DISECCION AORTICA PDF
En la clasificación de Dubost, la disección abdominal representa del 1 al 2% de todas las disecciones aórticas, cuadro clínico aún más infrecuente si excluimos. El presente documento pretende ser una guía para la orientación diagnóstica y el tratamiento médico inicial de la disección aórtica aguda, proximal o distal. RESUMEN. Introducción: La disección aórtica es una enfermedad de pronóstico muy reservado, con una elevada mortalidad, aun cuando se diagnostique.
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These conditions include the following:. Indications for the surgical treatment of aortic dissection include an acute proximal aortic dissection and an acute distal aortic dissection with one or more complications.
The reason for surgical repair of type A dissections is that ascending aortic dissections often involve the aortic valve, which, having lost its suspensory support, telescopes down into the aortic root, resulting aorrtica aortic incompetence.
If the individual has managed to survive this window period, his prognosis is improved. If there is high clinical suspicion, a more sensitive imaging test CT angiogramMR angiographyor transesophageal echo may be warranted.
Carotid artery stenosis Renal artery stenosis. Through these secondary tears, the blood can re-enter the true lumen. If a pleural effusion were to develop due to an aortic dissection, it is more commonly in the left hemithorax rather than the right hemithorax. Tex Heart Inst J. It is usually associated with pericardial tamponade, severe aortic insufficiency, or rupture of the aorta.
In acute dissection, fast-acting agents which can be given intravenously and have doses that are easier to adjust such as esmololpropranololor labetalol are preferred. A Systematic Review and Meta-analysis”. An acute dissection is one in which the individual presents within the first two weeks.
For uncomplicated Stanford type B distal aortic dissections including abdominal aortic dissectionsmedical management is preferred over surgical. It is a noninvasive test, does not require the use of iodinated contrast material, and can detect and quantitate the degree of aortic insufficiency. The Stanford classification is useful as it follows clinical practice, as type A ascending aortic dissections generally require primary surgical treatment, whereas type B dissections generally are treated medically as initial treatment with surgery reserved for any complications.
Chest CT with descending type B Stanford aortic dissection red circle.
Disección aórtica aguda abdominal infrarrenal | Angiología
Long-term blood pressure control is required for every person who has experienced aortic dissection. Establishing the incidence disecdion aortic dissection has been difficult because many cases are only diagnosed after death which may have been attributed to another causeand is often initially misdiagnosed. A measurement of blood D-dimer level may be useful in diagnostic evaluation. Often, the diagnosis is made by visualization of the intimal flap on a diagnostic imaging test.
This page was last edited on 1 Decemberat From Wikipedia, the free encyclopedia. This type of scan is timed to an injection to capture the contrast as it enters the aorta. Vascular surgerycardiothoracic surgery. Aortic dissection is more common in those with a history of high blood pressurea number of connective tissue diseases that affect blood vessel wall strength such as Marfan syndrome and Ehlers Danlos syndromea bicuspid aortic valveand previous heart surgery.
Other tests that may be used include an aortogram or magnetic resonance angiogram of the aorta. The Stanford classification is divided into two groups, A and B, depending on whether the ascending aorta is involved.
Severe hypotension at presentation is a grave prognostic indicator.
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July – August Pages Show more Show less. Blood pressure riseccion, not smoking . However, type B dissections are not improved, from a mortality point of view, by the operation, unless leaking, rupture, or compromise to other organs, e.
Aortoiliac occlusive disease Degos disease Erythromelalgia Fibromuscular dysplasia Raynaud’s phenomenon. Hypertensive heart disease Hypertensive emergency Hypertensive nephropathy Essential hypertension Secondary hypertension Renovascular hypertension Benign hypertension Pulmonary hypertension Systolic hypertension White coat hypertension. J Thorac Cardiovasc Surg. Retrieved 6 January It is a relatively noninvasive test, requiring the individual to swallow the echocardiography probe.
Strokemesenteric ischemiamyocardial ischemiaaortic rupture . Proximal aortic dissections tend to be more associated with weakening of the vascular wall due to cystic medial degeneration.
Archived from the original on 5 January The procedure is known as aortography. Aortic dissection AD occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart. If the pain is pleuritic in nature, it may suggest acute pericarditis caused by bleeding into the pericardial sac.
The high pressure rips the tissue of the media apart along the laminated plane splitting the inner two-thirds and the outer one-third of the media apart. The DeBakey system, named after cardiothoracic surgeon Michael E.