Which patients should be treated with surgery?

Patients who have dissection involving the ascending portion of the aorta extending into the aortic arch are the ones best treated with surgery. In addition, surgery should be considered in those with distal aortic dissection if there is an unsatisfactory response to medical treatment, compromise of vital organs, or threat of impending rupture.

Which patients are best treated medically?

Medical treatment is a treatment of choice for uncomplicated dissection of the descending aorta. It also appears to be superior to surgical therapy for patients with stable isolated dissection of the aortic arch in which none of the great vessels is compromised. Finally, if a dissection is detected 2 weeks after its proposed onset, then it is considered to be a stable chronic dissection and is best treated medically. Long-term medical therapy should focus on the control of hypertension.

What diseases or syndromes predispose patients to aortic dissection?

Patients often have long-standing high blood pressure which produces stress on the aortic wall. In addition, hereditary disease, such as Marfan syndrome, can cause cystic medial degeneration of the aortic wall, predisposing to the dissection. There is also a relationship with pregnancy and dissection.

What is the most common site for an atherosclerotic aneurysm involving the aorta?

The abdominal aorta (abdominal aortic aneurysm).

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