<- Home <- Arhive <- Vol. 25, Issue 4, December 2017

Rom J Leg Med25(4)418-427(2017)
© Romanian Society of Legal Medicine

Acute type A aortic dissection - diagnosis and treatment in a frequent litigation disease

A. G. Iosifescu, V. A. Iliescu,

Abstract: Prompt diagnosis and emergency operation are of utmost importance for salvage of patients with acute type A aortic dissection (ATAAD). However, despite great progress in the field, there is a high rate of misdiagnosis and a significant failure rate of the treatment. Consequently, ATAAD became a frequent cause of litigation. As the last decades brought valuable new information in the field through analysis of large multicenter databases, we reviewed some of the present-day knowledge and some statistic results from a group of 393 consecutive ATAAD patients operated, between January 2009- June 2017, in our institution. Diagnosis of this frequently elusive disease, requires persistent suspicion of the disease in any acute chest pain and availability of emergency imaging techniques. Surgical treatment is the required management; the surgical goal is not cure of dissection, but decrease the incidence of early fatal complications of disease. The still significant early complication and mortality rate is due to malperfusion, comorbidities and complexity of intervention. We summed up ongoing debate around strategies and techniques employed for surgical treatment and on their choice in specific categories of ATAAD patients. Surgical option is frequently difficult (posing ethical problems too): as the more extensive surgery is, the worse the early results, but the better late outcome; also, in identifying patients with extreme surgical risk, that could have better chances with medical treatment alone. There is increasing evidence on the benefits of hybrid procedures (surgical and endovascular) in the ATAAD treatment; future will show their extended use.
Keywords: type A acute aortic dissection, diagnosis, surgical treatment, review.

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