Talk:Aortic dissection

Aortic aneurysm

Care needs to be taken not to duplicate. Dissection I take to mean the splitting of layer of a blood vessel, vs aneurysm to be a stretched dilatation. An aneurysm may go on to dissect or rupture. This is a really comprehensive article, well done, and great care needs be taken in how we move any information over to Aortic Aneurysm. (merging into one article will be too long, but splitting risk duplication or incomplete discussion in any one article). David Ruben 20:19, 15 August 2005 (UTC)

Not a lot of information should go from here to aortic aneurysm. Most aortic dissections do not start from aortic aneurysms so the two articles are about different subjects and should remain separate. Alex.tan 14:35, August 17, 2005 (UTC)

Cleanup request

This article is full of medical jargon. It needs to be made more accessible to the general reader. -- Beland 03:00, 17 August 2005 (UTC)

I disagree with the cleanup request. There is nothing wrong with the tone (underlying emotion of the article). I disagree with the accusation of the use of jargon. The language seems simple as far as is possible, with the unavoidable used of technical vocabulary, which is consistently well defined. As such, the text is understandable to the non-expert and is therefore not jargon. The introduction is excellent for the general reader. As the article progesses, the complexity increases only as is necessary. The authors of this article are to be congratulated. Beland needs to be more specific. --Anthony Duff 21:51, 14 September 2005 (UTC)

Removed request, please put it on the article page if you want to use it. - FrancisTyers 16:13, 24 December 2005 (UTC)

FAC

With a bit of co-operation, it could even be FAC. NCurse _work 10:51, 5 July 2006 (UTC)

Which images to choose from here? NCurse _work 11:25, 5 July 2006 (UTC)

Genetic predisposition?

Is anyone aware of known genetic predispositions specifically to aortic dissection? Are there any foundations pursuing research on this? In my own family, aortic dissection has caused the death of my grandmother (during childbirth with my mother), my aunt, a cousin, and nearly caused the death of my uncle (who survived by a matter of minutes), all people in otherwise excellent health. We have not been able to find anything about this kind of predisposition anywhere. None of my family has any other symptoms of Marfan, but with such a high rate of the exact same condition, it seems like there is likely something congential about it... Does anyone have any information to add to the article, or at least to point me in the right direction? -Porlob 21:07, 6 October 2006 (UTC)

Partial thrombosis

Partial thrombosis of the false lumen is a negative prognostic indicator [1] JFW | T@lk 08:52, 7 August 2007 (UTC)

Transthoracic Echo could be listed a valid Diagnostic Modality

Personally, as a sonographer I have diagnosed previously unknown dissections by doing a thorough transthoracic exam. Transthoracic echo may be not be as sensitive as transesophageal echo or CT in diagnosing the full extent of he dissection, especially beyond the aortic arch, but considerably sensitive to the presence of the condition in the proximal aorta up through the arch. —Preceding unsigned comment added by 170.223.52.149 (talk) 20:10, 5 August 2008 (UTC)

Lancet

doi:10.1016/S0140-6736(08)60994-0 recent Lancet review. JFW | T@lk 21:22, 27 August 2008 (UTC)

User:Delldot/img delldot ∇. 08:05, 28 October 2008 (UTC)

>6cm needing emergency surgery

>6cm is not an indication of emergency surgery. I haven't access to the reference in order to disprove it. —Preceding unsigned comment added by 89.100.143.244 (talk) 20:28, 19 March 2009 (UTC)

Uploaded a new image

Do you think this would add anything?

CT with contrast demonstrating aneurysmal dilation and a dissection of the ascending aorta

Doc James (talk · contribs · email) 11:18, 12 December 2010 (UTC)

Yes. Shows both dilation and dissection of the ascending aorta. JFW | T@lk 11:24, 12 December 2010 (UTC)

Should we keep the other CT image? It is hard to view IMO as some much of the chest is not shown.Doc James (talk · contribs · email) 11:26, 12 December 2010 (UTC)

Nice one, much clearer. I'd say remove the other one, although the legend with it is neatly done. --WS (talk) 23:52, 12 December 2010 (UTC)

Traffic

Expect a fair amount of extra traffic as Richard Holbrooke seems to have died from aortic dissection. JFW | T@lk 08:56, 15 December 2010 (UTC)

Risk scoring

... seems to have arrived: doi:10.1161/​CIRCULATIONAHA.110.988568 JFW | T@lk 15:24, 4 December 2012 (UTC)

DOI not switched on. http://circ.ahajournals.org/content/123/20/2213 is the link. JFW | T@lk 20:45, 4 December 2012 (UTC)

doi:10.3949/ccjm.78a.11053 is a nice review. JFW | T@lk 20:45, 4 December 2012 (UTC)

Diagnostic review

... for emergency physicians. doi:10.1016/j.emc.2011.12.001 JFW | T@lk 15:30, 4 December 2012 (UTC)

And a recent review in the BMJ doi:10.1136/bmj.d8290 JFW | T@lk 15:36, 4 December 2012 (UTC)

And the 2010 multi-society guideline doi:10.1161/​CIR.0b013e3181d4739e JFW | T@lk 09:27, 7 December 2012 (UTC)

Plans for update

I'm planning an update drive for this article with the eventual aim of producing a Good Article. The 2010 guideline (mentioned above) is very comprehensive and could serve as a scaffold for significant updates. It goes into a fair bit of detail on the management, e.g. malperfusion (a concept not currently mentioned by name in the article), penetrating aortic ulcer as a cause, underlying genetic syndromes and who to screen, etc. Various other recommendations are made, many of which could be included.

