Management of acute aortic syndrome

Nature Reviews Cardiology

Volumn 12, Issue 2, 2015, Pages 103-114

  Clough, Rachel E ^a   Nienaber, Christoph A ^b  

^a and University of Bristol   (United Kingdom)

^b ROSTOCK UNIVERSITY MEDICAL CENTER   (Germany)

Author keywords

[No Author keywords available]

Indexed keywords

ANTIHYPERTENSIVE AGENT; BIOLOGICAL MARKER;

ACUTE AORTIC SYNDROME; ACUTE CORONARY SYNDROME; ANTIHYPERTENSIVE THERAPY; AORTA DISSECTION; AORTA VALVE REPLACEMENT; BARE METAL STENT; CLINICAL FEATURE; COMPUTER ASSISTED TOMOGRAPHY; ECHOCARDIOGRAPHY; ESOPHAGUS PERFORATION; HEMATOMA; HUMAN; INCIDENCE; LONG TERM CARE; LUNG EMBOLISM; NUCLEAR MAGNETIC RESONANCE IMAGING; PNEUMOTHORAX; PRIORITY JOURNAL; PROGNOSIS; REVIEW; SURGICAL MORTALITY; THORAX RADIOGRAPHY; TRANSESOPHAGEAL ECHOCARDIOGRAPHY; TREATMENT OUTCOME; TREATMENT RESPONSE; ACUTE DISEASE; ANEURYSM, DISSECTING; AORTIC ANEURYSM; AORTIC DISEASES; DISEASE MANAGEMENT; SYNDROME; ULCER;

ACUTE DISEASE; ANEURYSM, DISSECTING; AORTIC ANEURYSM; AORTIC DISEASES; DISEASE MANAGEMENT; HEMATOMA; HUMANS; PROGNOSIS; SYNDROME; ULCER;

EID: 84923127738     PISSN: 17595002     EISSN: 17595010     Source Type: Journal    
DOI: 10.1038/nrcardio.2014.203     Document Type: Review

References (135)

