Aortic Dissection: Urgent Endovascular Treatment

Aortic dissection is a life-threatening condition that is associated with high morbidity and mortality. This chapter reviews the classification, etiology, pathophysiology, diagnosis, management, and outcomes with particular focus on the endovascular treatment. Aortic dissections are classified temporally, anatomically, and functionally. The most common risk factors for aortic dissection are male sex, poorly controlled hypertension, advanced age, prior cardiac surgery, and structural abnormalities of the aortic wall. Patients most commonly present with sudden onset of severe chest or back pain. Those with Type A dissections more commonly report anterior chest pain while those with Type B dissections more commonly report back or abdominal pain. The mainstay of medical treatment for uncomplicated Type B aortic dissection is anti-impulse and antihypertensive combination therapy. Spinal cord ischemia remains an important complication in open surgical and endovascular stent graft repair of aortic dissections. Surveillance is essential in the management of Type B aortic dissection.