Stopping a Killer

Abstract

Aneurysms and acute dissections are the major diseases affecting the ascending thoracic aorta. These conditions are related; the natural history of an aneurysm involving the ascending aorta is to progressively and asymptomatically enlarge over time, ultimately leading to an acute ascending aortic dissection (type A dissection based on the Stanford classification, type I and II dissections based on the DeBakey classification). Although medical treatments can slow the enlargement of an aneurysm, the mainstay of treatment to prevent dissections is surgical repair of the ascending aortic aneurysm. This is typically recommended when the aneurysm diameter reaches 5.0 to 5.5 cm1; however, studies on patients presenting with acute ascending dissections indicate that up to 60% present with aneurysms 1200 patients presenting with ascending aortic dissection to emergency departments participating in the International Registry of Acute Aortic Dissections (IRAD).4 Article see p 1911 Many of the factors associated with a delay in …