1. Patel, P. J., Grande, W. & Hieb, R. A. Endovascular management of acute aortic syndromes. Semin. Intervent. Radiol. 28, 10-23 (2011).
2. Brinster, D. R. Endovascular repair of the descending thoracic aorta for penetrating atherosclerotic ulcer disease. J. Card. Surg. 24, 203-208 (2009).
3. Cho, J. R. et al. Clinical characteristics of acute aortic syndrome in Korean patients: from the Korean multi-center registry of acute aortic syndrome. Korean Circ. J. 42, 528-537 (2012).
4. Hagan, P. G. et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA 283, 897-903 (2000).
5. Meszaros, I. et al. Epidemiology and clinicopathology of aortic dissection. Chest 117, 1271-1278 (2000).
6. Bickerstaff, L. K. et al. Thoracic aortic aneurysms: a population-based study. Surgery 92, 1103-1108 (1982).
7. Clouse, W. D. et al. Acute aortic dissection: population-based incidence compared with degenerative aortic aneurysm rupture. Mayo Clin. Proc. 79, 176-180 (2004).
8. Coady, M. A. et al. Surgical management of descending thoracic aortic disease: open and endovascular approaches. A scientific statement from the American Heart Association. Circulation 121, 2780-2804 (2010).
9. LeMaire, S. A. & Russell, L. Epidemiology of thoracic aortic dissection. Nat. Rev. Cardiol. 8, 103-113 (2011).
10. Hiratzka, L. F. et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 121, e266-e369 (2010).
11. Wu, D., Shen, Y. H., Russell, L., Coselli, J. S. & LeMaire, S. A. Molecular mechanisms of thoracic aortic dissection. J. Surg. Res. 184, 907-924 (2013).
12. Gravholt, C. H. et al. Clinical and epidemiological description of aortic dissection in Turner's syndrome. Cardiol. Young. 16, 430-436 (2006).
13. Matura, L. A., Ho, V. B., Rosing, D. R. & Bondy, C. A. Aortic dilatation and dissection in Turner syndrome. Circulation 116, 1663-1670 (2007).
14. Loeys, B. L. et al. The revised Ghent nosology for the Marfan syndrome. J. Med. Genet. 47, 476-485 (2010).
15. Milewicz, D. M. et al. Reduced penetrance and variable expressivity of familial thoracic aortic aneurysms/dissections. Am. J. Cardiol. 82, 474-479 (1998).
16. Tsai, T. T., Nienaber, C. A. & Eagle, K. A. Acute aortic syndromes. Circulation 112, 3802-3813 (2005).
17. Suzuki, T. 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 108, 312-317 (2003).
18. von Kodolitsch, Y., Schwartz, A. G. & Nienaber, C. A. Clinical prediction of acute aortic dissection. Arch. Intern. Med. 160, 2977-2982 (2000).
19. Klompas, M. Does this patient have an acute thoracic aortic dissection? JAMA 287, 2262-2272 (2002).
20. von Kodolitsch, Y. et al. Chest radiography for the diagnosis of acute aortic syndrome. Am. J. Med. 116, 73-77 (2004).
21. Eggebrecht, H. et al. Value of plasma fibrin D-dimers for detection of acute aortic dissection. J. Am. Coll. Cardiol. 44, 804-809 (2004).
22. Suzuki, T. et al. Diagnosis of acute aortic dissection by D-dimer: the International Registry of Acute Aortic Dissection Substudy on Biomarkers (IRAD-Bio) experience. Circulation 119, 2702-2707 (2009).
23. Gonsalves, C. F. The hyperattenuating crescent sign. Radiology 211, 37-38 (1999).
24. Evangelista, A. et al. Acute intramural hematoma of the aorta: a mystery in evolution. Circulation 111, 1063-1070 (2005).
25. Evangelista, A. et al. Imaging modalities for the early diagnosis of acute aortic syndrome. Nat. Rev. Cardiol. 10, 477-486 (2013).
26. Becker, H. C. & Johnson, T. Cardiac CT for the assessment of chest pain: imaging techniques and clinical results. Eur. J. Radiol. 81, 3675-3679 (2012).
27. Ketelsen, D. et al. Estimation of radiation exposure of retrospective gated and prospective triggered 128-slice triple-rule-out CT angiography. Acta. Radiol. 52, 762-766 (2011).
28. Troxler, M., Mavor, A. I. & Homer-Vanniasinkam, S. Penetrating atherosclerotic ulcers of the aorta. Br. J. Surg. 88, 1169-1177 (2001).
29. Tumlin, J. et al. Pathophysiology of contrast-induced nephropathy. Am. J. Cardiol. 98, 14K-20K (2006).
30. Martin, D. R. & Semelka, R. C. Health effects of ionising radiation from diagnostic CT. Lancet 367, 1712-1714 (2006).
31. Pearce, M. S. et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380, 499-505 (2012).
32. Ueda, T., Chin, A., Petrovitch, I. & Fleischmann, D. A pictorial review of acute aortic syndrome: discriminating and overlapping features as revealed by ECG-gated multidetector-row CT angiography. Insights Imaging 3, 561-571 (2012).
