Difficulties in Diagnosis and Ways to Optimize Computed Tomography in Acute Aortic
            Lesions

Timely diagnosis and treatment of patients with acute aortic dissection continues to be one of the most important and discussed problems in emergency medicine. Due to accurate diagnosis and an effective surgical approach, the results of interventions for acute aortic dissection have improved, at least in specialized centers. However, for patients suffering from malperfusion against the background of acute dissection, the prognosis in some cases remains unfavorable. The cause of malperfusion can be stenosis or occlusion of the main branches of the aorta, which can be detected using computed tomography aortography (CT-AG). Today, it is the method of choice in the diagnosis of not only acute aortic dissection, but also its complications, including malperfusion ones. The purpose of this article is to analyze the capabilities of CT-AG in detecting various types of stenosis arising in the transition of dissection to the main branches of the aorta, as well as the actual manifestations of malperfusion in organs and tissues in acute aortic dissection, according to various authors.

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The role of computed tomography in the diagnosis of malperfusion syndrome in acute aortic dissection (literature review)

Nunaeva

Zabavskaya

Muslimov

et al. 2022

vmirvz

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The Choice of Tactics for Surgical Treatment of Acute De Bakey Type I Aortic Dissection in a Multidisciplinary Surgical Hospital

Redkoborody¹,

Selyaev²,

Rubtsov³

et al. 2023

Neotložnaâ med. pomoŝʹ

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BACKGROUND Acute proximal aortic dissection (Stanford type A) remains the most common fatal pathology of the thoracic aorta. Despite the improvement of surgical technologies, hospital mortality after emergency surgical interventions is 17–25%, in complicated cases it can reach 80–90%.AIM OF STUDY Description of the perioperative treatment tactics adopted at the N.V. Sklifosovsky Research Institute for Emergency Medicine as well as the evolution of approaches that make it possible to obtain satisfactory hospital and long-term results in the treatment of aortic dissection.MATERIAL AND METHODS the study included 278 patients operated on from 2015 to 2021 in the acute stage of aortic dissection (less than 48 hours from the moment of manifestation of the disease). The operated patients were divided into two groups, depending on the presence of complicated forms: group A, 102 patients with uncomplicated course of the disease; group B, 176 patients with complicated course of the disease. Additionally, patients were divided depending on the level of distal reconstruction performed: group I, 83 patients, surgery was limited to prosthetics of the ascending aorta, without removing the clamp; group II, 137 patients who underwent hemi-arch surgery; group III, 58 patients, with distal reconstruction involving the aortic arch.RESULTS Total hospital mortality was 28.1%: 25.3% in group I, 29.1% in group II, 29.3% in group III. In the group of uncomplicated dissection, postoperative mortality was 18.6%, while in the group of complicated dissection it was 33.5%.CONCLUSION An integrated multidisciplinary approach with the formation of an “aortic team”, an individual approach to surgery, depending on the anatomy of the dissection and the clinical status of the patient, will improve the results of the treatment of acute aortic dissection, as the most severe and multiple organ pathology of the aorta.FINDING 1. Hospital mortality of complicated forms of dissection remains significantly higher — 33.5% versus 18.5% of uncomplicated course. 2. The most optimal method of distal reconstruction in patients with the peracute stage of dissection is an open anastomosis with the aorta using the “hemi-arch” technique. 3. If it is necessary to extend the surgical intervention on the aortic arch, a distal anastomosis in areas 0, 1, 2 with the possibility of a subsequent endovascular stage is the priority.

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Difficulties in Diagnosis and Ways to Optimize Computed Tomography in Acute Aortic Lesions

Cited by 2 publications

References 28 publications

The role of computed tomography in the diagnosis of malperfusion syndrome in acute aortic dissection (literature review)

The role of computed tomography in the diagnosis of malperfusion syndrome in acute aortic dissection (literature review)

The Choice of Tactics for Surgical Treatment of Acute De Bakey Type I Aortic Dissection in a Multidisciplinary Surgical Hospital

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