Diagnostik und Therapie der chronischen Aortendissektion

Abstract

Aortic dissection is an uncommon but highly lethal disease with an incidence of approximately 20 000 new cases per year in the United States. Diagnosis, however, is not obvious, since aortic dissection was missed in 38 % of patients at presentation, with 28 % of patients first diagnosed at autopsy. If untreated, mortality for acute proximal aortic dissection increases by approximately 1 % per hour over the first 48 hours and may reach 70 % at 1 week; some 90 % of untreated patients with aortic dissection die within 3 months of presentation. The type A dissection is an indication for surgical treatment. Type B dissection should be treated in complicated cases by stentgraft implantation an in uncomplicated cases it should be treated conventionally by antihypertensive treatment. Because of being an disease of the entire aortic media there should be, despite the initial treatment, a closed clinical and imaging follow-up. There is an evidence that up to 20-28 % of these conventional treated patients will develop a thoracic aortic aneurysm requiring repair in the follow-up of 40-50 month which underlines the require of endovascular repair.

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