Key result
Acute aortic dissection is highly lethal, with historical data showing 60% mortality within a week and an intimal tear communicating with the lumen in 90% of autopsied cases.
This review outlines the pathologic and clinical features of acute aortic dissection to guide therapeutic judgments.
Urges rapid diagnosis in suspected cases; leaves open impact of contemporary therapies on historical mortality.
Acute aortic dissection is highly lethal. A comprehensive review in 1958 revealed that one patient in five with this disorder died within 24 hours, two in five within 72 hours, and three in five within a week.1Fortunately, the application of recently developed therapeutic techniques appears to improve the outlook. In this review, reference will be made to the pathologic and clinical features of this entity and particularly those features which form the basis for judgements regarding therapy. Pathologic Features Longitudinal cleavage of the aortic media is the primary lesion. The separation of the medial layers varies in extent but may involve the entire length of the vessel. This cleavage plane communicates with the lumen through an intimal tear in 90% of autopsied cases. Although termed "entrance tears," their contribution to the genesis of medial dissection is uncertain since they are not invariably present. External rupture into the pericardial
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Joseph Lindsay (1971) conducted a review in Acute aortic dissection. Acute aortic dissection is highly lethal, with historical data showing 60% mortality within a week and an intimal tear communicating with the lumen in 90% of autopsied cases.