What are the ACR appropriateness criteria for the diagnosis and treatment of acute aortic type A dissection?

Updated: Nov 09, 2018
  • Author: John M Wiesenfarth, MD, FACEP, FAAEM; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

The American College of Radiology has established ACR Appropriateness Criteria for the diagnosis and treatment of suspected aortic dissection. [5]

Type A dissections

Urgent surgical intervention is required in type A dissections. The area of the aorta with the intimal tear usually is resected and replaced with a Dacron graft. The operative mortality rate is usually less than 10%, and serious complications are rare with ascending aortic dissections.

The development of more impermeable grafts, such as woven Dacron, collagen-impregnated Hemashield (Meadox Medicals, Oakland, NJ), aortic grafts, and gel-coated Carbo-Seal Ascending Aortic Prothesis (Sulzer CarboMedics, Austin, Tex), has greatly enhanced the surgical repair of thoracic aortic dissections.

With the introduction of profound hypothermic circulatory arrest and retrograde cerebral perfusion, the morbidity and mortality rates associated with this highly invasive surgery have decreased.

Dissections involving the arch are more complicated than those involving only the ascending aorta, because the innominate, carotid, and subclavian vessels branch from the arch. Deep hypothermic arrest usually is required. If the arrest time is less than 45 minutes, the incidence of central nervous system complications is less than 10%.

Aortic stent grafting is a challenging technique. It may prove feasible and has offered good results in a small series of patients. It may be a reasonable alternative in high-risk patients in the near future.


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