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      Spontaneous Supraceliac Isolated Abdominal Aortic Dissection Sparing Major Visceral and Renal Vessels and Presenting as Chronic Limb Ischemia

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          Abstract

          Aortic dissections that originate from isolated tears in the abdominal aorta are uncommon. Rarer still are cases of isolated abdominal aortic dissections arising in suprarenal locations, as most appear from infrarenal intimal defects. We present a quite unusual case of a spontaneous supraceliac isolated abdominal aortic dissection sparing the renal and mesenteric arteries and manifesting as chronic rather than acute limb ischemia. The atypical presentation of this case led to repeated misdiagnosis with consequent loss of part of the patient's limb. Better illustration of the natural history of this ill-defined pathology is needed to aid understanding and improve patient care.

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          The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease.

          P. Hagan, C. A. Nienaber, E. Isselbacher … (2000)
          Acute aortic dissection is a life-threatening medical emergency associated with high rates of morbidity and mortality. Data are limited regarding the effect of recent imaging and therapeutic advances on patient care and outcomes in this setting. To assess the presentation, management, and outcomes of acute aortic dissection. Case series with patients enrolled between January 1996 and December 1998. Data were collected at presentation and by physician review of hospital records. The International Registry of Acute Aortic Dissection, consisting of 12 international referral centers. A total of 464 patients (mean age, 63 years; 65.3% male), 62.3% of whom had type A dissection. Presenting history, physical findings, management, and mortality, as assessed by history and physician review of hospital records. While sudden onset of severe sharp pain was the single most common presenting complaint, the clinical presentation was diverse. Classic physical findings such as aortic regurgitation and pulse deficit were noted in only 31.6% and 15.1% of patients, respectively, and initial chest radiograph and electrocardiogram were frequently not helpful (no abnormalities were noted in 12.4% and 31.3% of patients, respectively). Computed tomography was the initial imaging modality used in 61.1%. Overall in-hospital mortality was 27.4%. Mortality of patients with type A dissection managed surgically was 26%; among those not receiving surgery (typically because of advanced age and comorbidity), mortality was 58%. Mortality of patients with type B dissection treated medically was 10.7%. Surgery was performed in 20% of patients with type B dissection; mortality in this group was 31.4%. Acute aortic dissection presents with a wide range of manifestations, and classic findings are often absent. A high clinical index of suspicion is necessary. Despite recent advances, in-hospital mortality rates remain high. Our data support the need for continued improvement in prevention, diagnosis, and management of acute aortic dissection.
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            The International Registry of Acute Aortic Dissection (IRAD)

            Peter G. Hagan, Christoph Nienaber, Eric Isselbacher … (2000)
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              Dissection of the abdominal aorta. Current evidence and implications for treatment strategies: a review and meta-analysis of 92 patients.

              F Schlösser, Frans Moll, Frederik H W Jonker … (2009)
              To report meta-analyses of published clinical experiences with abdominal aortic dissection (AAD), a rare event that is accountable for up to 4% of all aortic dissections. All English-language articles regarding abdominal aortic dissection were identified using MEDLINE, Cochrane Library Central, and EMBASE databases. All identified articles were critically appraised for relevance and validity before data extraction and the meta-analyses were performed. Original data were identified on 92 AAD patients (62 men; mean age 59+/-16 years). Of all AADs, 73 (79%) were spontaneous, 13 (14%) traumatic, and 6 (7%) iatrogenic; the majority (68, 74%) were acute presentations. The mean dissection length was 59+/-16 mm. A pre-existing abdominal aortic aneurysm was present in 39 (42%). Hypertension was more frequently present in patients with spontaneous dissections compared to other dissection types (p = 0.001). Concurrent aortic aneurysms were more often associated with spontaneous dissections (p = 0.002). Aortic rupture occurred in 9 (10%) AADs. Open surgical repair was performed in 46 (50%), endovascular repair in 19 (21%), and conservative medical treatment in 27 (29%). In-hospital mortality was 4% overall [1 (2%) in the open repair group, 0 endovascular, and 2 (8%) conservative treatment]. Major complications occurred in 9% [6 (13%) in the open repair group, 1 (5%) in the endovascular group, and 1 (4%) in the conservative treatment cohort]. AAD is a rare event that appears to be associated with hypertension and pre-existing aneurysmal degeneration of the abdominal aorta. AAD patients are at considerable risk of in-hospital mortality and complications. Endovascular therapy appears to be associated with a relatively low risk of mortality or major complications compared to open repair and conservative treatment.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Vasc Med
                Journal ID (publisher-id): IJVM
                Title: International Journal of Vascular Medicine
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2090-2824
                ISSN (Electronic): 2090-2832
                Publication date (Print): 2011
                Publication date (Electronic): 28 April 2011
                Volume: 2011
                Electronic Location Identifier: 890204
                Affiliations
                Department of Vascular Surgery, Doncaster Royal Infirmary, Armthorpe Road, Doncaster DN2 5LT, UK
                Author notes

                Academic Editor: Frank R. Arko

                Article
                DOI: 10.1155/2011/890204
                PMC ID: 3096317
                PubMed ID: 21603145
                SO-VID: 274bdf8c-3673-4dad-9ef2-72ef2b7d9fb2
                Copyright © Copyright © 2011 Sean O. Z. Bello et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 31 January 2011
                Date accepted : 1 March 2011
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Cardiovascular Medicine
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine

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