Key result
Medical management remains preferred for stable chronic aortic dissections, reserving repair for complications.
Why the study?
Chronic aortic dissections have a complex natural history influenced by multiple factors, and optimal management strategies remain challenging.
Medical management with antihypertensives is the treatment of choice for stable chronic aortic dissections, while repair is indicated for complications.
Affirms medical first-line strategy for stable cases in practice; leaves open need for RCTs on BP targets and repair thresholds.
Chronic aortic dissections are complex lesions with a fairly predictable natural history depending on factors such as baseline aortic diameter, the degree of false lumen thrombosis, the presence of a persistent communication, an underlying connective tissue disorder, and the control of hypertension. Medical management with antihypertensive therapy including beta-blockers is the treatment of choice for all stable chronic aortic dissections. Repair is indicated in the case of complications: aortic rupture, malperfusion syndromes, symptomatic dissections, asymptomatic dissections becoming significantly aneurysmal or demonstrating a rapid growth rate. In this regard, serial imaging of the aorta is crucial to detect unstable lesions requiring surgery or an endovascular intervention. As endograft technologies improve endovascular approach may become the future standard of care.
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Giugliano et al. (2009) conducted a review in Chronic aortic dissection. Medical management and surgical/endovascular repair was evaluated. Medical management with antihypertensive therapy is the treatment of choice for stable chronic aortic dissections, while repair is indicated for complications such as rupture or rapid growth.
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