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Acute aortic syndrome: pathology and therapeutic strategies

¹ Department of Interventional Radiology, St Mary’s Hospital, London, UK
² Academic Department of Vascular Surgery, St Mary’s Hospital

Correspondence to:
Correspondence to:
Dr F Ahmad
Department of Interventional Radiology, St Mary’s Hospital, Praed Street, London W2 1NY, UK; farhan{at}doctors.org.uk

Acute aortic syndrome (AAS) describes the acute presentation of patients with characteristic "aortic pain" caused by one of several life threatening thoracic aortic pathologies. These include aortic dissection, intramural haematoma, penetrating atherosclerotic ulcer, aneurysmal leak, and traumatic transection. AAS heralds imminent aortic rupture. Highlighting acute aortic pathology as an AAS is therefore important to encourage prompt recognition of this condition and avoid diagnostic delays. The management of AAS remains a therapeutic challenge. The traditional surgical approach to acute "type B" (descending thoracic) aortic pathology is unsatisfactory with high morbidity and mortality. Endovascular aortic stent grafts now represent an alternative minimally invasive approach in these patients who are often poor surgical candidates. Studies show endovascular repair to be technically feasible with fewer complications. This review discusses AAS pathology and in particular assesses the current role for endovascular aortic repair in its treatment.

Abbreviations: AAS, acute aortic syndrome; AD, aortic dissection; IMH, intramural haematoma; PAU, penetrating atherosclerotic ulcer; CT, computed tomography; MRI, magnetic resonance imaging

Keywords: acute aortic syndrome; endovascular aortic repair; stent graft

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