Akute Aortendissektion: Perspektiven des Internationalen Registers für akute Aortendissektion (IRAD)

Abstract

Acute aortic dissection was first described by Dr. Nicholls, physician to the late king George II on necropsy over 200 years ago. Since that time, acute aortic dissection (AAD) continues to be one of the most feared pain syndromes because of its high morbidity and mortality. AAD poses a special challenge for physicians because of its relative rarity and its ability to mimic other more common conditions. With the high morbidity and mortality of AAD coupled with its relative low incidence, research in aortic dissection has largely been concentrated on single center registries enrolled over decades to allow for adequate numbers of patients for comparison and long term follow-up. However, the treatment for aortic dissection is a rapidly moving field with evolving surgical techniques, anesthesia, cardiopulmonary support, ICU and follow-up care. The urgency to collect data on larger numbers of patients over a shorter period of time was necessary to effectively describe the clinical course, management, and outcomes of this aggressive disease. In 1996, the International Registry of Acute Aortic Dissection (IRAD) was established with the mission to better understand the presentation, diagnosis, management, and outcomes of patients presenting with acute aortic dissection in the modern era. By 2000, over 450 patients had been enrolled from 12 international aortic referral centers. In the present report, we will review what IRAD has learned from these 2000 patients regarding the clinical presentation, prognosis, diagnostic imaging, therapeutic approaches and follow-up in the management of AAD. There is no comparable database available in the world that provides contemporary, multi-national outcomes data for surgical, endovascular and medical therapy in various forms of acute aortic syndromes. Thus, with contemporary information on acute aortic conditions, IRAD is unique and provides a valuable platform for modern strategic planning and teaching, and serves at the same time (on the scientific scope) as a hypothesis generating source of new information on an old disease.

Literatur

• 1 Hirst A E, Johns V J, Kime Jr S W. Dissecting aneurysm of the aorta: a review of 505 cases.  Medicine (Baltimore). 1958;  37 217-279
• 2 Elveback L, Lie J T. Continued high incidence of coronary artery disease at autopsy in Olmsted County, Minnesota, 1950 to 1979.  Circulation. 1984;  70 345-349
• 3 Roger V L, Weston S A, Killian J M. et al . Time trends in the prevalence of atherosclerosis: a population-based autopsy study.  Am J Med. 2001;  110 267-273
• 4 von Kodolitsch Y, Schwartz A G, Nienaber C A. Clinical prediction of acute aortic dissection.  Arch Intern Med. 2000;  160 2977-2982
• 5 David P, McPeak E, Vivas-Salas E. Dissecting aneurysma of aorta; Review of 17 autopsied cases of acute dissecting aneurysm of aorta encountered at Massachusetts General Hospital from 1937 through 1946 inclusive, 8 of which were correctly diagnosed antemortem.  Ann Intern Med. 1947;  27 405-412
• 6 Levinson D C, Edmaedes D T, Griffith G C. Dissecting aneurysm of the aorta; its clinical, electrocardiographic and laboratory features; a report of 58 autopsied cases.  Circulation. 1950;  1 360-387
• 7 Hagan P G, Nienaber C A, Isselbacher E M. et al . The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease.  Jama. 2000;  283 897-903
• 8 Hsue P Y, Salinas C L, Bolger A F. et al . Acute aortic dissection related to crack cocaine.  Circulation. 2002;  105 1592-1595
• 9 Eagle K A, Isselbacher E M, DeSanctis R W. Cocaine-related aortic dissection in perspective.  Circulation. 2002;  105 1529-1530
• 10 Gan X, Zhang L, Berger O. et al . Cocaine enhances brain endothelial adhesion molecules and leukocyte migration.  Clin Immunol. 1999;  91 68-76
