Acute aortic syndromes

In the modern era, acute aortic syndromes include an acute aortic dissection, an intra¬mural hematoma (IMH), and a symptomatic penetrating aortic ulcer (PAU). An acute aor¬tic dissection requires an intimal tear, which is a disruption of the medial layer provoked by intramural bleeding, resulting in separation of the aortic wall layers and subsequent formation of a true lumen and a false lumen with or without communication. An IMH develops in the media of the aortic wall in the absence of a false lumen and intimal tear. It is diagnosed by the presence of a circular or crescent-shaped 0.5-mm thickening of the aortic wall in the absence of detectable blood flow. A PAU is defined as ulceration of an aortic atherosclerotic plaque penetrating the internal elastic lamina into the media. Propagation of the ulcerative process may lead to an IMH, a pseudoaneurysm, an aortic rupture, or an acute aortic dissection. Recent developments in terms of diagnostic imaging and surgical treatment of acute aortic syndromes have made early diagnosis even more relevant, espe¬cially in terms of survival. This book presents a comprehensive examination of the three pathologies that fall within acute aortic syndromes, with a special focus on diagnostics and surgical treatment.