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      Acute Stanford Type A Aortic Dissection: A Review of Risk Factors and Outcomes

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          Abstract

          Acute aortic dissection (AAD) can be said to be a relatively uncommon emergency with fatal outcomes mainly due to delayed/missed diagnosis and treatment. Its ability to masquerade as other emergencies like acute coronary syndrome and pulmonary embolism makes the prognosis unfavorable in a significant proportion of patients. Patients have been seen to present to the accident and emergency department or outpatient setting with typical or atypical symptoms as we will discuss in this article. We have focused on indicators for risk and prognosis of acute Stanford type A aortic dissection in this traditional review. It is well known that despite recent developments and improvements in treatment modalities, AAD is still associated with a significant mortality rate and postoperative complications.

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          Most cited references26

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          2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC).

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

            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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              Insights From the International Registry of Acute Aortic Dissection: A 20-Year Experience of Collaborative Clinical Research.

              Acute aortic dissection (AAD) is a life-threatening condition associated with high morbidity and mortality rates, and it remains a challenge to diagnose and treat. The International Registry of Acute Aortic Dissection was established in 1996 with the mission to raise awareness of this condition and provide insights to guide diagnosis and treatment. Since then, >7300 cases have been included from >51 sites in 12 countries. Although presenting symptoms and physical findings have not changed significantly over this period, the use of computed tomography in the diagnosis has increased, and more patients are managed with interventional procedures: surgery in type A AAD and endovascular therapy in type B AAD; with these changes in care, there has been a significant decrease in overall in-hospital mortality in type A AAD but not in type B AAD. Herein, we summarized the key lessons learned from this international registry of patients with AAD over the past 20 years.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                17 March 2023
                March 2023
                : 15
                : 3
                : e36301
                Affiliations
                [1 ] General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
                [2 ] General Surgery, Pilgrim Hospital, Boston, GBR
                [3 ] Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
                [4 ] Internal Medicine, Hayatabad Medical Complex, Peshawar, PAK
                [5 ] Internal Medicine, Lady Reading Hospital, Peshawar, PAK
                [6 ] Internal Medicine, Mu'tah University, Amman, JOR
                [7 ] Research and Development, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
                [8 ] Internal Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, IND
                [9 ] Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
                [10 ] Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
                [11 ] General Medicine, Government Medical College, Surat, IND
                Author notes
                Article
                10.7759/cureus.36301
                10108894
                74fe6da6-c6e6-4c9f-be97-5954ef74bcc1
                Copyright © 2023, Chukwu et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 4 September 2022
                : 17 March 2023
                Categories
                General Surgery

                outcomes,risk factors,acute type a dissection,stanford type a acute aortic dissection,aorta repair,complications of aortic dissection

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