![]() ![]() 4–9 Consensus exists that surgery to prevent rupture or dissection of the ascending thoracic aortic aneurysm should be recommended when the ascending aortic diameter reaches 5.5 cm for non-Marfan patients and 4.5 cm in Marfan patients. ![]() Guidelines for timing of aortic root repair are based on clinical observations by experienced clinicians and surgeons and a consensus based on clinical series and patient characteristics. The mainstay of prevention of aortic dissection, aside from treatment of hypertension, is elective aortic surgery in patients with dilated ascending aortas. Even patients with Marfan syndrome, Ehlers-Danlos syndrome, familial aortic aneurysm, or congenitally bicuspid aortic valve who are known to be at increased risk for dissection often go unrecognized until they present with an acute aortic syndrome. Established clinical risk factors are systemic hypertension (widespread in the general population) and aortic dilation or aneurysm, which can only be found with diagnostic imaging. Identification of patients at risk for aortic dissection is difficult. Methods other than size measurement of the ascending aorta are needed to identify patients at risk for dissection. Mortality (27% of patients) was not related to aortic size.Ĭonclusions- The majority of patients with acute type A acute aortic dissection present with aortic diameters <5.5 cm and thus do not fall within current guidelines for elective aneurysm surgery. Marfan syndrome patients were more likely to dissect at larger diameters (odds ratio, 14.3 95% confidence interval, 2.7 to 100 P=0.002). Independent predictors of dissection at smaller diameters (<5.5 cm) included a history of hypertension (odds ratio, 2.17 95% confidence interval, 1.03 to 4.57 P=0.04), radiating pain (odds ratio, 2.08 95% confidence interval, 1.08 to 4.0 P=0.03), and increasing age (odds ratio, 1.03 95% confidence interval, 1.00 to 1.05 P=0.03). Maximum aortic diameters averaged 5.3 cm 349 (59%) patients had aortic diameters <5.5 cm and 229 (40%) patients had aortic diameters <5.0 cm. Methods and Results- We examined 591 type A dissection patients enrolled in the International Registry of Acute Aortic Dissection between 19 (mean age, 60.8 years). We used data from our registry of acute aortic dissection patients to better understand the relationship between aortic diameter and type A dissection. However, few studies of acute aortic dissection patients and aortic size exist. Customer Service and Ordering Informationīackground- Studies of aortic aneurysm patients have shown that the risk of rupture increases with aortic size.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA). ![]() ![]() Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB). ![]()
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