• 11 Kolodgie F D, Virmani R, Cornhill J F. et al . Increase in atherosclerosis and adventitial mast cells in cocaine abusers: an alternative mechanism of cocaine-associated coronary vasospasm and thrombosis.  J Am Coll Cardiol. 1991;  17 1553-1560
• 12 Kolodgie F D, Wilson P S, Mergner W J, Virmani R. Cocaine-induced increase in the permeability function of human vascular endothelial cell monolayers.  Exp Mol Pathol. 1999;  66 109-122
• 13 Miller D C, Mitchell R S, Oyer P E. et al . Independent determinants of operative mortality for patients with aortic dissections.  Circulation. 1984;  70 153-164
• 14 Ehrlich M, Fang W C, Grabenwoger M. et al . Perioperative risk factors for mortality in patients with acute type A aortic dissection.  Circulation. 1998;  98 294-298
• 15 Fann J I, Smith J A, Miller D C. et al . Surgical management of aortic dissection during a 30-year period.  Circulation. 1995;  92 113-121
• 16 Mehta R H, Suzuki T, Hagan P G. et al . Predicting death in patients with acute type a aortic dissection.  Circulation. 2002;  105 200-206
• 17 Nienaber C A, Fattori R, Mehta R H. et al . Gender-related differences in acute aortic dissection.  Circulation. 2004;  109 3014-3021
• 18 Tsai T T, Evangelista A, Nienaber C A. et al . Long-term survival in patients presenting with type A acute aortic dissection: insights from the International Registry of Acute Aortic Dissection (IRAD).  Circulation. 2006;  114 350-356
• 19 Suzuki T, Mehta R H, Ince H. et al . Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD).  Circulation. 2003;  108 (Suppl 1) 12-317
• 20 Glower D D, Speier R H, White W D. et al . Management and long-term outcome of aortic dissection.  Ann Surg. 1991;  214 31-41
• 21 Miller D C. The continuing dilemma concerning medical versus surgical management of patients with acute type B dissections.  Semin Thorac Cardiovasc Surg. 1993;  5 33-46
• 22 Svensson L G, Crawford E S, Hess K R. et al . Dissection of the aorta and dissecting aortic aneurysms. Improving early and long-term surgical results.  Circulation. 1990;  82 24-38
• 23 Tsai T T, Fattori R, Trimarchi S. et al . Long-Term Survival in Patients Presenting With Type B Acute Aortic Dissection. Insights From the International Registry of Acute Aortic Dissection.  Circulation. 2006;  0 0-1
• 24 Mohr-Kahaly S, Erbel R, Kearney P. et al . Aortic intramural hemorrhage visualized by transesophageal echocardiography: findings and prognostic implications.  J Am Coll Cardiol. 1994;  23 658-664
• 25 Nienaber C A, Richartz B M, Rehders T. et al . Aortic intramural haematoma: natural history and predictive factors for complications.  Heart. 2004;  90
• 26 Nienaber C A, Eagle K A. Aortic dissection: new frontiers in diagnosis and management: Part II: therapeutic management and follow-up.  Circulation. 2003;  108 772-778
• 27 Kaji S, Akasaka T, Horibata Y. et al . Long-term prognosis of patients with type a aortic intramural hematoma.  Circulation. 2002;  106 248-252
• 28 Kaji S, Nishigami K, Akasaka T. et al . Prediction of progression or regression of type A aortic intramural hematoma by computed tomography.  Circulation. 1999;  100 281-286
• 29 Neri E, Capannini G, Carone E. et al . Evolution toward dissection of an intramural hematoma of the ascending aorta.  Ann Thorac Surg. 1999;  68 1855-1856
• 30 Evangelista A, Mukherjee D, Mehta R H. et al . Acute intramural hematoma of the aorta: a mystery in evolution.  Circulation. 2005;  111 1063-1070
• 31 Bickerstaff L K, Pairolero P C, Hollier L H. et al . Thoracic aortic aneurysms: a population-based study.  Surgery. 1982;  92 1103-1108
• 32 Nallamothu B K, Mehta R H, Saint S. et al . Syncope in acute aortic dissection: diagnostic, prognostic, and clinical implications.  Am J Med. 2002;  113 468-471
• 33 Cambria R P, Brewster D C, Gertler J. et al . Vascular complications associated with spontaneous aortic dissection.  J Vasc Surg. 1988;  7 199-209