33. Nienaber, C. A. The role of imaging in acute aortic syndromes. Eur. Heart. J. Cardiovasc. Imaging 14, 15-23 (2013).
34. Baliga, R. R. et al. The role of imaging in aortic dissection and related syndromes. JACC Cardiovasc. Imaging 7, 406-424 (2014).
35. Cecconi, M. et al. The role of transthoracic echocardiography in the diagnosis and management of acute type A aortic syndrome. Am. Heart J. 163, 112-118 (2012).
36. Nienaber, C. A. et al. The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N. Engl. J. Med. 328, 1-9 (1993).
37. Erbel, R. et al. Diagnosis and management of aortic dissection. Eur. Heart J. 22, 1642-1681 (2001).
38. Sommer, T. et al. Aortic dissection: a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography, and MR imaging. Radiology 199, 347-352 (1996).
39. Evangelista, A. et al. Diagnosis of ascending aortic dissection by transesophageal echocardiography: utility of M-mode in recognizing artifacts. J. Am. Coll. Cardiol. 27, 102-107 (1996).
40. Penco, M. et al. Usefulness of transesophageal echocardiography in the assessment of aortic dissection. Am. J. Cardiol. 86, 53G-56G (2000).
41. Erbel, R. et al. Effect of medical and surgical therapy on aortic dissection evaluated by transesophageal echocardiography. Implications for prognosis and therapy. The European Cooperative Study Group on Echocardiography. Circulation 87, 1604-1615 (1993).
42. Shiga, T., Wajima, Z., Apfel, C. C., Inoue, T. & Ohe, Y. Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis. Arch. Intern. Med. 166, 1350-1356 (2006).
43. Russo, V., Renzulli, M., Buttazzi, K. & Fattori, R. Acquired diseases of the thoracic aorta: role of MRI and MRA. Eur. Radiol. 16, 852-865 (2006).
44. Kramer, C. M., Barkhausen, J., Flamm, S. D., Kim, R. J. & Nagel, E. Standardized cardiovascular magnetic resonance (CMR) protocols 2013 update. J. Cardiovasc. Magn. Reson. 15, 91 (2013).
45. Murray, J. G. et al. Intramural hematoma of the thoracic aorta: MR image findings and their prognostic implications. Radiology 204, 349-355 (1997).
46. Clough, R. E., Waltham, M., Giese, D., Taylor, P. R. & Schaeffter, T. A new imaging method for assessment of aortic dissection using four-dimensional phase contrast magnetic resonance imaging. J. Vasc. Surg. 55, 914-923 (2012).
47. Shimony, A., Filion, K. B., Mottillo, S., Dourian, T. & Eisenberg, M. J. Meta-analysis of usefulness of d-dimer to diagnose acute aortic dissection. Am. J. Cardiol. 107, 1227-1234 (2011).
48. Newby, L. K. et al. ACCF 2012 expert consensus document on practical clinical considerations in the interpretation of troponin elevations: a report of the American College of Cardiology Foundation task force on Clinical Expert Consensus Documents. J. Am. Coll. Cardiol. 60, 2427-2463 (2012).
49. Parolari, A. et al. Biological features of thoracic aortic diseases. Where are we now, where are we heading to: established and emerging biomarkers and molecular pathways. Eur. J. Cardiothorac. Surg. 44, 9-23 (2013).
50. Milewicz, D. M. et al. Fibrillin-1 (FBN1) mutations in patients with thoracic aortic aneurysms. Circulation 94, 2708-2711 (1996).
51. Marshall, L. M. et al. Thoracic aortic aneurysm frequency and dissection are associated with fibrillin-1 fragment concentrations in circulation. Circ. Res. 113, 1159-1168 (2013).
52. Makita, S. et al. Behavior of C-reactive protein levels in medically treated aortic dissection and intramural hematoma. Am. J. Cardiol. 86, 242-244 (2000).
53. Schillinger, M. et al. C-reactive protein and mortality in patients with acute aortic disease. Intensive Care Med. 28, 740-745 (2002).
54. Nomura, F. et al. Changes in coagulation condition, cytokine, adhesion molecule after repair of type A aortic dissection. Eur. J. Cardiothorac. Surg. 26, 348-350 (2004).
55. Iyano, K., Kawada, T., Aiba, M. & Takaba, T. Correlation of hemostatic molecular markers and morphology of the residual false lumen in chronic aortic dissection. Ann. Thorac. Cardiovasc. Surg. 10, 106-112 (2004).
56. Shinohara, T. et al. Soluble elastin fragments in serum are elevated in acute aortic dissection. Arterioscler. Thromb. Vasc. Biol. 23, 1839-1844 (2003).
57. Kodama, K. et al. Tight heart rate control reduces secondary adverse events in patients with type B acute aortic dissection. Circulation 118, S167-S170 (2008).
