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Aortic Dissection
and Acute Aortic
Syndromes
Frank W.Sellke
Editor-in-Chief
Joseph S.Coselli
ThoralfM.Sundt
JosephE.Bavaria
Neel R.Sodha
Editors
123

Aortic Dissection and Acute Aortic Syndromes

FrankW.Sellke
Editor-in-Chief
Joseph S. Coselli • Thoralf M. Sundt
Joseph E. Bavaria • Neel R. Sodha
Editors
Aortic Dissection and Acute
Aortic Syndromes

Editor-in-Chief
FrankW.Sellke
Rhode Island Hospital
Brown University
Providence,RI
USA
Editors
Joseph S. Coselli
Department of Surgery
Baylor College of Medicine
Houston
USA
Joseph E. Bavaria
Perelman Center for Advanced Medicine
University of Pennsylvania
Philadelphia, Pennsylvania
USA
Thoralf M. Sundt
Massachusetts General Hospital and
Harvard Medical School
Boston, Massachusetts
USA
Neel R. Sodha
Thoracic Cardiothoracic Surgery
Rhode Island Hospital and Alpert Medical
School of Brown University
Providence, RI,
USA
ISBN 978-3-030-66667-5 ISBN 978-3-030-66668-2 (eBook)
https://doi.org/10.1007/978-3-030-66668-2
© Springer Nature Switzerland AG 2021
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microlms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specic statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Contents
https://t.me/med1917
Part I History, Presentation and Genetics of Acute Aortic Syndromes
Overview and History of Aortic Dissection and Other Acute
Aortic Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Afshin Ehsan and Frank W. Sellke
Aortic Anatomy and the Pathophysiology of Acute Aortic Syndromes . . . 17
Lauren V. Huckaby and Thomas G. Gleason
Histopathology of Acute Aortic Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . 39
David Ranney and Ryan P. Plichta
Genetically-Triggered Aortic Dissections . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Melissa L. Russo and Jia Jennifer Ding
Presentation of Acute Aortic Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Santi Trimarchi, Hector W. L. de Beaufort,
and Theodorus M. J. van Bakel
Classification Systems of Acute Aortic Syndromes . . . . . . . . . . . . . . . . . . . 69
Arminder S. Jassar, Rizwan Q. Attia, and Eric M. Isselbacher
Medical Conditions Predisposing to Aortic Dissection and
Preventive Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Eduardo Bossone, Valentina Russo, Andrea Salzano, and Kim Eagle
What Do the Guidelines Say for the Treatment of Acute
Aortic Syndromes? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Jordan P. Bloom, Navyatha Mohan, and Thoralf M. Sundt
Part II Imaging and Initial Management of Acute Aortic Syndromes
Initial Medical Management of Acute Aortic Syndromes . . . . . . . . . . . . . . 119
Abigail R. Benkert and Jeffrey G. Gaca
v

vi
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Contents
Imaging of Aortic Dissection: CT, MRI, and Angiography . . . . . . . . . . . . . 131
Albree Tower-Rader, Lars G. Svensson, and Venu Menon
Imaging of Intramural Hematoma and Penetrating Atherosclerotic
Ulcer by CT and MRI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Zachary Hartley-Blossom, Saurabh Agarwal, and Michael K. Atalay
Echocardiography for the Diagnosis and Management of
Acute Aortic Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Sumbal Janjua, Andrew D. Maslow, and Athena Poppas
Long-Term Imaging of the Aorta: Considerations
and Comparison of Modalities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Nicholas S. Burris, Bradley D. Allen, and David M. Williams
Part III Treatment of Acute Thoracic Aortic Syndromes
Blunt Traumatic Aortic Injury: Etiology, Diagnosis,
and Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Bruce L. Tjaden and Anthony L. Estrera
Catheter-Induced Aortic Dissection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
Hannah Chaudry, Marwan Saad, and J. Dawn Abbott
Aortic Intramural Hematoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Neel R. Sodha and Frank W. Sellke
Penetrating Atherosclerotic Ulcer: Presentation and Management . . . . . . 249
Ignas B. Houben, Pieter Van Bakel, and Himanshu J. Patel
Endovascular Treatment of Type A Aortic Dissections . . . . . . . . . . . . . . . . 261
Maximilian Kreibich and Friedhelm Beyersdorf
Valve Sparing Aortic Root Replacement for Aortic Valve
Insufficiency in Type A Aortic Dissection . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
Eltayeb Mohamed Ahmed and Edward P. Chen
Basic Approaches for the Surgical Management of Acute
Type A Aortic Dissection: Safe Management Strategies for
the General Cardiac Surgeon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Tirone E. David
Valve Repair for Aortic Valve Insufficiency in the Setting of
Acute Aortic Dissection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Talal Al-Atassi and Munir Boodhwani
Management of the Aortic Arch in Acute Aortic Dissection Type A . . . . . 305
Takashi Kunihara and Hans-Joachim Schäfers
Frozen Elephant Trunk for Aortic Dissection . . . . . . . . . . . . . . . . . . . . . . . 323
Emidio Germano, Kyle Miletic, and Eric E. Roselli

