery dissection were male and had a high blood pressure. Primary renal artery dissection occurred at the right side (12 cases), left side (19), and bilaterally (7). The renal arterial branches were rarely involved in primary renal artery dissection. Assays of peripheral blood renin activity were performed in 15 patients, and all cases had a high value. Therefore, the present case is thought to be unique because he was a normotensive patient with normal plasma renin activity and the renal arterial branch was only dissected.

Aortic Dissection↗

PubMed2003

Modified radical neck dissection via extra-thyroideal space (MRND vets) in papillary thyroid carcinoma.

The purpose of this study was to describe an alternative lateral neck access to perform lymph nodes sampling and/or neck dissection via extra-thyroideal space (MRND vets) in papillary thyroid carcinoma with lymph nodes involvment. Twenty-four consecutive patients with papillary thyroid carcinoma were included. Lymph nodes sampling and modified radical neck dissection, unilateral or bilateral, were performed acceding via a lateral dissection through a traditional Kocher incision, running along the medial fascia of the neck, posteriorly to the sterno-cleido-mastoideus muscle (SCM). Mean age was 39.04 +/- 13.69 years. Twenty patients were women, and 4 were men. Mean tumor size was 2.5 +/- 1 cm.. Total thyroidectomy with lymph nodes dissection of the central compartment associated to modified radical neck dissection was performed in 17 patients: among these, nine patients had a preoperative diagnosis of the latero-cervical lymph nodes metastases, and eight had a perioperative diagnosis of metastases of the extensive sampling of the lower third of the jugular chain. Metastatic lymph nodes were found in 107 out of 615 lymph nodes dissected. The MNRD vets access for modified lateral neck dissection seems to carry a lower risk in terms of specific morbility and allows a quicker recovery and a better cosmetic result. This access has to be considered as a less invasive procedure compared to other surgical accesses for the radical modified lateral neck dissection.

Adult↗

PubMedDate not supplied

Ruptured thoracic aortic dissection presenting as opacified left hemothorax.

Acute aortic dissections are uncommon, with a reported incidence of 2000 cases per year in the United States. Hemothorax is an unusual but well-described complication of ruptured thoracic aortic dissection. It usually occurs on the left and can be seen in both proximal and distal dissections. Chest radiographs (CXR) in thoracic aortic dissections often reveal a widened mediastinum or abnormal aortic silhouette, evident in 80%-90% of cases. However, CXR may be normal in about 12% of patients with aortic dissection. Clues that would indicate aortic dissection such as abnormal aortic silhouette and widened mediastinum may be obscured by an opacified hemothorax caused by rupture of a thoracic aortic dissection. A high index of suspicion is necessary to make a diagnosis of ruptured thoracic aortic dissection in a patient presenting with hemothorax. This is illustrated in the case described.

Aged↗

PubMed1991

The role of arterial reconstruction in spontaneous renal artery dissection.

