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By Mardi Gomberg-Maitland, Jonathan L. Halperin, Mark A. Creager (auth.), Mark A. Creager MD (eds.)

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The International Registry of Acute Aortic Dissection (lRAD): new insights into an old disease. lAMA 2000, 283:897-903. 3. Eagle KA, Doroghazi RM, DeSanctis RW, Austen GW: Aortic dissection. In The Practice of Cardiology, 2nd ed. Edited by Eagle KA, Haber E, DeSanctis RW, Austen WG. Boston: Little Brown; 1989:1369-1392. 4. : New classifications of aortic dissection with improved impact on prognosis. I Am CoIl Cardiol 2002, 39:264A. 5. Isselbacher EM: Diseases of the aorta. In Heart Disease: a Textbook of Cardiovascular Medicine, 6th ed.

Penetrating atherosclerotic ulcerations occur almost exclusively in the descending thoracic aorta. Patients tend to be elderly with hypertension and evidence of atherosclerotic disease elsewhere. Presenting symptoms include chest and back pain similar to that of aortic dissection. The natural history of penetrating atherosclerotic ulcer is unclear, but at present management strategies are essentially the same as for classic aortic dissection. ATLAS OF VASCULAR DISEASE 44 SURVIVAL AND LATE FOLLOW-UP LATE COMPLICATIONS OF AORTIC DISSECTION AND FOllOW-UP EVALUATION Late comp lications Recurrent dissection or progress ion of dissection Progre ive aortic insuffiCiency requiring ()ortic v() lve replacement (in patients not initially having undergone aortic valve replacem nt) Aneurysm formation-may lead to aortic rupture Patients at particularly high risk Those with Marfan syndrome-very hi gh risk of recu rrent dissection or of aneurysm formation with rupture Those with a patent false lumen- increased incidence of late comp li c()tions and death FIGURE 2-48.

A, The proximal and distal false lumina have expanded outward, producing an enlarged aortic silhouette with an abnormal bulging contour, while the diameter of the true lumen is narrowed minimally. B, The false lumen has expanded inward, causing marked narrowing of the true lumen, but this results in little or no change in the silhouette of the ascending or descending aorta. An unremarkable chest radiograph might be seen in this case. ) FIGURE 2-16. Chest radiograph suggestive of aortic dissection.

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