Acute Aortic Dissection: Population-Based Incidence Compared With Degenerative Aortic Aneurysm Rupture

Clouse, W. Darrin; Hallett, John W.; Schaff, Hartzell V.; Spittell, Peter C.; Rowland, Charles M.; Ilstrup, Duane M.; Melton, L. Joseph

doi:10.4065/79.2.176

Cited by 551 publications

(342 citation statements)

References 19 publications

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“…Clinically, ATAA management balances the risk of aneurysm rupture with the risk of surgery-related complications and death [2,3]. Risk of rupture is correlated with aneurysm diameter [2,7]; aneurysms greater than 6 cm in diameter exhibit a significantly higher risk of rupture [2]. Thus, for patients without valvular disorders, current guidelines indicate surgical intervention for ATAA diameters greater than 5.5 cm and monitoring for those less than 5.5 cm [2].…”

Section: Introductionmentioning

confidence: 99%

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Prefailure and Failure Mechanics of the Porcine Ascending Thoracic Aorta: Experiments and a Multiscale Model

Shah

Witzenburg

Hadi

et al. 2014

Journal of Biomechanical Engineering

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Ascending thoracic aortic aneurysms (ATAA) have a high propensity for dissection, which occurs when the hemodynamic load exceeds the mechanical strength of the aortic media. Despite our recognition of this essential fact, the complex architecture of the media has made a predictive model of medial failure-even in the relatively simple case of the healthy vessel-difficult to achieve. As a first step towards a general model of ATAA failure, we characterized the mechanical behavior of healthy ascending thoracic aorta (ATA) media using uniaxial stretch-to-failure in both circumferential (n ¼ 11) and axial (n ¼ 11) orientations and equibiaxial extensions (n ¼ 9). Both experiments demonstrated anisotropy, with higher tensile strength in the circumferential direction (2510 6 439.3 kPa) compared to the axial direction (750 6 102.6 kPa) for the uniaxial tests, and a ratio of 1.44 between the peak circumferential and axial loads in equibiaxial extension. Uniaxial tests for both orientations showed macroscopic tissue failure at a stretch of 1.9. A multiscale computational model, consisting of a realistically aligned interconnected fiber network in parallel with a neo-Hookean solid, was used to describe the data; failure was modeled at the fiber level, with an individual fiber failing when stretched beyond a critical threshold. The best-fit model results were within the 95% confidence intervals for uniaxial and biaxial experiments, including both prefailure and failure, and were consistent with properties of the components of the ATA media.

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Section: Introductionmentioning

confidence: 99%

“…Ascending aortic aneurysms have an incidence rate of 10.4 per 100,000 person-years [7], with significant risk of dissection or rupture [7]. Clinically, ATAA management balances the risk of aneurysm rupture with the risk of surgery-related complications and death [2,3].…”

Section: Introductionmentioning

confidence: 99%

Prefailure and Failure Mechanics of the Porcine Ascending Thoracic Aorta: Experiments and a Multiscale Model

Shah

Witzenburg

Hadi

et al. 2014

Journal of Biomechanical Engineering

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“…Recent population-based and observational studies using international registries (most notably IRAD), however, have allowed major improvements in this regard, primarily because of improvements in diagnostic testing (see Diagnostic Modalities). Studies by Mészáros et al 5 and Clouse et al 37 have estimated the incidence of aortic dissection to range from 2.9 to 3.5 per 100,000 person-years among populations in Olmsted County, Minnesota, and Western Europe, respectively. Several studies from IRAD have furthered our insight into demographic characteristics of AAD.…”

Section: Epidemiology Acute Aortic Syndromesmentioning

confidence: 99%

“…The leading cause of mortality from this type of aneurysm is aortic rupture, accounting for 60% of deaths. 37 …”

Section: Thoracic Aortic Aneurysmsmentioning

confidence: 99%

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Acute Aortic Syndromes and Thoracic Aortic Aneurysm

Ramanath

Sundt

et al. 2009

Mayo Clinic Proceedings

196

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Acute and chronic aortic diseases have been diagnosed and studied by physicians for centuries. Both the diagnosis and treatment of aortic diseases have been steadily improving over time, largely because of increased physician awareness and improvements in diagnostic modalities. This comprehensive review discusses the pathophysiology and risk factors, classification schemes, epidemiology, clinical presentations, diagnostic modalities, management options, and outcomes of various aortic conditions, including acute aortic dissection (and its variants intramural hematoma and penetrating aortic ulcers) and thoracic aortic aneurysms. Literature searches of the PubMed database were conducted using the following keywords: aortic dissection, intramural hematoma, aortic ulcer, and thoracic aortic aneurysm. Retrospective and prospective studies performed within the past 20 years were included in the review; however, most data are from the past 15 years. and studied by physicians for centuries. Descriptions of such pathologic conditions of the aorta as aneurysm and dissection date back as early as the 2nd century during the time of Galen, whose discoveries were largely made through studies of apes. More "recent" reports were described by Vesalius in 1557, followed by Nichols in 1732, who detailed the process of aortic dissection. In 1761, Morgagni reported detailed pathologic features of a patient with a ruptured aorta. 1 However, our true understanding of aortic pathology began with the dissertation by Shennan 2 in 1934, which included a description of penetrating atheromatous plaques of the thoracic aorta. His report was followed by the first successful management of aortic dissection by DeBakey in 1955. 1 Since then, our knowledge of the pathologic conditions of the aorta has grown considerably and continues to evolve with ongoing research into the pathophysiology of these conditions, technological advances in the modes of detection, and improved therapeutic options. Clinical databases, such as the International Registry of Acute Aortic Dissection (IRAD), the largest current registry for acute aortic syndromes, have also contributed tremendously to our knowledge of acute aortic pathology.For the practicing clinician, knowledge of aortic disease is paramount because patients with aortic conditions contribute significantly to the overall mortality from cardiovascular disease. This review discusses the pathophysiology, epidemiology, presentation, diagnosis, and therapeutic options for several forms of acute and chronic aortic pathology: aortic dissection (including its variants intramural hematoma [IMH] and penetrating atheromatous aortic ulcer) and thoracic aortic aneurysm (TAA). Literature searches were performed of the PubMed database using the following key words: aortic dissection, intramural hematoma, aortic ulcer, and thoracic aortic aneurysm. Retrospective and prospective studies conducted within the past 15 years, along with some data from years prior, were included in this review.

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