58. Feldman, M., Shah, M. & Elefteriades, J. A. Medical management of acute type A aortic dissection. Ann. Thorac. Cardiovasc. Surg. 15, 286-293 (2009).
59. Raymond, C. E. et al. Prevalence and factors associated with false positive suspicion of acute aortic syndrome: experience in a patient population transferred to a specialized aortic treatment center. Cardiovasc. Diagn. Ther. 3, 196-204 (2013).
60. Landon, B. E., O'Malley, A. J., Giles, K., Cotterill, P. & Schermerhorn, M. L. Volume-outcome relationships and abdominal aortic aneurysm repair. Circulation 122, 1290-1297 (2010).
61. Holt, P. J. et al. Provider volume and long-term outcome after elective abdominal aortic aneurysm repair. Br. J. Surg. 99, 666-672 (2012).
62. Nienaber, C. A. et al. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ. Cardiovasc. Interv. 6, 407-416 (2013).
63. DeBakey, M. E. et al. Surgical management of dissecting aneurysms of the aorta. J. Thorac. Cardiovasc. Surg. 49, 130-149 (1965).
64. Daily, P. O., Trueblood, H. W., Stinson, E. B., Wuerflein, R. D. & Shumway, N. E. Management of acute aortic dissections. Ann. Thorac. Surg. 10, 237-247 (1970).
65. Hirst, A. E. Jr, Johns, V. J. Jr & Kime, S. W. Jr. Dissecting aneurysm of the aorta: a review of 505 cases. Medicine (Baltimore) 37, 217-279 (1958).
66. Booher, A. M. et al. The IRAD classification system for characterizing survival after aortic dissection. Am. J. Med. 126, 730.e19-24 (2013).
67. Dake, M. D., Thompson, M., van Sambeek, M., Vermassen, F. & Morales, J. P. DISSECT: a new mnemonic-based approach to the categorization of aortic dissection. Eur. J. Vasc. Endovasc. Surg. 46, 175-190 (2013).
68. Fattori, R. et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J. Am. Coll. Cardiol. 61, 1661-1678 (2013).
69. Fattori, R. et al. Complicated acute type B dissection: is surgery still the best option?: a report from the International Registry of Acute Aortic Dissection. JACC Cardiovasc. Interv. 1, 395-402 (2008).
70. Estrera, A. L. et al. Outcomes of medical management of acute type B aortic dissection. Circulation 114, I384-I389 (2006).
71. Nienaber, C. A. & Powell, J. T. Management of acute aortic syndromes. Eur. Heart J. 33, 26b-35b (2012).
72. Onitsuka, S. et al. Long-term outcome and prognostic predictors of medically treated acute type B aortic dissections. Ann. Thorac. Surg. 78, 1268-1273 (2004).
73. Tsai, T. T. et al. Partial thrombosis of the false lumen in patients with acute type B aortic dissection. N. Engl. J. Med. 357, 349-359 (2007).
74. Clough, R. E. et al. A new method for quantification of false lumen thrombosis in aortic dissection using magnetic resonance imaging and a blood pool contrast agent. J. Vasc. Surg. 54, 1251-1258 (2011).
75. Qin, Y. L., Deng, G., Li, T. X., Jing, R. W. & Teng, G. J. Risk factors of incomplete thrombosis in the false lumen after endovascular treatment of extensive acute type B aortic dissection. J. Vasc. Surg. 56, 1232-1238 (2012).
76. Kato, M. et al. Determining surgical indications for acute type B dissection based on enlargement of aortic diameter during the chronic phase. Circulation 92, 107-112 (1995).
77. Marui, A. et al. Toward the best treatment for uncomplicated patients with type B acute aortic dissection: A consideration for sound surgical indication. Circulation 100, 275-280 (1999).
78. Song, J. M. et al. Long-term predictors of descending aorta aneurysmal change in patients with aortic dissection. J. Am. Coll. Cardiol. 50, 799-804 (2007).
79. Trimarchi, S. et al. Importance of refractory pain and hypertension in acute type B aortic dissection: insights from the International Registry of Acute Aortic Dissection (IRAD). Circulation 122, 1283-1289 (2010).
80. Evangelista, A. et al. Long-term outcome of aortic dissection with patent false lumen: predictive role of entry tear size and location. Circulation 125, 3133-3141 (2012).
81. Jonker, F. H. et al. Aortic expansion after acute type B aortic dissection. Ann. Thorac. Surg. 94, 1223-1229 (2012).
82. Karmonik, C. et al. Computational study of haemodynamic effects of entry- and exit-tear coverage in a DeBakey type III aortic dissection: technical report. Eur. J. Vasc. Endovasc. Surg. 42, 172-177 (2011).
