Kaji Shuichiro
Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1, Minatojima-minamimachi, Chuo-ku, Kobe, Japan.
Gen Thorac Cardiovasc Surg. 2019 Feb;67(2):203-207. doi: 10.1007/s11748-018-1030-y. Epub 2018 Nov 19.
Acute aortic dissection is a life-threatening disease. Current therapeutic guidelines recommend medical therapy with aggressive blood pressure lowering for patients with acute aortic dissection, when they are not indicated for emergency surgery. In particular, patients with aortic dissection without ascending aorta involvement (Stanford type B) are treated medically, unless they have fatal complications. Patients with type B aortic dissection who have critical complications have higher early mortality than that in patients without complications. However, recent advances in thoracic endovascular aortic repair can improve the clinical outcomes in such patients. Accordingly, current guidelines recommend thoracic endovascular aortic repair for patients with complicated type B aortic dissection. However, patients with visceral ischemia still have a poor prognosis, even when they are treated with thoracic endovascular aortic repair; an early diagnosis and intervention is crucial to prevent mortality. Understanding the pathophysiological anatomy that can induce organ malperfusion might be important for an early diagnosis and intervention. This review summarizes the current state of acute medical management in patients with acute aortic dissection, based on current evidence and expert consensus, focusing on patients with type B aortic dissection.
急性主动脉夹层是一种危及生命的疾病。目前的治疗指南建议，对于不适合急诊手术的急性主动脉夹层患者，采用积极降压的药物治疗。特别是，无升主动脉受累的主动脉夹层患者（斯坦福B型）接受药物治疗，除非出现致命并发症。有严重并发症的B型主动脉夹层患者早期死亡率高于无并发症患者。然而，胸主动脉腔内修复术的最新进展可改善此类患者的临床结局。因此，目前的指南建议对复杂B型主动脉夹层患者进行胸主动脉腔内修复术。然而，即使接受胸主动脉腔内修复术治疗，内脏缺血患者的预后仍然较差；早期诊断和干预对于预防死亡至关重要。了解可导致器官灌注不良的病理生理解剖结构可能对早期诊断和干预很重要。本综述基于当前证据和专家共识，总结了急性主动脉夹层患者急性药物治疗的现状，重点关注B型主动脉夹层患者。
