![]() A possible explanation for this disparity is that AAD can be caused by different mechanisms, and aortic diameter could play a crucial role in the presence of genetic disorders, aortic valve flow abnormalities, or aorta wall weakness after surgical trauma from cannulation or cross clamping, but aortic dilation may have a less important role in patients with arterial hypertension. In comparison with the group with aortic diameters of <5.5 cm, the cohort with larger diameters included more patients with Marfan syndrome, bicuspid aortic valve, and history of prior coronary artery bypass surgery. It is important to note that smaller aortic size does not preclude AAD. 8 Although the current surgical guidelines for thoracic aortic aneurysm repair (≥5.5 cm) are designed to mitigate risk of AAD in patients at higher risk for dissection, it would fail to prevent most of the AAD seen in this cohort. Copyright © 2015, Elsevier.Īlthough ascending aortic dilation is a well-established risk factor for AAD, an interesting finding of the registry was that 60% of patients had maximum aortic diameters <5.5 cm and 40% of patients had aortic diameters <5.0 cm. Reproduced from Pape et al 2 with permission of the publisher. Referred from primary site to International Registry of Acute Aortic Dissection centerĪortic aneurysm and acute aortic dissection Demographics and History of Patients with AAD Category 6 Black patients presented with a higher prevalence of type B AAD (52.4%), were younger, and more frequently had a history of hypertension (89.7%), diabetes mellitus (13.2%), or cocaine abuse (12%) in comparison with white patients. 4, 5 Analysis of the young patients with AAD (<40 years of age) revealed that younger patients were less likely to have a history of hypertension (34%) or atherosclerosis (1%), but more likely to have Marfan syndrome or bicuspid aortic valve (59%). 1, 2 A history of atherosclerosis was present in 27% of patients, known aortic aneurysm in 16%, previous cardíac surgery in 16%, Marfan syndrome in 5%, and an iatrogenic cause in 4% 3 cocaine use was implicated in 1.8% of patients. A number of risk factors were related to aortic dissection, with hypertension (76.6%) being the most common ( Table 1). Two-thirds of included patients were men, with a mean age of 63 years. In the IRAD series, 67% of patients presented with type A AAD, with the remaining 33% type B. This review will cover most of these points, highlighting the critical findings of the IRAD that have been published over these past 2 decades. IRAD investigators have published >80 articles derived from the large database of patients with AAD of >7300 cases, thus far, to raise awareness of this difficult-to-diagnose entity and provide insights regarding optimal diagnosis and management. Since the first publication in 2000 with the participation of 12 large referral centers in 6 countries, the IRAD has expanded to 51 active sites in 12 countries in North America, Europe, Asia, and Australia. These forms were analyzed by the IRAD Coordinating Center at the University of Michigan 1 for face validity and then entered into a secure online database. Data on demographics, presenting history, physical examination, imaging studies, management, and outcomes were collected by each referral center ( Figure I in the online-only Data Supplement) and entered on case report forms covering 350 variables using standard definitions and methods. The International Registry of Acute Aortic Dissection (IRAD) was established in 1996 for the purpose of enrolling a large number of patients at a number of aortic centers to assess the presentation, management, and outcomes of AAD. Customer Service and Ordering InformationĪcute aortic dissection (AAD) is a rare, life-threatening condition that remains a challenge to diagnose and treat.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA). ![]() Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).
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