Thoracic and abdominal aortic disease

Summary

The aorta is stratified into thoracic aorta (aorta ascending, aortic arch and aorta descending) and abdominal aorta.

Aortic disease includes occlusive disease (not covered in this chapter), aneurysmal dilatation, aorta dissection and trauma.

The pathogenesis of aortic aneurysm is not fully understood, but is believed to be multifactorial. Disturbance of the metabolic balance resulting in excessive extracellular matrix degradation may be the key to progressive wall deterioration with subsequent expansion or rupture.

Aortic dissections are classified according to the anatomical location using the Stanford and DeBakey classification. The fundamental distinction is whether the dissection is proximal or distal to the left subclavian artery origin.

Diagnostic modalities to identify and classify aortic disease include computed tomography and magnetic resonance imaging.

Asymptomatic aneurysms are initially managed medically, while an intervention is indicated for symptomatic and expanding aneurysms. Patients with an acute uncomplicated aortic dissection should be admitted to a monitoring unit and treated medically for pain and blood pressure control.

In general an intervention is indicated for Type A dissections and complicated Type B dissections.

The choice between a surgical or endovascular intervention for aorta disease will depend on the localisation and extent of disease. It is anticipated that there...