Spontaneous renal artery dissection is an uncommon cause of renovascular hypertension, usually associated with fibromuscular dysplasia. Among reported nonautopsy cases (N = 80), arterial reconstruction has seldom been attempted (N = 21) and the outcome has frequently been poor (48% clinical failure rate). This is attributed in part to the frequent involvement of renal artery branches by the dissection. Furthermore, the report of spontaneous reversion to normotension among patients treated medically has also clouded the role of surgery in this disease. Since progress in the technique of renal artery repair now allows successful treatment of anatomically complex lesions, we reviewed our experience with arterial reconstruction in the management of spontaneous renal artery dissection to determine the frequency of and factors correlating with cure after operative repair. Ten patients (eight men, two women; mean age, 39.3 +/- 5.9 years) were admitted with severe hypertension (10/10), often associated with neurologic symptoms, hematuria, or flank pain (8/10). Serum creatinine was elevated in only two patients. Angiography demonstrated changes consistent with fibromuscular dysplasia in 7 of 10 patients and evidence of dissection in 6 of 10. Bilateral disease was present in three patients. Only five patients had a single renal artery on the involved side. The dissection extended into the primary branches in 8 of 10 patients and involved both renal arteries in four of the five patients with two arteries. Histologic study confirmed fibromuscular dysplasia in six and intramural dissection in all operative specimens. Five patients underwent revascularization (in one case requiring the ex vivo technique), with use of hypogastric artery as a conduit in four of five or resection and primary reanastomosis in one of five. Three patients became normotensive, and two returned to their previous level of blood pressure control. Follow-up averaged 14.5 years. Two patients underwent nephrectomy after exploration demonstrated nonreconstructible vessels, and two underwent nephrectomy when intraoperative assessment of the kidney showed that revascularization had failed to adequately reverse extensive renal ischemia. After a mean follow-up of 14.6 years these patients remain normotensive, although two require antihypertensive medications. One patient was treated medically and is currently hypertensive off all medications. Nine of 10 patients have maintained a normal serum creatinine during follow-up. We conclude that renal revascularization is frequently successful in spontaneous renal artery dissection (five of seven, 71.4%) and results in sustained relief of hypertension with maximal conservation of renal tissue. This is important because of the young age at onset and the not infrequent occurrence of bilateral fibromuscular dysplasia, and even of dissection.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1989

[Surgical treatment in dissecting aneurysm of the infrarenal abdominal aorta--report of two cases].

In this paper, we present two cases of dissecting aneurysm in the infrarenal abdominal aorta and a review of this type of lesion. DeBakey's classification has found wide acceptance since it combines both anatomical description and a basis for management. However, there is another type of the aneurysm, omitted in this classification, which involves the infrarenal segment of the abdominal aorta, the intimal tear being distal to the renal arteries. Its clinical manifestation, therefore, differs from dissecting aneurysm of the thoracic aorta. The incidence of dissecting aneurysm in the lower abdominal aorta in the literature is 2-14%. Sixteen cases of atraumatic dissecting aneurysm in the abdominal aorta, including our two, have been reported in Japan. Radioimaging techniques such as ultrasound, computerized tomography with contrast enhancement and conventional angiography, allow diagnosis of dissecting aneurysm. Computerized tomography with contrast enhancement has led to more frequent preoperative diagnosis of dissecting aneurysm in the abdominal aorta. However, precise visualization of the intimal defect together with the site of entry is a prerequisite of operation. Angiography remains the most suitable method of achieving this end. Although both abdominal and thoracic aortic dissection share a common management in respect to hypotensive therapy, we believe that surgical intervention is required, especially in dissection of the abdominal aorta, with prosthetic replacement of the infrarenal segment and obliteration of any proximal or distal false lumen.

Aged↗

PubMed1989

[Neurologic manifestations of dissecting aneurysms of the aorta].

Dissecting aneurysm of the aorta keeps on being nowadays a diagnostic problem, although it is a well known entity. Dissecting aneurysms may be classified into type A, dissection involving the ascending aorta, and type B, dissection involving descending aorta. The frequency of neurologic manifestations oscillates from 18 to 30%. From the 133 cases of dissecting aneurysm attended at our hospital, 30 (22.5%) presented neurologic manifestations. Nine patients (30%) had symptoms of ischemic neuropathy; 13 (43.3%) presented symptoms compatible with spinal ischemia and 14 (46.7%) presented manifestations of brain ischemia, with involvement of supraaortic trunks proven at autopsy in eight cases. The neurologic complications of type A and B dissecting aneurysms were similar (28 and 26%); in up to 30% of patients, it was the initial symptom. In type A dissecting aneurysm, the most frequent neurologic manifestation was brain ischemia (57.1%) whereas ischemic neuropathy and spinal ischemia predominated in type B dissecting aneurysm. The overall mortality rate reached 76.7% (85.7% for type A and 55.5% for type B). The modality of treatment had no clear influence on the survival. In the presence of brain complications, the mortality was 100%.

Aged↗