83. Alimohammadi, M., Agu, O., Balabani, S. & Diaz-Zuccarini, V. Development of a patient-specific simulation tool to analyse aortic dissections: assessment of mixed patient-specific flow and pressure boundary conditions. Med. Eng. Phys. 36, 275-284 (2014).
84. Sabik, J. F. et al. Long-term effectiveness of operations for ascending aortic dissections. J. Thorac. Cardiovasc. Surg. 119, 946-962 (2000).
85. Metcalfe, M. J. et al. The first endovascular repair of an acute type A dissection using an endograft designed for the ascending aorta. J. Vasc. Surg. 55, 220-222 (2012).
86. Sobocinski, J. et al. Endovascular approaches to acute aortic type A dissection: a CT-based feasibility study. Eur. J. Vasc. Endovasc. Surg. 42, 442-447 (2011).
87. Lyons, O. et al. Endovascular management of Stanford type a dissection or intramural hematoma with a distal primary entry tear. J. Endovasc. Ther. 18, 591-600 (2011).
88. Tsai, T. T. et al. Long-term survival in patients presenting with type B acute aortic dissection: insights from the International Registry of Acute Aortic Dissection. Circulation 114, 2226-2231 (2006).
89. Acosta, S., Blomstrand, D. & Gottsater, A. Epidemiology and long-term prognostic factors in acute type B aortic dissection. Ann. Vasc. Surg. 21, 415-422 (2007).
90. Estrera, A. L. et al. Preoperative and operative predictors of delayed neurologic deficit following repair of thoracoabdominal aortic aneurysm. J. Thorac. Cardiovasc. Surg. 126, 1288-1294 (2003).
91. Safi, H. J. et al. Evolution of risk for neurologic deficit after descending and thoracoabdominal aortic repair. Ann. Thorac. Surg. 80, 2173-2179 (2005).
92. Tsai, T. T. et al. Long-term survival in patients presenting with type B acute aortic dissection: Insights from the International Registry of Acute Aortic Dissection. Circulation 114, 2226-2231 (2006).
93. Svensson, L. G. et al. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Ann. Thorac. Surg. 85, S1-S41 (2008).
94. Dake, M. D. et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N. Engl. J. Med. 340, 1546-1552 (1999).
95. Nienaber, C. A. et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N. Engl. J. Med. 340, 1539-1545 (1999).
96. Jones, D. W. et al. National trends in utilization, mortality, and survival after repair of type B aortic dissection in the Medicare population. J. Vasc. Surg. 60, 11-19 (2014).
97. Parker, J. D. & Golledge, J. Outcome of endovascular treatment of acute type B aortic dissection. Ann. Thorac. Surg. 86, 1707-1712 (2008).
98. Brunkwall, J., Kasprzak, P., Verhoeven, E., Heijmen, R. & Taylor, P. Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial. Eur. J. Vasc. Endovasc. Surg. (2014).
99. Lombardi, J. V. et al. Prospective multicenter clinical trial (STABLE) on the endovascular treatment of complicated type B aortic dissection using a composite device design. J. Vasc. Surg. 55, 629-640 (2012).
100. Lombardi, J. V. et al. Aortic remodeling after endovascular treatment of complicated type B aortic dissection with the use of a composite device design. J. Vasc. Surg. 59, 1544-1554 (2014).
101. Kolbel, T. et al. Addressing persistent false lumen flow in chronic aortic dissection: the knickerbocker technique. J. Endovasc. Ther. 21, 117-122 (2014).
102. Knowles, M. et al. The effects of operative indication and urgency of intervention on patient outcomes after thoracic aortic endografting. J. Vasc. Surg. 53, 926-934 (2011).
103. Vilacosta, I. et al. Acute aortic syndrome: a new look at an old conundrum. Heart 95, 1130-1139 (2009).
104. Knollmann, F. D., Lacomis, J. M., Ocak, I. & Gleason, T. The role of aortic wall CT attenuation measurements for the diagnosis of acute aortic syndromes. Eur. J. Radiol. 82, 2392-2398 (2013).
105. Kitai, T. et al. Detection of intimal defect by 64-row multidetector computed tomography in patients with acute aortic intramural hematoma. Circulation 124, S174-S178 (2011).
106. Kitai, T. et al. Clinical outcomes of medical therapy and timely operation in initially diagnosed type A aortic intramural hematoma: a 20-year experience. Circulation 120, S292-S298 (2009).
107. Song, J. K. et al. Outcomes of patients with acute type A aortic intramural hematoma. Circulation 120, 2046-2052 (2009).
108. Ganaha, F. et al. Prognosis of aortic intramural hematoma with and without penetrating atherosclerotic ulcer: a clinical and radiological analysis. Circulation 106, 342-348 (2002).