• 34 Fann J I, Sarris G E, Mitchell R S. et al . Treatment of patients with aortic dissection presenting with peripheral vascular complications.  Ann Surg. 1990;  212 705-713
• 35 Bossone E, Rampoldi V, Nienaber C A. et al . Usefulness of pulse deficit to predict in-hospital complications and mortality in patients with acute type A aortic dissection.  Am J Cardiol. 2002;  89 851-855
• 36 Park S W, Hutchison S, Mehta R H. et al . Association of painless acute aortic dissection with increased mortality.  Mayo Clin Proc. 2004;  79 1252-1257
• 37 Tsai T T, Bossone E, Isselbacher E M. et al . Clinical characteristics of hypotension in patients with acute aortic dissection.  Am J Cardiol. 2005;  95 48-52
• 38 Moore A G, Eagle K A, Bruckman D. et al . Choice of computed tomography, transesophageal echocardiography, magnetic resonance imaging, and aortography in acute aortic dissection: International Registry of Acute Aortic Dissection (IRAD).  Am J Cardiol. 2002;  89 1235-1238
• 39 Trimarchi S, Nienaber C A, Rampoldi V. et al . Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience.  J Thorac Cardiovasc Surg. 2005;  129 112-122
• 40 Rampoldi V, Trimarchi S, Eagle K A. et al . Simple risk models to predict surgical mortality in acute type A aortic dissection: the International Registry of Acute Aortic Dissection score.  Ann Thorac Surg. 2007;  83 55-61
• 41 Nienaber C A, Zannetti S, Barbieri B. et al . INvestigation of STEnt grafts in patients with type B Aortic Dissection: design of the INSTEAD trial – a prospective, multicenter, European randomized trial.  Am Heart J. 2005;  149 592-599
• 42 Fattori R, Napoli G, Lovato L. et al . Descending thoracic aortic diseases: stent-graft repair.  Radiology. 2003;  229 176-183
• 43 Fattori R. Endovascular treatment of aortic dissection: are we going into the right direction?.  Eur J Vasc Endovasc Surg. 2008;  36 520-521
• 44 Pape L A, Tsai T T, Isselbacher E M. et al . Aortic Diameter > = 5.5 cm Is Not a Good Predictor of Type A Aortic Dissection: Observations From the International Registry of Acute Aortic Dissection (IRAD).  Circulation. 2007;  116 1120-1127
• 45 Bernard Y, Zimmermann H, Chocron S. et al . False lumen patency as a predictor of late outcome in aortic dissection.  Am J Cardiol. 2001;  87 1378-1382
• 46 Erbel R, Engberding R, Daniel W. et al . Echocardiography in diagnosis of aortic dissection.  Lancet. 1989;  1 457-461
• 47 Pretre R, Von Segesser L K. Aortic dissection.  Lancet. 1997;  349 1461-1464
• 48 Satta J, Laara E, Juvonen T. Intraluminal thrombus predicts rupture of an abdominal aortic aneurysm.  J Vasc Surg. 1996;  23 737-739
• 49 Wolf Y G, Thomas W S, Brennan F J. et al . Computed tomography scanning findings associated with rapid expansion of abdominal aortic aneurysms.  J Vasc Surg. 1994;  20 529-535 discussion 535–538
• 50 Vorp D A, Lee P C, Wang D H. et al . Association of intraluminal thrombus in abdominal aortic aneurysm with local hypoxia and wall weakening.  J Vasc Surg. 2001;  34 291-299
• 51 Williams D M, LePage M A, Lee D Y. The dissected aorta: part I. Early anatomic changes in an in vitro model.  Radiology. 1997;  203 23-31
• 52 Chung J W, Elkins C, Sakai T. et al . True-lumen collapse in aortic dissection: part I. Evaluation of causative factors in phantoms with pulsatile flow.  Radiology. 2000;  214 87-98
• 53 Chung J W, Elkins C, Sakai T. et al . True-lumen collapse in aortic dissection: part II. Evaluation of treatment methods in phantoms with pulsatile flow.  Radiology. 2000;  214 99-106
• 54 Tsai T T, Evangelista A, Nienaber C A. et al . Partial thrombosis of the false lumen in patients with acute type B aortic dissection.  N Engl J Med. 2007;  357 349-359
• 55 Nienaber C A, Eagle K A. Aortic dissection: new frontiers in diagnosis and management: Part I: from etiology to diagnostic strategies.  Circulation. 2003;  108 628-635
• 56 Tsai T T, Nienaber C A, Eagle K A. Acute aortic syndromes.  Circulation. 2005;  112 3802-3813