Aortic dissection
Aortic dissection
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DOI：
10.1038/nrdp.2016.53
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发表时间：
2016-07-21
影响因子：
81.5
通讯作者：
Pepper, John
中科院分区：
文献类型：
--
作者：
Nienaber, Christoph A.;Clough, Rachel E.;Pepper, John
主动脉夹层是由主动脉内膜层撕裂或主动脉壁内出血引起的危及生命的疾病，导致主动脉壁层分离（夹层）。主动脉夹层最常见于65- 75岁的人群，在这一人群中，每年每10万人中有35例发病。其他风险因素包括高血压、血脂异常和涉及结缔组织的遗传性疾病，如马凡氏综合征。快速诊断确认和充分治疗对于管理受影响的患者至关重要。现代管理是多学科的，包括一系列非侵入性成像，生物标志物检测和遗传风险分析。修复或替换主动脉受损区域的方法的选择取决于夹层的严重程度和位置以及手术并发症的风险。开放手术修复最常用于涉及升主动脉和主动脉弓的夹层，而微创血管内介入治疗适用于并发破裂、灌注不良、持续疼痛、低血压或高风险影像学特征的降主动脉夹层。对主动脉夹层基础病理生理学的最新了解使更多患者被认为存在严重并发症风险，因此需要血管内介入治疗，而不仅仅是内科或外科干预。
Aortic dissection is a life-threatening condition caused by a tear in the intimal layer of the aorta or bleeding within the aortic wall, resulting in the separation (dissection) of the layers of the aortic wall. Aortic dissection is most common in those 65-75years of age, with an incidence of 35 cases per 100,000 people per year in this population. Other risk factors include hypertension, dyslipidaemia and genetic disorders that involve the connective tissue, such as Marfan syndrome. Swift diagnostic confirmation and adequate treatment are crucial in managing affected patients. Contemporary management is multidisciplinary and includes serial non-invasive imaging, biomarker testing and genetic risk profiling for aortopathy. The choice of approach for repairing or replacing the damaged region of the aorta depends on the severity and the location of the dissection and the risks of complication from surgery. Open surgical repair is most commonly used for dissections involving the ascending aorta and the aortic arch, whereas minimally invasive endovascular intervention is appropriate for descending aorta dissections that are complicated by rupture, malperfusion, ongoing pain, hypotension or imaging features of high risk. Recent advances in the understanding of the underlying pathophysiology of aortic dissection have led to more patients being considered at substantial risk of complications and, therefore, in need of endovascular intervention rather than only medical or surgical intervention.