Contents
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vii
One-Stage Repair of Extensive Chronic Thoracic Aortic Dissection . . . . . 333
Alexander Kulik and Nicholas T. Kouchoukos
Management of Complicated Type A Aortic Dissection:
The Cornell-New York Presbyterian Approach . . . . . . . . . . . . . . . . . . . . . . 349
Erin Iannacone, Christopher Lau, Mario Gaudino,
and Leonard N. Girardi
Management of Complicated Acute Type A Aortic Dissection:
The Stanford Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
Albert J. Pedroza and Michael P. Fischbein
Management of Type B Aortic Dissection . . . . . . . . . . . . . . . . . . . . . . . . . . . 381
Ali Khoynezhad, Tiffany Worthington, Raffat Jaber, Jeffrey Altshuler,
and Rodney White
Subacute and Chronic Type A Aortic Dissection . . . . . . . . . . . . . . . . . . . . . 401
Lars G. Svensson
Management of Chronic Descending Thoracic and Thoracoabdominal
Dissection and Aneurysm - Stent Grafting, Debranching . . . . . . . . . . . . . . 409
Roland Assi and Wilson Y. Szeto
Management of Chronic Dissection of the Descending Thoracic
and Thoracoabdominal Aorta: Open Approach . . . . . . . . . . . . . . . . . . . . . 423
Cuneyt Köksoy, Alice Le Huu, and Joseph S. Coselli
Diagnosis and Management of Ruptured Thoracic Aortic Aneurysms . . . 447
Christopher Lau, Mario Gaudino, Erin Iannacone,
and Leonard N. Girardi
Monitoring and Medical Treatment of Chronic Thoracic, Abdominal,
and Thoracoabdominal Aortic Aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . 461
Melinda S. Schaller, Winona W. Wu, and Marc L. Schermerhorn
External Aortic Support and Other Alternative Strategies in the
Management of Aortic Pathology of Patients with Connective
Tissue Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469
John Pepper
Management of Operative Complications After Type A Aortic
Dissection Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 483
Michael P. Robich and Jennifer S. Lawton
Neuroprotection During Dissection Repair . . . . . . . . . . . . . . . . . . . . . . . . . 497
Christian V. Ghincea, Yuki Ikeno, Andrew L. Mesher, Muhammad Aftab,
and T. Brett Reece
Acute Type A Aortic Dissection: When Not to Operate . . . . . . . . . . . . . . . 519
Ashraf A. Sabe, Ryan P. Plichta, and G. Chad Hughes

viii
https://t.me/med1917
Contents
Delayed Surgery for Acute Aortic Dissection . . . . . . . . . . . . . . . . . . . . . . . . 535
Polina Pinkhasova, Mohammad A. Zafar, Bulat A. Ziganshin,
and John A. Elefteriades
Anesthetic Management of Acute Aortic Dissection . . . . . . . . . . . . . . . . . . 553
Michael Tien and Albert T. Cheung
Coagulopathy and Bleeding Management for Aortic
Dissection Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 577
Jerrold H. Levy and Roman M. Sniecinski
Part IV Postoperative Monitoring and Medical Management
Monitoring After Surgery for Acute Aortic Syndromes . . . . . . . . . . . . . . . 597
Andrew M. Vekstein and Adam R. Williams
Medical Management of Uncomplicated Type B Acute
Aortic Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 609
Arvind K. Pandey, Umberto Campia, and Patrick T. O’Gara
Symptomatic Thoracic Aortic Aneurysms . . . . . . . . . . . . . . . . . . . . . . . . . . 623
Rizwan Q. Attia, Arminder S. Jassar, and Duke E. Cameron
Future Considerations for Acute Aortic Syndromes . . . . . . . . . . . . . . . . . . 643
Konstantin von Aspern, Christian D. Etz, and Michael A. Borger

Part I
https://t.me/med1917
History, Presentation and Genetics of
Acute Aortic Syndromes

Overview andHistory ofAortic Dissection
https://t.me/med1917
andOther Acute Aortic Syndromes
AfshinEhsan andFrankW.Sellke
Introduction
Acute aortic syndromes are complex and potentially life-threatening pathologies of
the aorta that have only been successfully managed in the last 70years. The spectrum of disease ranges from intra-mural hematomas and penetrating aortic ulcers to
aortic dissections and ruptured aneurysms, with dissections being the most frequent
of these aortic pathologies. The ability to diagnose and treat these conditions have
required advances in imaging as well as open and endovascular surgical techniques.
The historical evolution of our understanding of these conditions and subsequent
management reect the critical nature of acute aortic syndromes and the pioneering
efforts of innovators determined to improve the outcomes of these complex patients.
History ofAcute Aortic Syndromes
The earliest reports of aortic pathology were noted in the Ebers Papyrus, an Egyptian
scroll named after the Egyptologist, George Ebers (1837–1898CE), which dates
back to 1550BCE.The scrolls are believed to be copied from earlier texts and it’s
here that peripheral and abdominal aneurysms were rst described [1]. The Greek
physician, Galen de Pergamon (129-c. 200/c. 216CE), described “localized pulsatile swellings” and a ruptured aneurysm: “when an aneurysm is wounded, the blood
spouted out with so much violence that it can scarcely be arrested” [2]. A Greek
surgeon and contemporary of Galen, Antyllos, further described aneurysms as being
either false traumatic or true aneurysms. He also provided the earliest record of
A. Ehsan (*) · F. W. Sellke
Warren Alpert Medical School of Brown University and Rhode Island Hospital,
Providence, RI, USA
e-mail: aehsan@lifespan.org
J. S. Coselli et al. (eds.), Aortic Dissection and Acute Aortic Syndromes,
https://doi.org/10.1007/978-3-030-66668-2_1
3© Springer Nature Switzerland AG 2021
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