109. Kaji, S. et al. Long-term prognosis of patients with type B aortic intramural hematoma. Circulation 108 (Suppl 1), 307-311 (2003).
110. Sueyoshi, E. et al. New development of an ulcerlike projection in aortic intramural hematoma: CT evaluation. Radiology 224, 536-541 (2002).
111. Robbins, R. C. et al. Management of patients with intramural hematoma of the thoracic aorta. Circulation 88, 1-10 (1993).
112. Tittle, S. L. et al. Midterm follow-up of penetrating ulcer and intramural hematoma of the aorta. J. Thorac. Cardiovasc. Surg. 123, 1051-1059 (2002).
113. Song, J. K. et al. Outcomes of medically treated patients with aortic intramural hematoma. Am. J. Med. 113, 181-187 (2002).
114. Maraj, R., Rerkpattanapipat, P., Jacobs, L. E., Makornwattana, P. & Kotler, M. N. Meta-analysis of 143 reported cases of aortic intramural hematoma. Am. J. Cardiol. 86, 664-668 (2000).
115. von Kodolitsch, Y. et al. Intramural hematoma of the aorta: predictors of progression to dissection and rupture. Circulation 107, 1158-1163 (2003).
116. Nienaber, C. A. et al. Intramural hemorrhage of the thoracic aorta. Diagnostic and therapeutic implications. Circulation 92, 1465-1472 (1995).
117. Kan, C. B., Chang, R. Y. & Chang, J. P. Optimal initial treatment and clinical outcome of type A aortic intramural hematoma: a clinical review. Eur. J. Cardiothorac. Surg. 33, 1002-1006 (2008).
118. Ho, H. H. et al. Type A aortic intramural hematoma: clinical features and outcomes in Chinese patients. Clin. Cardiol. 34, E1-E5 (2011).
119. Estrera, A. et al. Acute type A intramural hematoma: analysis of current management strategy. Circulation 120, S287-S291 (2009).
120. Li, D. L. et al. Acute type B aortic intramural hematoma: treatment strategy and the role of endovascular repair. J. Endovasc. Ther. 17, 617-621 (2010).
121. Lavingia, K. S., Ahanchi, S. S., Redlinger, R. E., Udgiri, N. R. & Panneton, J. M. Aortic remodeling after thoracic endovascular aortic repair for intramural hematoma. J. Vasc. Surg. 60, 929-936 (2014).
122. White, C. et al. Endovascular treatment of an acute ascending aortic intramural hematoma. Int. J. Surg. Case Rep. 5, 126-128 (2014).
123. D'Ancona, G. et al. Haemodynamic predictors of a penetrating atherosclerotic ulcer rupture using fluid-structure interaction analysis. Interact. Cardiovasc. Thorac. Surg. 17, 576-578 (2013).
124. Stanson, A. W. et al. Penetrating atherosclerotic ulcers of the thoracic aorta: natural history and clinicopathologic correlations. Ann. Vasc. Surg. 1, 15-23 (1986).
125. Quint, L. E. et al. Ulcer-like lesions of the aorta: imaging features and natural history. Radiology 218, 719-723 (2001).
126. Nathan, D. P. et al. Presentation, complications, and natural history of penetrating atherosclerotic ulcer disease. J. Vasc. Surg. 55, 10-15 (2012).
127. Cho, K. R. et al. Penetrating atherosclerotic ulcer of the descending thoracic aorta and arch. J. Thorac. Cardiovasc. Surg. 127, 1393-1401 (2004).
128. Botta, L. et al. Endovascular repair for penetrating atherosclerotic ulcers of the descending thoracic aorta: early and mid-term results. Ann. Thorac. Surg. 85, 987-992 (2008).
129. Coady, M. A., Rizzo, J. A. & Elefteriades, J. A. Pathologic variants of thoracic aortic dissections. Penetrating atherosclerotic ulcers and intramural hematomas. Cardiol. Clin. 17, 637-657 (1999).
130. Coady, M. A. et al. Penetrating ulcer of the thoracic aorta: what is it? How do we recognize it? How do we manage it? J. Vasc. Surg. 27, 1006-1016 (1998).
131. Eggebrecht, H. et al. Endovascular stent-graft treatment of penetrating aortic ulcer: results over a median follow-up of 27 months. Am. Heart J. 151, 530-536 (2006).
132. Clough, R. E. et al. Endovascular treatment of acute aortic syndrome. J. Vasc. Surg. 54, 1580-1587 (2011).
133. Scali, S. T. et al. Pathology-specific secondary aortic interventions after thoracic endovascular aortic repair. J. Vasc. Surg. 59, 599-607 (2014).
134. Clough, R. E. et al. Pathology specific early outcome after thoracic endovascular aortic repair. Eur. J. Vasc. Endovasc. Surg. (2014).
135. National Institute for Health and Care Excellence (NICE). Endovascular stent-graft placement in thoracic aortic aneurysms and dissections. Interventional Procedure Guidance 127 [online], http://www.nice.org.uk/guidance/ipg127 (2005).