1. Classification
   • I propose this is moved to a subsection of "diagnosis", because multiple concepts need to be introduced before the classification will make any sense to the reader
2. Signs and symptoms
3. Causes
   • This should be sourced very tightly, and be separated in sections about predisposition and about provoking events
4. Pathophysiology
   • We need to talk a bit about aneurysms, but also about the mechanism of the actual dissection. Laplace's law anyone?
5. Diagnosis
   • Should we mention the "triple rule out" scan?
6. Treatment
   • We need more on endovascular management, which has taken off quite impressively
7. Prognosis
8. Epidemiology
   • To be written
9. Notable cases
   • I propose that this is changed into a "history" section, and that we only preserve the famous people whose illness has made a lasting impact.
10. References
11. External links

Anyone willing to help is welcome. JFW | T@lk 17:15, 9 December 2012 (UTC)

I'm going to have another go at this. JFW | T@lk 11:52, 26 May 2013 (UTC)

Need to work the subarticle Familial aortic dissection into this too. JFW | T@lk 14:07, 2 June 2013 (UTC)

Hi! I'd update the prognosis because the paper stating that there's a 40% chance of immediate death from an AoD references papers for that from the years 1958 and 1972 respectively! In another paper referenced there from 1991, chances of dying went down to 25% within the first 24hours! Modern medicine has drastically increased the chances of surviving an AoD and I think it would be important to update that accordingly. Adding a table from the German wikipedia (with translated text) which references a study from the university of Michigan from 2002. 134.61.102.141 (talk) 18:48, 10 February 2017 (UTC) Liza.

Sources

For a good update, I will list some sources here:

• doi:10.1016/S0140-6736(08)60994-0 Lancet 2008 (broad review)
• doi:10.1161/​CIR.0b013e3181d4739e Circulation 2010 (American guideline)
• PMID 22199439 Texas Heart Inst J 2011 (historical review, useful)
• doi:10.1016/j.jvs.2011.06.099 J Vasc Surg 2011 (endovascular repair of complicated type B dissections)
• doi:10.1016/j.jacc.2011.06.067 JACC 2011 (provision of surgery for type A dissection)
• doi:10.1016/j.emc.2011.12.001 Emerg Med Clin N Am 2012 (diagnosis and managment)
• doi:10.1136/bmj.d8290 BMJ 2012 (broad review)
• doi:10.1002/bjs.8840 Br J Surg 2012 (type A management)
• doi:10.1016/j.ejvs.2012.07.018 Eur J Vasc Endovasc Surg 2012 (endovascular repair of type A dissections)
• doi:10.1016/j.ahj.2012.10.006 Am Heart J 2013 (biomarkers)
• doi:10.1007/s11547-012-0815-9 Radiol Med 2013 (radiological perspective)

Oddly, there is no separate MeSH entry for aortic dissection, so the searching is more complicated than it should be. JFW | T@lk 12:36, 26 May 2013 (UTC)

Endpoints for surgery studies doi:10.1161/CIRCULATIONAHA.113.006421. JFW | T@lk 14:18, 17 April 2014 (UTC)

New European guidelines: doi:10.1093/eurheartj/ehu281 JFW | T@lk 22:49, 2 November 2014 (UTC)

D-dimer

D-dimer has been investigated as a biomarker to exclude aortic dissection in low probability patients:

• doi:10.1016/j.annemergmed.2015.02.013
• doi:10.1016/j.jemermed.2007.06.030
• doi:10.1097/MD.0000000000000471

Probably time we add these sources, even if guidelines don't discuss this yet. JFW | T@lk 11:43, 10 June 2015 (UTC)

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Split the article to type A and type B aortic dissection

Friends, is it just me or anyone else feels the article should be split into type A and type B Aortic Dissection? Most sources treat them separately. Cinadon36 18:12, 4 February 2023 (UTC)

Some errors

• Primal tear as the first step in Dissection pathophysiology, is still debated. Opponents highlight that at ~5% of dissections, there are no tears. See Sabiston, Chapter on Dissections, p 1220.
• Also, same source, claims that "cystic necrosis" is a misnomer. There are no cysts neither necrosis, nowhere at aorta. Cinadon36 20:21, 4 February 2023 (UTC)